Aetiology 1. Trauma: blow on nose 2. Developmental: Birth moulding High arched palate Unequal growth b/w skull base & palate 3. Mass in opposite nasal cavity 4. Racial factors: common in Europeans 5. Hereditary: in posterior D.N.S.
Clinical features 1.Nasal block: present on side of D.N.S. C/L paradoxical nasal obstruction due to compensatory inferior turbinate hypertrophy. 2. Recurrent cold: due to associated sinusitis 3. Headache: due to contact with lateral wall (Sluder’s neuralgia), sinusitis
Clinical features 4. Epistaxis: stretched mucosa on DNS dry crusting & bleeding on removal; stretched blood vessels over spur. 5. Hyposmia: seen in high D.N.S. 6. External nasal deformity
Edwin Smith Surgical Papyrus (dated 17th century BC): world's oldest surgical document & only surviving copy of a part of an Ancient Egyptian textbook on trauma surgery written in 3500 B.C. Listed are 48 traumatic injury cases, with description of examination, diagnosis & treatment. Treatment of DNS: fracture reduction of DNS with internal pack using grease coated linen & external packing with stiff rolls of linen.
Bosworth operation (late 19th century): deviated part of septum amputated along with mucosa Asch (1899): full thickness cruciate incisions on septal cartilage Freer (1902): SMR of total septal cartilage Killian (1904): SMR with preservation of dorsal & caudal portion of septal cartilage Metzenbaum (1929): Swinging door technique for caudal septal dislocation Peer (1937): Removal of caudal septum & replacement after its alteration Cottle (1948) : Maxilla-Premaxilla septoplasty
Septal haematoma Collection of blood under perichondrium & periosteum of nasal septum. Aetiology: 1. Nasal trauma 2. Septal surgery 3. Bleeding disorders
Clinical features Bilateral nasal obstruction Sense of pressure over nasal bridge B/L smooth, rounded septal swelling On palpation mass is soft & fluctuant Absence of raised temperature, erythema, swelling & tenderness of skin over nose.
Treatment 1. Small: wide bore needle aspiration 2. Large: a. incision & drainage b. nasal packing (prevent recurrence) c. systemic antibiotics (prevent abscess)
Complications Thickened nasal septum Septal abscess with cartilage necrosis Saddle nose Supra-tip deformity Septal perforation
Septal abscess Collection of pus under perichondrium & periosteum of nasal septum. Aetiology: 1. secondary infection of septal hematoma 2. following furuncle of nose or upper lip 3. following typhoid or measles
Clinical Features Bilateral nasal obstruction with fever Skin over nose shows raised temperature, erythema, swelling & tenderness B/L smooth, soft, fluctuant septal swelling Septal mucosa congested Submandibular node enlarged & tender
Treatment Treat cause of septal perforation Alkaline nasal douche for crusting Small perforation: closed by mucosal advancement flaps Large perforation: Silastic obturator, Alloderm. Results of surgery are poor.