2 ANATOMYThe nose is a pyramidal-shaped organ located in the midface, with its apex projecting anteriorly and its base attached to the facial skeleton.The upper third of the nose is supported by the paired nasal bones and the frontal process of the maxilla; the lower two thirds is maintained by cartilaginous structures.
5 ANATOMY The nasal septum is composed of 2 major structural components: Anterior quadrangular cartilagePosterior bony portion, predominately consisting of the vomer and perpendicular plate of the ethmoid bone.
7 ANATOMYThe arterial supply is a rich anastomosis of 4 major blood suppliesThe anterior and posterior ethmoid arteries supply the septum superiorly.Branches of the facial artery supply the septum anteriorly.The sphenopalatine artery supplies the septum posteriorlyThe greater palatine artery supplies the septum inferiorly.Internal carotid ----opthalmic artery-----anterior and posterior ethmoidal arteryExternal carotid -----facial and maxillary arteryFacial aretry superior labial artery -----septal branch supplying the anterioinferior part of the septumMaxillary artery -----branches of sphenopalatine artery and greater palatine artery
16 Clinical Features Nasal obstruction Headache Sinusitis Epistaxis Unilateral or bilateralAscertain site of obstructionCottle testHeadacheSinusitisEpistaxisRemoval of crustsVessles over a spurAnosmiaTotal or partialExternal deformityMiddle ear infection
21 MANAGEMENT Submucus Resection (SMR) Septoplasty > 16 years of age Radical procedureSeptoplasty< 16 years of ageConservative procedure
22 SUBMUCUS RESECTION (SMR) In adultsUnder General or Local AnaesthesiaSingle incision on one sideMucoperichondrial & mucoperiosteum flaps raised from BOTH sidesDeflected bony & cartilaginous septum is removedFlaps repositioned and nose loosely packed
24 SEPTOPLASTY Flap raised on ONE side only Blood supply retained on the other sideOnly the most deviated part of the septum is removedRest of the septum is repositioned by releasing the interlock stress.Flap repositioned & nose packed