DISEASES OF THE NASAL SEPTUM IIIRD BHMS 2018-2019 BATCH - 17/02/2021 BY DR SHREYA N. PADIYAR, ASSISTANT PROFESSOR, DEPARTMENT OF SURGERY - Yengage

DISEASES OF THE NASAL SEPTUM
IIIRD BHMS
2018-2019 BATCH
17/02/2021
BY
DR SHREYA N. PADIYAR,
ASSISTANT PROFESSOR,
DEPARTMENT OF SURGERY

OBJECTIVES

At the end of the class students should be able to understand:

Deviated nasal septum.

Septal Haematoma.

DEVIATED NASAL
   SEPTUM
A deviated septum occurs
when the thin wall (nasal
septum) between your nasal
passages is displaced to one
side.

ETIOLOGY

1) Racial: The deflections are more common in Europeans than
in Asian or African races.

2) Age: Deflections are uncommon in children.

3) Sex: They are found more commonly in males.

4) Hereditary: Heredity may be a factor in its causation.

5) High arched palate: Lack of descent of broadening of the
palate as occurs normally during infancy may be a factor. This
might cause buckling of the developing septum.

6) Trauma: Trauma is the most important factor. Injury
ruptures the chondro-osseous joint capsule of the septum and
causes dislocations and fracture of the premaxillary wings.

7) Birth moulding theory: Prolonged and forceful stress during
the birth process affects the nose and causes dislocations and
deformations.

8) Secondary: the septum may deviate secondary to a tumour,
mass or polyp in the nose.

TYPES OF DEVIATED NASAL SEPTUM

1) Anterior dislocation:

Septal cartilage may be dislocated into one of the nasal
  chambers.

This is better appreciated by looking at the base of nose
  when patient’s head is tilted backwards.

2) C-shaped Deformity:

Septum is deviated in a simple curve to one side.

Nasal chamber on the concave side of the nasal septum will
  be wider and may show compensatory hypertrophy of
  turbinates.

3) S-shaped Deformity:

Either in vertical or anteroposterior plane.

Such a deformity may cause bilateral nasal obstruction.

4) Spur
A spur is a shelf-like projection often found at the junction
 of bone and cartilage.
A spur may press on the lateral wall and gives rise to
 headache.
It maybe predisposed to repeated epistaxis from the vessels
 stretched on its convex surface.

5) Thickening:

May result from trauma leading to overriding of the
  cartilaginous fragments, which grow later in double layers.

PATHOPHYSIOLOGY OF THE DEVIATED NASAL
SEPTUM
The deviated septum, depending on its location and degree,
  is the most common cause of nasal obstruction.

The nasal cavity on the opposite side of the deviation
  becomes roomy which further leads to compensatory
  hypertrophy of the turbinates on the roomy side.

The deviated septum obstructs the drainage of the paranasal
  sinuses on the side of the deviation.

While the drainage of the sinuses on the other side is
  hindered by hypertrophied turbinates, which swells on the
  medial as well as the lateral sides.

SYMPTOMS

Nose block (common), may be present on both sides.

Headache due to different causes: Sinusitis, Neuralgic
  headache, Vacuum headache…

Recurrent colds: due to stagnation of secretions.

Epistaxis: there will be dryness and crusting of the mucosa
  which leads to picking of the nose.

Anosmia (rare).

SIGNS
Deformity of the external nose.

Cottle test:

Anterior rhinoscopy:

Reveals the deviation of the nasal septum and the type of
  deviation.

Secondary hypertrophy of the turbinates may be present.

COMPLICATIONS

Recurrent sinusitis.

Middle ear infection (due to recurrent URTI or from forcible
  blowing of nose).

Recurrent infection of the pharynx, larynx, and
  tracheobronchial tree due to mouth breathing.

Asthma.

Atrophic rhinitis (roomy side of the nose).

DIFFERENTIAL DIAGNOSIS

Hypertrophic turbinates:

• It appears like deviated nasal septum but can be
  differentiated easily by softness of the mucosa of the
  turbinates with a sensation of touching the bone on deep
  palpation by a probe.

Polyps:

• Can be identified by their softness and pearly white
  appearance.

• They are insensitive to touch.

Septal haematoma:

• After a septal injury, produces a soft watch glass like
  swelling on both sides.

TREATMENT
Advised only if the patient has persistent or recurrent
  symptoms due to the deviated septum.

Surgical treatment:

• Submucosal Resection of the nasal septum (SMR)

• Septoplasty.

Septal haematoma:

• Etiology:

❖Injury to the nose results in collection of blood between the
  two mucosal layers of the nasal septum.

❖Postoperative: after submucosal resection of the nasal
  septum.

CLINICAL FEATURES

Bilateral nasal obstruction is the commonest presenting
  symptom.

This may be associated with frontal headache and a sense of
  pressure over the nasal bridge.

Examination reveals smooth rounded swelling of the
  septum in both the nasal fossae.

Palpation may show the mass to be soft and fluctuant.

TREATMENT

Small haematomas can be aspirated with a wide bore sterile
  needle.

Larger haematomas are incised and drained by a small
  anteroposterior incision parallel to the nasal floor.

SUMMARY

Deviated nasal septum.

Septal Haematoma.

QUESTION BANK

Define deviated nasal septum, enumerate its types, etiology,
  clinical features, complications and management.
  (1+2+2+2+1+2).

Define deviated nasal septum, explain the types of deviated
  nasal septum and its clinical features. (1+2+2).

Write a short note on septal haematoma.(3)

ASSIGNMENT

Define deviated nasal septum, enumerate its types, etiology,
  clinical features, complications and management.

Write a short note on septal haematoma.

REFERENCES

1) A short book of E.N.T. diseases by KB Bhargava, 11th
edition, Usha Publications.

2) Diseases of Ear, Nose, and Throat & head and neck surgery
by PL Dhingra, 7th edition, Elsevier publications.

3) Textbook on ear, nose, and throat diseases by Mohammed
Maqbool, 11th edition, Jaypee publications.

THANK YOU