ENT Specialist DEVIATED NASAL SEPTUM

DEVIATED NASAL SEPTUM

Introduction: It is the deviation of the nasal septum to one side of nasal cavity. 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 functions and blocking the osteomeatal complex. Aetiology:
  1. Birth moulding theory: Abnormal intrauterine posture and second stage of labour lasting more than 15 minutes in primipara.
  2. Trauma: Commonest cause of deviation.
  3. Secondary to a tumor, mass or polyps in the nose to compression.
  4. Developmental Buckling: If the septum starts growing rapidly it gets buckled to one side to accommodate itself.
  5. Racial factors: Caucasians are affected more than black Americans.
  6. Hereditary factors: Several members of the same family may have deviated nasal septum.
Pathology and deformities:

Deviation may involve only the cartilage, bone or both the cartilage and bone.

  1. Anterior dislocation: Septal cartilage may be dislocated into one of the nasal chambers. This is better visualized by looking at the base of nose when patient’s head is tilted backwards.
  2. C-shaped deformity: Here septum is deviated in a curve to one side. Nasal chamber on concave side of the nasal septum is wider and show compensatory hypertrophy of turbinates.
  3. S-shaped deformity: Either in vertical or anteroposterior plane. It causes bilateral nasal obstruction.
  4. Spurs: A spur is a shelf-like projection found at the junction of bone and cartilage. It may press on the lateral wall and gives rise to headache. It may also lead to repeated epistaxis from the vessels stretched on its convex surface.
  5. Thickening: Due to septal hematoma or overriding of dislocated septal fragments.
ENT Specialist Screenshot 2020 11 26 Ganpati nose

Symptoms:

  1. Nasal blockage.
  2. Headache due to

    a) Sinusitis with vacuum headache.
    b) Neuralgia.
  3. Epistaxis.
  4. Anosmia.
  5. External deformity of nose.
  6. Middle ear infection.
ENT Specialist Screenshot 2020 11 26 Ganpati nose docx2 1
Signs:
  1. External deformity of nose.
  2. Anterior rhinoscopy reveals deviation of the nasal septum.
  3. Cottles test: Pulling the cheek outward and upward causes opening of internal nares and relieves blockage.
Investigations:
  1. X-ray Paranasal sinuses (Waters view and Caldwell’s view).
      ➣ gives an idea of posterior deviation if any and status of the sinuses.
  2. CT Scan Paranasal sinuses (PNS) with the Axial and Coronal sections.
    ➣ Shows the deviation of nasal septum.
    ➣ Severity of sinusitis.
    ➣ Any disease involving the orbit or optic nerve, paranasal sinuses.
    ➣ Diagnose sphenoidal sinusitis.
Treatment: Depending on the severity of the symptoms and age, the patient is advised any of the following for deviated nasal septum:
  1. SMR (Sub Mucous Resection) surgery.
  2. Septoplasty Surgery: This is the more commonly done surgery. This is often combined with Functional Endoscopic Sinus Surgery (F.E.S.S.) if there is moderate to severe disease in the sinuses. The aim is to open the drainage pathways of the blocked osteomeatal complex.

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