2Aetiology 1. Trauma: blow on nose 2. Developmental: Birth moulding High arched palate Unequal growth b/w skull base & palate3. Mass in opposite nasal cavity4. Racial factors: common in Europeans5. Hereditary: in posterior D.N.S.
12Clinical features Nasal block: present on side of D.N.S. C/L paradoxical nasal obstruction due tocompensatory inferior turbinate hypertrophy.2. Recurrent cold: due to associated sinusitis3. Headache: due to contact with lateral wall (Sluder’s neuralgia), sinusitis
13Clinical features4. 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
16Edwin 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.
18Bosworth operation (late 19th century): deviated part of septum amputated along with mucosa Asch (1899): full thickness cruciate incisions on septal cartilageFreer (1902): SMR of total septal cartilageKillian (1904): SMR with preservation of dorsal & caudal portion of septal cartilageMetzenbaum (1929): Swinging door technique for caudal septal dislocationPeer (1937): Removal of caudal septum & replacement after its alterationCottle (1948) : Maxilla-Premaxilla septoplasty
43S.M.R. Septoplasty Radical surgery Conservative Not done below 17 yr Done after 4 yrKillian’s incisionFreer’s incisionCannot correct anterior DNSCan correctB/L mucoperichondrium elevatedOne side onlyRadical removal of cartilageOnly inferior stripRhinoplasty incision can’t combineCanRevision surgery difficultRelatively easyCartilage graft can be harvestedNoComplications commonRare
44Complications of septal surgery 1. Haemorrhage Septal haematoma3. Septal abscess Septal perforation5. Saddle nose Columellar retraction7. Flapping septum Persistent deviation9. Nasal synechia C.S.F. rhinorrhoea11. Infection Toxic shock syndrome
45Septal haematoma Collection of blood under perichondrium & periosteum of nasal septum.Aetiology:1. Nasal trauma2. Septal surgery3. Bleeding disorders
46Clinical features Bilateral nasal obstruction Sense of pressure over nasal bridgeB/L smooth, rounded septal swellingOn palpation mass is soft & fluctuantAbsence of raised temperature, erythema, swelling & tenderness of skin over nose.
50Septal abscess Collection of pus under perichondrium & periosteum of nasal septum.Aetiology:1. secondary infection of septal hematoma2. following furuncle of nose or upper lip3. following typhoid or measles
51Clinical Features Bilateral nasal obstruction with fever Skin over nose shows raised temperature, erythema, swelling & tendernessB/L smooth, soft, fluctuant septal swellingSeptal mucosa congestedSubmandibular node enlarged & tender
62Treatment Treat cause of septal perforation Alkaline nasal douche for crustingSmall perforation: closed by mucosaladvancement flapsLarge perforation: Silastic obturator, Alloderm. Results of surgery are poor.