Download NASALSEPTUM AND ITS DISEASES

Dr. Sudeep K.C.
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Columellar septum-formed of columella
containing the medial crura of alar cartilages
united together by fibrous tissue and covered
on either side by skin.
Membranous septum- it consists of double
layer of skin with no bony or cartilaginous
support. It lies between the columella and the
caudal border of septal cartilage. Both
columellar and membranous parts are freely
movable from side to side.
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Septum proper- it consists of
osetocartilaginous framework,covered with
nasal mucos membrane .It consists of
◦ The perpendicular plate of ethmoid
◦ The vomer and
◦ A large septal cartilage wedged between the above
two bones anteriorly .
 other bones which make minor contributions at the
periphery are : crest of nasal bones, nasal spine of
frontal bone, rostrum of sphenoid , crest of palatine
bones and the crest maxilla, and the anterior nasal
spine of maxilla.
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Septal cartilage not only forms a partition
between the right and left nasal cavities but
also provides support to the tip & left nasal
cavities but also provides support to the tip
and dorsum of cartilaginous part of nose. Its
destruction eg. In septal abscess, injuries,
tuberculosis or excessive removal during
septal surgery, leads to depression of lower
part of nose and drooping of nasal tip.
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INTERNAL CAROTID SYSTEM
◦ Anterior ethmoidal artery
◦ Posterior ethmoidal artery
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EXTERNAL CAROTID SYSTEM
Branches of opthalmic
artery.
◦ Sphenopalatine artery(branch of maxillary artery),
gives nasopalatine and posterior nasal septal
branches.
◦ Septal branch of greater palatine artery (branch of
maxillary artery)\
◦ Septal branch of superior labial artery( br of facial
artery)
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LITTLE’S AREA OR KIESSELBACH’S PLEXUS
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Trauma on the nose from front, side or
below can result in injuries to nasal septum.
Fracture of septal cartilage or its dislocation
from vomerine groove can result from trauma
to lower nose .
 Septal injuries with mucosal tear profuse
epistaxis.
 While with intact mucosa result in septal
haematoma .
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“jarjaway” fracture blows from front it starts
just above anterior nasal spine and runs
horizontally backwards.
“chevallet” fracture results from blows from
below ; it runs vertically from anterior nasal
spine upwards to junction of bony and
cartilaginous dorsum of nose.
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Early recognition and treatment of septal injuries
is essential.
Haematomas should be drained.
Discolated or fractured septal fragments
repositioned and supported between
mucoperichondrial flaps with sutures and nasal
packing.
COMPLICATIONS
Deviation of cartilaginous nose , or asymmetry of
nasal tip, columella or nostril.
AETIOLOGY:
 1) Trauma:
A lateral blow on nose may cause
displacement of septal cartilage.
A crushing blow from front may cause
buckling twisting fractures and duplication
of nasal septum.
 2)Racial factors:
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3)Hereditary factors:
4) Developmental error:
Nasal septum descends to meet the two halves
of developing palate in midline .
Unequal growth between palate and base of
skull may cause buckling of nasal septum.
TYPES OF DNS:
1) Anterior dislocation :
2) C-shaped deformity:
3) S-shaped deformity:
4) Spurs:
5) Thickening:
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1) Nasal obstruction: may be unilateral or
bilateral.
Cottle test: is used in nasal obstruction due to
abnormality of nasal valve.
2)Headache: deviated septum specially spur may
press on lateral wall of nose causing headache.
3)Sinusitis: deviated septum may obstruct sinus
ostia resulting in poor ventilation.
4)Epistaxis : Mucosa over deviated part is
exposed to drying effect of air currents that
forms crust which when removed will cause
bleeding.
5)Anosmia :failure of inspired air to reach the
olfactory region may result in total or partial loss
of sense of smell.
6)External deformity:
7) Middle ear infection:
TREATMENT:
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Submucous resection operation(SMR):it
consists of elevating mucoperichondrial and
mucoperiosteal flaps on either side of septum ,
removing deflected parts of bony and
cartilaginous septum , then repositioning the
flaps.
Septoplasty:
It is conservative approach. Much more
septal framework is preserved and only most
deviated parts is removed .
Mucoperichondrial/periosteal flap is raised
only on one side of septum retaining the
attachment and blood supply on the other.
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It is collection of blood under perichondrium or
periosteum of nasal septum . often results from
nasal trauma or septal surgery or in bleeding
disorders.
CLINICAL FEATURES:
 Bilateral nasal obstruction.
 Associated frontal headache .
 Sense of pressure over
nasal bridge.
EXAMINATION:
 It reveals smooth rounded swelling of septum
in both side . on palpation mass to be soft
and fluctuant.
TREATMENT:
 Small haematoma aspirated with wide bore
needle.
 Larger haematomaincised and drained .
following drainage nasal packing to be done
both sides to prevent reaccumulation.
 Antibiotics to prevent septal abscess.
COMPLICATIONS:
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If not drained ,may organise into fibrous
tissue leading to permanently thickened
septum.
If secondary infection occurs, it results in
septal abscess with necrosis of cartilage and
depression of nasal dorsum.
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Aetiology:
Mostly by secondary infection of septal
haematoma.
Occasionally by furuncle of nose.
CLINICAL FEATURES:
Severe B/L nasal obstruction with pain and
tenderness over the bridge of nose.
Fever with chills and frontal headache.
Skin over nose may be red and swollen.
It reveals
-smooth B/L swelling of nasal septum.
-septal mucosa is often congested .
- submandibular lymphnodes may also be
enlarged and tender.
TREATMENT:
Abscess should be drained by giving inscion on
most dependent part.pus and necrosed
pieces of cartilage are removed.antibiotics
given for 10 days.
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COMPLICATIONS:
Necrosis of septal cartilage results in
depression of cartilaginous dorsum.
Necrosis of septal flaps may lead to sepatal
perforation.
AETIOLOGY:
1) Traumatic perforations: it is most common
cause.
2)Pathological perforations : it can be caused
by septal abscess , rhinolith or neglected
foreign body causing pressure necrosis,
tuberculosis , leprosy , syphillis and
wegener’s granuloma.
3) Idiopathic:
CLINICAL FEATURES:
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Small anterior perforations cause whistling
sound during inspiration and expiration.
Larger perforation develop crust which
obstruct nose or cause severe epistaxis when
removed.
TREATMENT:
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Small perforations can be surgically closed by
flaps.
Larger perforations are difficult to close.
Their treatment is aimed to keep nose crust
free, by alkaline nasal douches and
application of ointment.