The nasal septum has 3 parts - the columellar septum, membranous septum, and septum proper. The septum proper provides structural support to the nose and is formed by bones and cartilage. The nasal septum is supplied by blood vessels and nerves and is prone to fractures and deviations from trauma. Deviated septum and septal hematomas can cause nasal obstruction and other issues. Septal abscesses may develop from infections of hematomas and can destroy cartilage. Perforations can occur from trauma, infections, drugs, or idiopathic causes. Small perforations may cause whistling sounds while larger perforations require management of crusts.

1. NASAL SEPTUM & ITS
DISEASES
NAVASSHAREEF .P .P
KMCTMEDCOLLEGE ; CALICUT; INDIA
Email:nasmbbs@gmail.com

2. Nasal septum
Anatomy
3 parts
1)Columellar septum
2)Membranous septum
3)Septum proper

3. Nasal septum

4. 1.Columellar septum
Formed of columella containing the
medial crura of alar cartilage united
together by fibrous tissue and covered
on either side by skin

5. 2.Membranous Septum
 Double layer of skin
 No bony or cartilaginous support
 Lies b/w columella & caudal border of septal
cartilage.
 Both columella & membranous parts are freely
movable from side to side

6. 3.Septum proper
Osteocartilagenous frame work
Covered with nasal mucous membrane
1.Perpendicular plate of ethmoid
2.The vomer
3.Large septal cartilage

7. Minor contributions from
-Crest of nasal bone
-Nasal spine of frontal bone
-Rostrum of sphenoid
-Crest of palatine bone
-Crest of maxilla
-Anterior nasal spine of maxilla

8. Septal cartilage
 Partition b/w right&left nasal cavities.
 Provides support to the tip & dorsum of cartilaginous part
of nose.
 Its destruction ( in Septal abscess, injuries, tuberculosis,
excessive removal during septal surgery ) causes
depression of lower part of nose &drooping of nasal tip

9. Blood supply
of nasal
septum

10. Little’s area/Kiesselbach’s plexus
 Vascular area in the anteroinferior part of nasal septum.
-Anterior ethmoidal artery
-Spheno palatine
-Greater palatine
-Septal branch of superior labial
+corresponding veins
 Commonest site for epistaxis
 Site for origin of “Bleeding polypus”(Hemangioma) of nasal

11. Nerve supply
1)Nerves of common sensation
Anterior ethmoidal nerve.
Branches of sphenopalatine ganglion.
Branches of infra orbital nerve
2)Olfactory nerves.
3)Autonomic nerves.

12. Nerve supply

13. Fractures of nasal
septumAetiopathogenesis
 Trauma
 Fracture of septal cartilage or its
dislocation from vomerine groove
 Septal injuries
 with mucosal tear-profuse epistaxis
 with intact mucosa-hematoma.

14. “ Jarjaway” fractures of nasal septum-
Blows from front.
Starts just above the antarior
nasal spine of maxilla &runs
horizontally backwards just
above the jn of septal cartilage
with vomer

15. “Chevallet” fractures of septal cartilage
Blows from below.
Runs vertically from antarior
nasal spine of maxilla upwards
to the jn of bony and
cartilaginous dorsum of nose.

16. Treatment of Fractures of nasal
septum
Hematoma should be drained
Dislocated or fractured septal fragments
should be repositioned& supported.

18. Complications of Fractures of nasal
septum
If injuries are ignored ,they would result in
 deviation of cartilaginous nose
 assymetry of nasal tip,columella
or the nostril.

19. DNS

20. DEVIATED NASAL SEPTUM
Aetiology
1)Trauma
Lateral blow on nose:-displacement of septal
cartilage from the vomerine groove&maxillary
crest
Crushing blow from the front:-buckling or
twisting fractures
Trauma at birth during passage thru birth canal.

21. 2)Developmental error
3)Racial factors
Caucasians affected more than negroes
4)Hereditary factors
Several members of the same family may have
deviated nasal septum.

22. Types of DNS
1)Anterior dislocation
Nasal septum dislocated to one of
the nasal chambers.

23. 2)C-shaped deformity
 Septum is deviated in a single curve to one
side.
 Nasal chamber on the concave side will be
wider &may show compensatory
hypertrophy of turbinates.

24. 3)S-shaped deformity
Septum may show an S-shaped
curve either in vertical or
anteroposterior plane.
Causes bilateral nasal
obstruction.

25. 4)Spurs
 Shelf like projection often found at the jn of
bone and cartilage.
 A spur may press on the lateral wall& give rise
to headache.
 It may also predispose to repeated epistaxis
from the vessels stretched on its convex
surface.

26. 5)Thickening
Due to organised hematoma or
Overriding of dislocated septal
fragments.

27. Clinical features :DNS
 DNS can involve any age and sex
 Males are affected more than females
1)Nasal obstruction
 Unilateral/bilateral
 Site of obstuction
i. Vestibular
ii. At the nasal valve
iii. Attic
iv. Turbinal
v. Choanal

28. COTTLE TEST
 Used to know whether nasal obstruction is due to
septal abnormality or not?
 Cheek is drawn laterally while the patient breathes
quietly
 If the nasal airway improves on the test side,test is +
ve
 Indicates abnormality vestibular component of nasal
valve

29. COTTLE TEST

30. 2)Headache
Deviated septum,esp. a spur may press on
lateral wall of nose giving rise to pressure
headache
3)Sinusitis
Deviated septum may obstruct sinus ostia
poor ventillation of sinus predispose or
perpetuate sinus infection.

31. 4)Epistaxis
Mucosa over the deviated parts of
septum exposed to drying effects of
air currents formation of crusts which
when removed causes bleeding
Bleeding may occur from vessels over a
nasal spur

32. 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

33. Septal hematoma
 Collection of blood under of perichondrium/
periosteum of nasal septum.
 Often results from nasal trauma or septal
surgery.
 It may occur spontaneously in bleeding
disorders .

34. Clinical features :Septal hematoma
 Bilateral nasal obstruction.
 Frontal headache & sense of pressure over
nasal bridge.
 Examn –smooth rounded swelling of the
septum in both the nasal fossa.
 Palpation-mass soft & fluctuant.

35. Treatment :Septal hematoma
Small hematomas aspirated with a wide
bore sterile needle.
Large hematomas incised and drained.
Following drainage nose is packed on
both sides to prevent reaccumulation.
Systemic antibiotics should be given to
prevent septal abscess.

36. Complications :Septal hematoma
Septal hematoma if not
drainedorganise into fibrous tissue
leading to permanantly thickened septum
Secondary infection results in septal
abscess with necrosis of
cartilage&depression of nasal septum.

37. Septal abscess
Aetiology
 Mostly from secondary infection of septal
hematoma.
 Occassionally it follows furuncle of the nose or
upper lip.
 It may follow a/c infection such typhoid or measles

38. Complications Septal abscess
Necrosis of septal cartilagedepression of
the cartilaginous dorsum.
Necrosis of septal flapsseptal
perforation.
Meningitis&cavernous sinus thrombosis-
rare &serious complication

39. Perforation of nasal septum
Aetiology
1)Traumatic perforation
 Most common cause.
 Common forms of trauma-injury to mucosal flaps during
SMR,cauterisation of septum with chemicals/galvanocautery
for epistaxis,habitual nose pricking.

40. 2)Pathologic perforation
 Septal abscess
 Nasal myiasis
 Rhinolith/neglected foreign body causing pressure
necrosis.
 c/c granulomatous condn
 lupus,TB,leprosy (perforation in cart. Part)
 Syphilis (bony part)
 Wegener’s granuloma-midline destructive lesion-
cause total septal perforation.

41. 3)Drugs & chemicals
i. Prolonged use of steroid sprays in nasal allergy.
ii. Coccaine addicts.
iii. Workers in certain occupations,eg.Cr plating,dichromate/soda
ash(sod.carbonate) manufacture or those exposed to As.
4)Idiopathic
 No h/o trauma,previous disease or Pt. may be unaware of
existence of perforation.

42. Clinical features:Perforation
Small ant.perforation-whistling sound
during inspiration/expiration.
Larger perforation-develop crusts
which obstruct the nose or may cause
severe epistaxis when removed

43. Treatment of septal perforation
 Find the cause of perforation first
 Inactive small perforation can be surgically closed by
plastic flaps.
 Larger perforation difficult to close.
 Their t/t is aimed to keep the nose crust free by alkaline
nasal douches&application of a bland oinment.
 Thin sialistic button worn to get relief
from symptoms.

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