This document discusses septoplasty and submucous resection of the nasal septum (SMR) procedures. It defines key terms like septum, deviated septum, and provides an overview of the causes and symptoms of a deviated septum. The document outlines the steps of SMR and septoplasty, including anesthesia, incisions, cartilage/bone removal, and packing. Potential complications are also summarized.

2.  Anatomy and Physiology of the nose
 Define septoplasty and related terms.
 Discussion of DNS.
 SMR and Septoplasity
 Pos-tcare Therapy

3.  Deviated- to turn aside from a regular course
 Cartilage- a tough elastic connective tissue
 Nasal septum- partition between two nasal
cavities
 Incision- the act of cutting
 Sinus- - It secretes mucus fluid that usually
drains into the nose

4. Nasal Septum
The septum is the wall of bone and cartilage that divides your nose
into two separate nostrils. A deviated septum occurs when your
septum is moved to one side of your nose.

5. CAUSES OF NASAL SEPTUM DEVIATION
1. Abnormal pressure applied to the nasal septum resulting in its deviation to
one side or another
2. Abnormalities acquired during the formation of the nasal septum
3. High arched palate
4. Race (its believed some races like Caucasians have more incidence of
DNS)
5. Hereditary
6. Trauma of the nose (blow to the nose)

6. TYPES OF NASAL SEPTUM DEVIATIONS

8. CLINICAL FEATURES OF DNS:
1. Difficulty breathing.
2. Nosebleeds
3. Infection of middle ear
4. Anosmia (lack of smell)
5. Nasal obstruction
6. Sinusitis
7. Epistaxis
8. External deformity
9. facial pain

9. DIFFFERENTIAL DIAGNOSIS
 Polyps
 Septal Hematomas
 Hypertrophied turbinates

10. TREATMENT OF DNS
1. Submucous Resection of Nasal Septum (SMR)
2. Septoplasty
3. Opiod analgesics and Antibiotics

11. SMR It is generally done in adults
 It consists of elevating mucoperichondrial and mucoperiosteal flap
on either side of the septum, removing the deflected parts of bony
and cartilagenous septum and then repositioning the flaps
Indications
 Deviated nasal septum causing nasal obstruction and recurrent
headaches
 Deviated nasal septum causing obstruction to ventilation of
paranasal sinuses and middle ear resulting in recurrent infections
 Recurrent epistaxis from septal spur
 As a part of septorhinoplasty
 Harvesting cartilage graft for tympanoplasty and rhinoplasty
 As an approach to surgeries of sphenoidal sinus, Vidian nerve and
pituitary gland

12. SMR STEPS
 Anesthesia - Local anesthesia or general anesthesia
 Positioning: reclining position with head end of the table raised
 Infiltration: subperichondrial infiltration with 2% xylocaine with
adrenaline
 Incision: killian’s incision- curvilinear incision 2-3mm behind the
anterior end of septal cartilage
 Elevation of flaps: the mucoperichondrial and mucoperiosteal
flap is elevated
 Incision of the cartilage- cartilage is incised just posterior to the first
incision
 Elevation of opposite mucoperichondrial and mucoperiosteal flap
 Removal of cartilage and bone - cartilage can be removed with
Ballinger swivel knife or luc’s forceps. Bony spur is removed using
gouge and hammer
 Preserve a strip of 1cm wide cartilage along the dorsal and
caudal borders (struts)


14. COMPLICATIONS OF SMR
 Bleeding
 Septal haematoma
 Damage to surrounding structures
 Septal abscess
 Septal Perforation
 Depression of bridge
 Retraction of columella
 Synichae
 Flapping septum
 Infection- sinus and middle ear
 CSF rhinorrhoea

15. CONDRANDICTIONS OF SMR
 Contraindications
 Acute URTI
 Patient below 17 years of age
 Bleeding disorders
 Uncontrolled hypertension
 Diabetes mellitus

16. SEPTOPLASTY
Septoplasty---is the surgical procedure to correct the shape of the
deviated septum of the nose .
 It is done to correct defects or deformities of the septum.
 It is performed to correct obstructions related to the nasal septum.
 The goal of septoplasty is to improve breathing through the nose and also
to prevent sinus infections.

18.  Nasal airway obstruction
 Can lead to mouth breathing, chronic nasal infection, or obstructive sleep apnea.
 Nasal septal deformity
 Headaches caused by septal spurs
 Chronic and uncontrolled nosebleeds
 Chronic sinusitis associated with a deviated septum
 Tumor excision
 Deviated nasal septum causing nasal obstruction and recurrent headaches
 Deviated nasal septum causing obstruction to ventilation of paranasal sinuses and
middle ear resulting in recurrent infections
 Recurrent epistaxis from septal spur

20.  Anesthesia: local or general anesthesia
 An incision is made in the lining of the septum Steps :
Infiltration
 Incision: Freer’s incision– a unilateral hemi-transfixation
incision at the caudal border of the septumto reach the
cartilage.
Exposure: the mucoperichondrial and mucoperiosteal
flap is elevated on only one side .
 The septum may then be stabilized with small
plastic tubes, splints or nasal packs to prevent bleeding.

21. PROCEDURES CONT………
 Separate septal cartilage from vomer and ethmoid plate
 Inferior strip of cartilage is removed
 Correct the bony septum by removing deformed parts
 Minor deviations of cartilage are corrected by criss cross incision
which breaks spring action of cartilage
 Nasal packing

25. POST-OPERATIVE COMPLICATIONS
 Bleeding
 Septal haematoma
 Damage to surrounding structures
 Septal abscess and deformities
 Septal Perforation
 Depression of bridge
 Retraction of columella
 Infection- sinus and middle ear
 Numbness of the upper teeth

27.  Patient should drinks and eats soft food.
 Avoid all moderate and heavy physical activity, including
sport for couple of days after the operation and avoid
bending.
 Avoid smoky, dusty and dry atmospheres.
 If temperature is increasing nasal or have a facial pain a
few days after the operation, patient should consult
doctor.
 Improvement in nasal breathing may take a few weeks.