NASAL SEPTUM & ITS
DISEASES
NAVASSHAREEF .P .P
KMCTMEDCOLLEGE ; CALICUT; INDIA
Email:nasmbbs@gmail.com
Nasal septum
Anatomy
3 parts
1)Columellar septum
2)Membranous septum
3)Septum proper
Nasal septum
1.Columellar septum
Formed of columella containing the
medial crura of alar cartilage united
together by fibrous tissue a...
2.Membranous Septum
 Double layer of skin
 No bony or cartilaginous support
 Lies b/w columella & caudal border of sept...
3.Septum proper
Osteocartilagenous frame work
Covered with nasal mucous membrane
1.Perpendicular plate of ethmoid
2.The ...
Minor contributions from
-Crest of nasal bone
-Nasal spine of frontal bone
-Rostrum of sphenoid
-Crest of palatine bone
-...
Septal cartilage
 Partition b/w right&left nasal cavities.
 Provides support to the tip & dorsum of cartilaginous part
o...
Blood supply
of nasal
septum
Little’s area/Kiesselbach’s plexus
 Vascular area in the anteroinferior part of nasal septum.
-Anterior ethmoidal artery
...
Nerve supply
1)Nerves of common sensation
Anterior ethmoidal nerve.
Branches of sphenopalatine ganglion.
Branches of in...
Nerve supply
Fractures of nasal
septumAetiopathogenesis
 Trauma
 Fracture of septal cartilage or its
dislocation from vomerine groove...
“ Jarjaway” fractures of nasal septum-
Blows from front.
Starts just above the antarior
nasal spine of maxilla &runs
hor...
“Chevallet” fractures of septal cartilage
Blows from below.
Runs vertically from antarior
nasal spine of maxilla upwards...
Treatment of Fractures of nasal
septum
Hematoma should be drained
Dislocated or fractured septal fragments
should be rep...
Complications of Fractures of nasal
septum
If injuries are ignored ,they would result in
 deviation of cartilaginous nos...
DNS
DEVIATED NASAL SEPTUM
Aetiology
1)Trauma
Lateral blow on nose:-displacement of septal
cartilage from the vomerine groove&...
2)Developmental error
3)Racial factors
Caucasians affected more than negroes
4)Hereditary factors
Several members of the s...
Types of DNS
1)Anterior dislocation
Nasal septum dislocated to one of
the nasal chambers.
2)C-shaped deformity
 Septum is deviated in a single curve to one
side.
 Nasal chamber on the concave side will be
wider...
3)S-shaped deformity
Septum may show an S-shaped
curve either in vertical or
anteroposterior plane.
Causes bilateral nas...
4)Spurs
 Shelf like projection often found at the jn of
bone and cartilage.
 A spur may press on the lateral wall& give ...
5)Thickening
Due to organised hematoma or
Overriding of dislocated septal
fragments.
Clinical features :DNS
 DNS can involve any age and sex
 Males are affected more than females
1)Nasal obstruction
 Unil...
COTTLE TEST
 Used to know whether nasal obstruction is due to
septal abnormality or not?
 Cheek is drawn laterally while...
COTTLE TEST
2)Headache
Deviated septum,esp. a spur may press on
lateral wall of nose giving rise to pressure
headache
3)Sinusitis
De...
4)Epistaxis
Mucosa over the deviated parts of
septum exposed to drying effects of
air currents formation of crusts which
...
5)Anosmia
Failure of inspired air to reach the
olfactory region may result in total or
partial loss of sense of smell.
6)...
Septal hematoma
 Collection of blood under of perichondrium/
periosteum of nasal septum.
 Often results from nasal traum...
Clinical features :Septal hematoma
 Bilateral nasal obstruction.
 Frontal headache & sense of pressure over
nasal bridge...
Treatment :Septal hematoma
Small hematomas aspirated with a wide
bore sterile needle.
Large hematomas incised and draine...
Complications :Septal hematoma
Septal hematoma if not
drainedorganise into fibrous tissue
leading to permanantly thicke...
Septal abscess
Aetiology
 Mostly from secondary infection of septal
hematoma.
 Occassionally it follows furuncle of the ...
Complications Septal abscess
Necrosis of septal cartilagedepression of
the cartilaginous dorsum.
Necrosis of septal fla...
Perforation of nasal septum
Aetiology
1)Traumatic perforation
 Most common cause.
 Common forms of trauma-injury to muco...
2)Pathologic perforation
 Septal abscess
 Nasal myiasis
 Rhinolith/neglected foreign body causing pressure
necrosis.
 ...
3)Drugs & chemicals
i. Prolonged use of steroid sprays in nasal allergy.
ii. Coccaine addicts.
iii. Workers in certain occ...
Clinical features:Perforation
Small ant.perforation-whistling sound
during inspiration/expiration.
Larger perforation-de...
Treatment of septal perforation
 Find the cause of perforation first
 Inactive small perforation can be surgically close...
.....THANK U.....
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Nasal septum & its diseases

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Published on: Mar 3, 2016
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Transcripts - Nasal septum & its diseases

  • 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.
  • 17. 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.
  • 18. DNS
  • 19. 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.
  • 20. 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.
  • 21. Types of DNS 1)Anterior dislocation Nasal septum dislocated to one of the nasal chambers.
  • 22. 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.
  • 23. 3)S-shaped deformity Septum may show an S-shaped curve either in vertical or anteroposterior plane. Causes bilateral nasal obstruction.
  • 24. 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.
  • 25. 5)Thickening Due to organised hematoma or Overriding of dislocated septal fragments.
  • 26. 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
  • 27. 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
  • 28. COTTLE TEST
  • 29. 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.
  • 30. 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
  • 31. 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
  • 32. 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 .
  • 33. 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.
  • 34. 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.
  • 35. 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.
  • 36. 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
  • 37. 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
  • 38. 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.
  • 39. 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.
  • 40. 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.
  • 41. 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
  • 42. 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.
  • 43. .....THANK U.....

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