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Septplasty
1.
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)
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)
13.
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.
17.
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
19.
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
22.
23.
24.
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
26.
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.