This document describes the submucous resection of the nasal septum procedure. It outlines the indications, contraindications, anesthesia used, positioning of the patient, steps of the operation including infiltration, incision, elevation of flaps, incision and removal of cartilage and bone, stitching, packing, and post-operative care. Potential complications are also listed. The submucous resection of the nasal septum is a procedure used to correct a deviated nasal septum causing nasal obstruction by elevating mucoperichondrial flaps and removing excess cartilage and bone.

2. SMR Operation
EAR, NOSE AND
THORAT

3. SUBMUCOUS RESECTION OF
NASAL SEPTUM
DR ABDUL SAMI
MPHIL EASTERN MEDICINE
The Islamia University of Bahawalpur
Pakistan

4. INDICATIONS
 Deviated nasal septum (DNS) causing symptoms of nasal obstructions.
 DNS causing obstruction to ventilation

5. CONTRAINDICATIONS
 Patient below 17 year of age
 Acute episode of respiratory infections
 Bleeding diathesis
 Untreated diabetes
 Hypertension

6. ANAESTHESIA
 Local anaesthesia is preffered
 general anaesthesia is used in children and apprehensive adults.

7. POSITION
 Reclining position with head end of the table raised

8. STEPS OF OPERATION
 There are following steps of operation

9. 1.INFILTRATION OF NASAL
SEPTUM
 This is done with
1. 2% xylocine
2. 1:50,000 adrenaline

10. 2.INCISION
 A curvilinear incision with forward convexity is made at mucocutaneous
junction on left side of the septum.

11. 3.ELEVATION OF MUCOPERICHONDRIAL
AND PERIOSTEAL FLAP
 It should beneath the perichondrium and periosteum

12. 4.INCISION OF CARTILAGE
 Cartilage is incised just posterior to the first incision

13. 5.ELEVATION OF OPPOSITE
MUCOPERICHONDRIUM AND
PERIOSTEUM
 With the elevator passed through cartilage incision
 Mucoperichondrium and periosteal flap is raised from opposite side of the
septum

14. 6.REMOVAL OF CARTILAGE AND
BONE
 Now cartilage and bone are removed between two flaps
 Cartilage can be removed with Ballenger swivel knife
 Bone with Luc’s foreceps
 Bony spur or rigde can be removed with gouge and hammer

15. 7.STITCHING
 One or two catgut or silk stitches are applied in the initial
mucoperichondrial inscision

16. 8.PACKING
 Ribbon gauze, smeared with furacin ointment or liquid paraffin is packed in
each nasal cavity to prevent collection of blood between two flaps

17. POST-OPERATIVE CARE
 Patient is placed in semi sitting position to prevent oozing blood
 A soft diet should be taken to minimize active mastication that cause
bleeding

18.  Analgesic should be taken to treat pain
 Antibiotics should be taken for 5-6 days

19.  Nasal packs should remove gently
 Decongestant nasal drops and steam inhalations are given daily for 5-6
days

20.  Silk stitch should remove on 5 or 6th day
 Patient should avoid trauma to the nose for several days

21. COMPLICATIONS
 Bleeding
 Septal heamatoma
 Septal abcess
 Perforation
 Depression of bridge (due to too much removal of cartilage)
 Persistence of deviation
 Flapping of nasal septum
 Toxic shock syndrome

22. THANK YOU

23. “a person gain more satisfaction who is satisfied”
(tabassum)