NOSE - Deviated Nasal Septum

Introduction

It is the deviation of the nasal bone dividing the nose into two nostrils to one side. Hence the patient may have recurrent blockage of one nostril. Septal deviations, though common, require to be treated only if they produce symptoms affecting nasal function.

What are the causes of deviated nasal septum?

  • Birth Moulding theory: Abnormal intrauterine posture and second stage of labour lasting more than 15 minutes in primipara.However these are postulated theories.
  • Trauma: Commonest cause of deviation.
  • Secondary to a tumour, mass or polyps in the nose to compression.
  • Developmental Buckling: If the septum starts growing rapidly it gets buckled to one side to accommodate itself.

What are the types of Septal deviation?

  • The deviation can be C shaped, S shaped high or low deviation.
  • Dislocation: The anterior end or the lower border of septum gets displaced to one side.
  • Septal spurs: They are seen at the. cartilago-bony junction of the septum.
  • Thickened septum post trauma

What are the symptoms of deviated nasal septum?

Common symptoms of deviated nasal septum are:

  • Nasal blockage
  • Headache due to
    • Sinusitis with vacuum headache
    • Neuralgia
  • Epistaxis
  • Anosmia

What are the common signs seen on examination of deviated nasal septum?

Common signs of deviated nasal septum:

  • External deformity of nose
  • Anterior rhinoscopy reveals deviation of the nasal septum.
  • Cottles test: Pulling the cheek outward and upward causes opening of internal nares and relieves blockage.

What are the investigations required for confirming the diagnosis of deviated nasal septum?

Investigations for deviated nasal septum include:

  • X-ray paranasal sinuses, Waters view and Caldwells view gives an idea of posterior deviation if any and status of the sinuses.
  • CT Scan paranasal sinuses (PNS) with the Axial and coronal sections.
    • Shows the severity of sinusitis
    • Any complications involving the orbit or optic nerve
    • Diagnose sphenoidal sinusitis

What is the treatment for deviated nasal septum?

Depending on the severity of the symptoms and age, the patient is advised any of the following for deviated nasal septum:

  • SMR (Sub Mucous Resection) surgery
  • Septoplasty Surgery.This is the more commonly done surgery

The above surgery is often combined with Functional Endoscopic Sinus Surgery if there is moderate to severe disease in the sinuses.



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