The document discusses the anatomy, functions, and diseases of the nasal septum, detailing its structure, blood supply, nerve supply, and the consequences of traumas such as fractures and deviations. It covers various conditions associated with the nasal septum including perforations, haematomas, and abscesses, their clinical features, and treatments. Complications arising from neglecting nasal septum injuries, such as nasal obstruction, headaches, and infections, are also highlighted.

1. NASAL SEPTUM
& Its Diseases

2. NASAL SEPTUM
Midline structure which divides the
right and left nasal cavities.
Consists of three parts
1.Columellar septum
2.Membranous septum
3.Septum proper.

3. 1. Columellar septum.
Formed of columella containing the medial crura of alar cartilages.
United together by fibrous tissue
Covered on either side by skin.
2. Membranous septum.
Double layer of skin
No bony or cartilaginous support.
Lies between the columella and the caudal border of septal cartilage.
Both columellar and membranous parts are freely movable from side to
side.

4. SEPTUM PROPER
Osteocartilaginous framework
Covered with nasal mucous membrane.
Principal Components are :
1. Perpendicular plate of ethmoid.
2. The vomer
3. Large septal cartilage
4. Minor contributions from
I. Crest of nasal bones ii. Nasal spine of frontal bone
Iii. Rostrum of sphenoid iv Crest of palatine bones
V. Crest of maxilla vi. Anterior nasal spine of maxilla.

5. Blood Supply of Septum:
Internal Carotid System
Anterior ethmoidal artery Branches of ophthalmic
artery
Posterior ethmoidal artery
External Carotid System:
1. Sphenopalatine artery branch of maxillary artery
2. Septal branch of greater palatine artery branch of
maxillary artery
3. Septal branch of superior labial artery (branch of facial artery).

6. LITTLE’S AREA OR Kiesselbach’s plexus
Vascular area in the anteroinferior part of nasal septum just above the
vestibule
Exposed to the drying effect of inspiratory current & finger nail trauma.
Common Site for epistaxis in children and young adults.
Four arteries anastomose here.
i. Anterior ethmoidal
ii. Septal branch sphenopalatine
iii. The greater palatine
iv. Septal branch of superior labial + corresponding veins

8. NERVE SUPPLY
1. Nerves of Common Sensation.
I. Anterior ethmoidal nerve.
(nasocillary nerve=> ophthalmic V1
division of trigeminal)
Ii anterior superior alveolar nerve Branch
of infraorbital nerve
(maxillary divisin V2 of trigeminal nerve.
II. Branches of pterygopalatine
ganglion.
(medial posterior superior nerve and
spenopalatine/nasopalatine nerve)
2. Olfactory nerves.

10. FRACTURES OF NASAL SEPTUM
Aetiopathogensis:
1. Trauma.
2. Fracture of septal cartilage or
3. its dislocation from vomerine groove.
4. Septal injuries:
 with mucosal tear-profuse epistaxis.
 with intact mucosa-Hematoma
“Jarjaway” fracture of nasal septum :
Blows from the front.
starts just above the anterior nasal spine of maxilla
and runs horizontally backwards just above
the junction of septal cartilage with the vomer

11. “Chevallet” fracture of
septal cartilage:
Blows from below.
Runs vertically from the anterior
nasal spine of maxilla upwards
to the junction of bony
and cartilaginous dorsum of nose

12. TREATMENT
Haematomas should be drained.
Dislocated or fractured septal fragments
should be repositioned and supported between
mucoperichondrial flaps with mattress sutures
and nasal packing..
COMPLICATIONS
Septum is important in supporting the lower part of the external nose. If
its injuries are ignored, they would result in deviation of the
cartilaginous nose, or asymmetry of nasal tip, columella or the nostril.

13. DNS
AETIOLOGY:
1. trauma.
Lateral blow on the nose => displacement of septal
cartilage from the vomerine groove and maxillary crest.
Crushing blow from the front => buckling, twisting, fractures and
duplication of nasal septum with telescoping of its fragments.
Trauma at birth during passage via birth canal.
2. Developmental error.
3. Racial Factors.
Caucasians are affected more than black Americans.
4. hereditary Factors.
Several members of the same family may have
deviated nasal septum

14. TYPES OF DNS
1. anterior dislocation.
Septal cartilage may be dislocated into one of
the nasal chambers.
2. C-shaped deformity.
Septum is deviated in a simple curve to one side.
Nasal chamber on the concave side of the
nasal septum will be wider and may show
compensatory hypertrophy of turbinates.
3. S-shaped deformity.
S shaped curve either in vertical or
anteroposterior plane.
cause bilateral nasal obstruction.

15. 4. Spurs.
Shelf-like projection often found at the junction
of bone and cartilage.
May press on the lateral wall and gives rise to
headache.
May also predispose to repeated epistaxis from
the vessels stretched on its convex surface.
5. thickening.
Due to organized haematoma or
overriding of dislocated septal fragments

16. CLINICAL FEATURES
1. NASAL OBSTRUCTION.
obstruction may be unilateral or bilateral.
Site of obstruction
(i) vestibular (caudal septal dislocation)
(ii) Nasal valve (synechiae, usually post-rhinoplasty)
(iii) attic (upper part of nasal septum due to high septal
deviation)
(iv) turbinal (hypertrophic turbinates or concha bullosa)
and
(v) choanal

17. 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, the test is +
 Indicates abnormality of the
vestibular component of nasal valve

18. 2. Headache.
Especially a spur, may press on the lateral wall of nose
giving rise to pressure headache.
3. Sinusitis.
May obstruct sinus ostia => poor ventilation of the sinuses.
Predispose or perpetuate sinus infections.
4. Epistaxis.
Mucosa over dns is exposed to the drying effects of air
currents=> crusts, removal => bleed.
Bleeding may also occur from vessels over a septal spur.

19. 5. Anosmia.
Failure of the inspired air to reach the olfactory region may result in total or
partial loss of sense of smell.
6. External deformity.
Septal deformities may be associated with deviation of the cartilaginous or
both the bony and cartilaginous dorsum of nose, deformities of the nasal tip
or columella.
7. Middle ear infection.
DNS also predisposes to middle ear infection.

20. TREATMENT:
Minor degrees of septal deviation with no symptoms require no treatment.
DNS produces mechanical nasal obstruction or symptoms than operation is indicated

21. SEPTAL HEMATOMA
Collection of blood under the
perichondrium or periosteum of the nasal
septum
Results from nasal trauma or septal surgery.
May occur spontaneously in bleeding
disorders.
CLINICAL FEATURES
Bilateral nasal obstruction is the commonest
presenting symptom.
May be associated with frontal headache
and a sense of pressure over the nasal
bridge

22. Examination reveals smooth rounded swelling of the septum in both the nasal
fossae.
Palpation may show the mass to be soft and fluctuant.
TREATMENT
Small haematomas can be aspirated with a wide bore sterile needle.
Larger haematomas are incised and drained by a small anteroposterior
incision parallel to the nasal floor.
Nose is packed on both sides to prevent reaccumulation.
Systemic antibiotics should be given to prevent septal abscess.
COMPLICATIONS
if not drained, may organize into fibrous tissue leading to a permanently
thickened septum.
If secondary infection supervenes =>septal abscess with necrosis of cartilage
and depression of nasal dorsum.

23. SEPTAL ABSCESS
AETIOLOGY
From secondary infection of
septal haematoma.
Occasionally follows furuncle of
the nose or upper lip.
May also follow acute infection
such as typhoid or measles.

24. Clinical Features:
Severe bilateral nasal obstruction with pain and tenderness over the
bridge of nose.
Patient may also complain of fever with chills and frontal headache.
Skin over the nose may be red and swollen.
Internal examination of nose reveals smooth bilateral swelling of the
nasal septum .
Fluctuation can be elicited in this swelling.
Septal mucosa is often congested.
Submandibular lymph nodes may also be enlarged and tender

25. Treatment:
Abscess should be drained as early as possible.
Incision is made in the most dependent part of the abscess and a piece of septal
mucosa excised.
Pus and necrosed pieces of cartilage are removed by suction.
Incision may require to be reopened daily for 2–3 days to drain any pus or to
remove any necrosed pieces of cartilage.
Systemic antibiotics are started as soon as diagnosis has been made and continued at
least for a period of 10 days.
COMPLICATIONS:
Necrosis of septal cartilage often results in depression of the cartilaginous dorsum in
the supratip area and may require augmentation rhinoplasty 2–3 months later.
Necrosis of septal flaps may lead to septal perforation.
Meningitis and cavernous sinus thrombosis following septal abscess, though rare
these days, can be serious complications.

26. Perforation of Nasal Septum
1.traumatic perforations.
Most common cause.
Injury to mucosal flaps during SMR
Cauterization of septum with
chemicals or galvanocautery for
epistaxis.
Habitual nose picking
Occasionally, septum is deliberately
perforated to put ornaments.
2. pathological perforations.
1. Septal abscess.
2. Nasal myiasis.
3. Rhinolith or neglected foreign body
causing pressure necrosis

27. 4. Chronic granulomatous conditions like lupus, tuberculosis and leprosy cause
perforation in the cartilaginous part while syphilis involves the bony part.
5. Wegener’s granuloma is a midline destructive lesion which may cause total septal
destruction.
3. drugs and chemicals
1. Prolonged use of steroid sprays in nasal allergy.
2. Cocaine addicts.
3. Workers in certain occupations, e.g. chromium plating, dichromate or soda ash
(sodium carbonate) manufacture or those exposed to arsenic or its compounds.
4. idiopathic. many cases,no history of trauma or previous disease and the patient may
even be unaware of the existence of a perforation.
CLINICAL FEATURES
Small anterior perforations cause whistling sound during inspiration or expiration.
Larger perforations develop crusts which obstruct the nose or cause severe epistaxis
when removed.

28. TREATMENT
Finding of cause before treatment .
May require biopsy from the granulations or biopsy of the edge of the
perforation.
Inactive small perforations can be surgically closed by plastic flaps.
Larger perforations are difficult to close.
treatment is aimed to keep the nose crust-free by alkaline nasal douches
application of a bland ointment.
Sometimes, a thin silastic button can be worn to get relief from the
symptoms