Disease of the nasal septum can cause nasal obstruction, excessive nasal discharge, epistaxis, headache and sinusitis. The diseases could be deviated nasal septum, septal haematoma, septal abscess and septal perforation. All these complaints are treatable.

1. DISEASES
OF
NASAL SEPTUM
Brig Anwar ul Haq
MBBS(QAU),FCPS(Pak),FICS(USA),OJT(London)
ENT Specialist
03018513303

3. FRACTURES OF NASAL SEPTUM
Etiology & pathogenesis
• Trauma
• Fate of septum -
• Buckling
• Vertical or horizontalfracture crushed into pieces
• Septal injuries with mucosal tear
• Profuse epistaxis
• Septal injuries without mucosal tear
• Septal hematoma

5. EARLY RECOGNITION & TREATMENT
 Haematoma
 Drained
 Fracture
 Reduced / repositioned
 Supported
 Mucoperichondrial flaps
 Mattress sutures
 Nasal packing

6. OUTCOME
• No deformity
• Dislocated or fractured septal
fragments
• Deviation
• Cartilag
• Bone
• External nasal deformity

8. Deviated Nasal Septum
• Deviated nasal septum
• Cartilage
• Bone
• Both.
• Affecting 80%of people
• Any sexand age
• Male>female

9. ETIOLOGY
• Trauma
• Development error
• Racial factors
• Hereditary factor

10. TRAUMA
• Lateral blow
• Crushing from front
• Common in children
• Inflicted at birth
• Birth injuries

11. TRAUMA
• Lateral blow
displacement from
vomerine groove and
maxillary crest
• Crushing from front-
buckling,twisting,fractur
es and duplication
• Common in children
• Inflicted at birth
• Birth injuries should be
corrected immediately
to avoid future DNS

12. DEVELOPMENT ERRORS
• Inconsistency between growth
• Unequal growth between thepalate
and the baseof skull
• Adenoid hypertrophy->
• high arched palate ->DNS
• Also seenin cleft lip &palate and
dental abnormalities

15. Racial factors
• Caucasiansmore than blackamericans
Hereditary factors
• Several members from samefamily
• Connective tissue disorders
• Marfan syndrome
• Homocystinuria
• Ehlers-danlos syndrome.
Compensate deformity
pressure on septum
hypertrophied nasal turbinates
by tumor ofthe nose

17. TYPESOF
DNS
• Anterior or caudal
dislocation
• C-shaped deformity
• S-shapeddeformity
• Septal spurs(shelf like
projection)
• Septal thickening
• Impacted septum

18. CLINICAL FEATURES
Nasal obstruction
• Unilateral or bilateral
• High septal deviation causes
nasal obstruction more than
lower ones
• Paradoxical
Sitesof obstruction
• vestibular
• Nasal valve
• Attic
• Turbinal
• Choanal

19. COTTLES TEST
• Nasal valve
• Cheekis drawn
laterally
• Indicates vestibular
component of nasal
valves

20. Nasal Obstruction

21. Headache
• Spur pressing lateral wall
• sluder’s neuralgia / pressure headache

23. Sinusitis
• DNS
• obstruct sinus ostia

33. Mucous with Blood

34. Epistaxis
• Mucosa over deviated part
• Exposed
• Drying effect
• Crusts formation
• Removal
• Epistaxis

35. External deformity
• Cartilaginous
• Bony
• Or both and cartilaginous
• Middle ear
infection
• Mouth
breathing
• Snoring and pharyngitis
Atrophic rhinitis and myiasis

36. COMPLICATIONS
• Acute and chronic rhinitis
• Acute and chronic sinusitis
• Acute and chronic otitis media
• Acute and chronic pharyngitis
• Acute and chronic laryngitis;
• Conjunctivitis - nasolacrimal canal
• Reflex disorders of internal organs
• Bronchial asthma
• Asthmatic bronchitis
• Headache

37. DIAGNOSIS
• History
• General examination
• Nose
• Face
• Oral cavity
• Anterior and posteriorrhinoscopy
• Probing of the nose
• X-ray
• CTscan

38. TREATMENT
 Minor degree - no treatment
 Treatment
 Surgery

39. MEDICAL
 :decongestants
 antihistamines,nasal
 steroid sprays
 Mechanical: nasal strips
 Surgery:
 Submucous resection (SMR) operation
 Septoplasty

40. Mechanical:
Nasal strips

41. Surgery:
Submucous resection (SMR)
Septoplasty

42. • Aadults
• GA
• La
• Mucoperichondrial and
mucoperiosteal flaps
• On either side of
theseptal
framework
SUBMUCOUS RESECTIONOPERATION

43. • Single side incision
• Removing the deflected
• Bony
• Cartilaginous
• Repositioning the flaps
SUBMUCOUS RESECTIONOPERATION

44. SEPTOPLASTY
• Conservativesurgery
• Only most deviated
parts areremoved
• Restof the septal
framework iscorrected
and repositioned by
plastic means.
• Mucoperichondrial or
mucoperiosteal flap is
generally raised only in
one side of theseptum
retaining the
attachment and blood
supply of theother

45. SMR SEPTOPLASTY
Radicalsurgery conservative
Not done below 17yrs Done after 4yrs
Killian’s incision Freer’s incision
Cannot correct anterior DNS Cancorrect
B/Lmucoperichondrium is elevated Oneside only
Radicalremoval of cartilage Only inferior strip
Rhinoplasty incision cannot combine can
Revision surgery is difficult Relatively easy
Cartilage graft canbe harvested no
Complication common rare

46. SEPTALHAEMATOMA
Definition
• Collection of blood under the perichondriumor
periosteum of nasalseptum
Aetiology
1. Nasal trauma
2. Septal surgery
3. Bleeding disorders

47. CLINICAL FEATURES
• Bilateral nasal obstruction and mouth breathing
• Frontal headache
• Sense of pressure over nasal bridge
• Smooth rounded swelling of the septum in both
nasal fossae
• Soft and fluctuant mass felt
• Absence of raised
temperature,erythema,swelling and
tenderness over the skin of nose

48. CLINICAL FEATURES
• Temperature
• Erythema
• Swelling
• tenderness over the skin of nose

49. TREATMENT
• Aspiration –
• Small haematoma
• Incised and drained
• Large Haematoma
• Nose is packed
• both sides to prevent reaccumulation
• Antibiotics

50. • Thickened septum
• Septal abscess
• depression of nasaldorsum - Saddle nose
• Supratip deformity
• Septal perforation
COMPLICATIONS

51. SEPTALABSCESS
Definition
• Collection of pus under the
perichondrium or periosteumof
nasal septum
Etiology
• Secondaryinfection from septal
haematoma
• Furuncle of the nose or upperlip
• Acute infection suchastyphoid or
measles

52. CLINICALFEATURES
• Severebilateral nasalobstruction
• pain
• tenderness over the bridge ofnose
• fever with chills and frontalheadache

53. CLINICALFEATURES
• Skinover the nose –
• Red andswollen
• Smooth bilateral swelling of nasal
septum
• Fluctuation
• Septal mucosa-- congested
• Submandibular lymph nodes
• Enlargedand tender

54. TREATMENT
• Early drainage
• Incision made in the most dependent parts of the abscess
• Apiece of septal mucosaisexcised
• Pusand necrosed pieces of cartilages are removed bysuction
and nasal packing is done
• Incision reopened daily for 2-3days
• Systemicantibiotics for 10days

55. COMPLICATIONS
• Necrosis of septal cartilage
• Saddle nose
• Supra tip deformity
• Septal perforation
• Meningitis
• Cavernous sinus thrombosis

56. PERFORATIONOFNASALSEPTUM
Etiology
Traumatic perforation
• Injury to mucosal flaps duringSMR
• cauterization of septum with chemicals
• galvanocautery for epistaxis
• Habitual nose- picking

57. 2 . Pathologicperforations
• Septal abscess
• Nasal myiasis
• Rhinolith or neglected foreignbody
• Chronic granulomatous conditions likeLupus,
tuberculosis, leprosy, syphilis
• Wegener’s granuloma

58. 3 . Drugsand chemicals
• Prolonged useof steroids in nasalallergy
• Cocaine addicts
• Workers in certain occupations. Eg.chromium
plating,dichromate or sodaashmanufacture
or those exposed to arsenic orits compounds
4.Idiopathic

59. CLINICAL
FEATURES
• Small anterior perforation causewhistling
sound during inspiration or expiration
• Largeperforations develop crusts which
obstruct the nose or causeepistaxiswhen
removed

60. TREATMENT
• Basedon causeand sizeof perforation
• Smallperforation--closed by plastic flaps
• Larger perforations
treatment aim -- to keep the nose--crust free
Byalkaline nasal douches and application of a
bland ointment
• Athin silastic button canbeworn

61. NASALSYNECHIA
Etiology
• Adhesions between septum and lateral wall
• Adhesions between middle turbinate and lateralwall
• Following nasalsurgery and nasalpacking
Clinical features
• Nasalobstruction
• Sinusitis and headache

62. Treatment
• Excisionand release of adhesion
• Dental wax plates/sialistic sheets between 2
surfaces
Prevention
• Proper perioperative cleaning
• Lubrication of nasal pack beforeinsertion
• Useof septal splints followingsurgery

63. THANKYOU