A deviated nasal septum (DNS) is a condition characterized by deviations in the nasal septum, which can be caused by trauma, developmental defects, and genetic factors. It presents with various clinical features, including nasal obstruction, pressure headaches, reduced sense of smell, and increased risk of infections. Treatment options range from observation for mild cases to surgical interventions like submucous resection or septoplasty for more severe cases requiring correction of the obstruction.

1. DNS (Deviated Nasal Septum)
Any deviation in the normal nasal septum is called DNS (Deviated Nasal Septum).
Deviated Nasal Septum may be caused by mechanical trauma and may be
associated with some developmental defects.
It has genetic disposition and many members of same family may be affected with
DNS. DNS is more common among Caucasians than the black Africans.
DNS is an important cause of nasal obstruction.

2. Etiology
Any trauma and errors in the development of nasal septum are the two important
factors causing DNS.
1) Trauma
2) Developmental Defects
There may be some racial factors as well as hereditary factors.
3) Racial Factors
4) Hereditary Factors
1) Trauma
A blow on the lateral aspect of the nose may cause displacement of septal
cartilage from maxillary process and vomerine groove, while a blow from the
front may cause twisting and fracture of nasal septum. Injuries of the nasal bone
mostly occur in the childhood. Trauma may also occur at birth during difficult
labour.
2) Developmental Defects
Nasal septum is formed by the tectoseptal process which descends to meet the
two halves of the developing palate bone in the midline. Unequal growth
between the palate and base of the skull may cause deviation of nasal septum.
3) Racial Factors
Caucasians are more vulnerable to be affected by DNS than the Black Americans.
4) Hereditary Factors
Several members of a same family may have deviated nasal septum.
Types of DNS
Deviation of nasal septum may involve only cartilage or bone or may involve both
cartilage and bone. DNS is of following types.
1. C-Shaped deformity

3. 2. Anterior dislocation
3. S-shaped deformity
4. Spurs
5. Thickening of nasal septum
1. C-Shaped deformity
Septum is deviated in a simple curve on the one side. Nasal chamber on the
concave side of the nasal septum will be wider and may show compensatory
hypertrophy of turbinates (conchae).
2. Anterior Dislocation
Septal cartilages 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.
3. S-shaped Deformity
S-shaped deformity occurs either in vertical or anterosuperior plane. Such a
deformity may cause bilateral nasal obstruction.
4. Spurs
A spur is a shelf like projection often found at the junction of bone and cartilage.
A spur may press on lateral nasal wall and give rise to headache. It may also
predispose to repeated epistaxis from the vessels stretched on its convex surface.
5. Thickening of Nasal Septum
It may be due to organized haematoma or overriding of dislocated septal cartilage
fragments.

4. Clinical Features
Patients with DNS may show following clinical features.
1. Nasal obstruction depends upon the type of septal deformity. Nasal
obstruction may be unilateral or bilateral.
2. Deviated septum especially a spur may press on the lateral wall of the nose
giving pressure headache.
3. Deviated nasal septum may block the sinus ostia resulting in poor
ventilation of sinuses leading to the sinusitis.
4. Mucosa over the deviated part may be exposed to the drying effects of air
leading to crust formation. When these crusts are removed, it causes
bleeding leading to epistaxis of nose.
5. DNS may also cause anosmia because of the failure of the air to reach the
olfactory epithelium. There may be partial or complete loss of sense of
smell.

5. 6. Deviated nasal septum may be associated with deviation of bone or
cartilage or both leading to the external deformity.
7. Patients of DNS are at increased risk of getting middle ear infection.
Treatment
Minor degrees of nasal deviations with no symptoms are commonly seen in most
of the patients and require no treatment usually. Treatment is usually required in
cases of nasal obstruction.
Sub mucous Resection (SMR) Operation
SMR is done in adults under local anesthesia. It consists of elevating the
mucoperichondrial and mucoperiosteal flaps on the either side the nasal septum
by giving a single incision on one side of septum, removing the deflected parts of
the bony and cartilaginous septum and then repositioning of the flaps.
Septoplasty
Septoplasty is a conservative and more efficient approach of septal cartilage
surgery. In this surgical operation most of the septal framework is retained and

6. only most deviated portion is removed while rest of the septal cartilage
framework is recorrected and repositioned. Mucoperichondrial and
mucoperiosteal flap is generally raised only on the one side of the septum and
retaining the blood supply as well as septal attachment on the other side of the
septum.
Septal Surgery is usually done after 18 years so as not to interfere with the growth
of nasal cartilages. However if a child has a severe DNS causing marked nasal
obstruction, conservative septal surgery i.e., septoplasty is done to provide a
patent airway.
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