بسم الله الحمن الرحيم (قل ان صلاتي و نسكي و محياي ومماتي لله رب العالمين لا شريك له وبدلك امرت وأنا اول المسلمين) طه 25-28
Introduction
Surgical anatomy Nasal septum divided the nasal cavity into Lt and Rt cavities. Each nasal cavity communicate with the exterior through Nares, and posterior through Choana.
Each nasal cavity consists of a skin lined anterior portion( Vestibule) and mucosa lined posterior portion ( Nasal cavity proper).
Lateral wall Formed mainly from inferior, middle and superior turbinate. Each of them contains the meatus
Hypertrophy of inferior turbinate can lead to nasal obstruction (ITH). Presence of air inside the middle turbinate also can cause nasal obstruction ( concha bullosa)
Nasal septum Nasal septum formed of 3 parts: 1- collumellar septum: Consists of Lt & Rt medial crura of LLC, united together by fibrous band and covered with skin.
Nasal septum 2- septum proper: Consists of osteocartilagenous framework, covered with nasal mucosa. It consists of: 1)Perpendicular plate of ethmoid 2)Vomer 3)Septal cartilage (quadrilateral)
Nasal septum 3- membranous septum: double layer of skin, presented between collumella and caudal border of septal cartilage
The septal cart. lies inferiorly on groove of maxillary crest, and posteriorly on groove of vomer. Septal cartilage also related to ULC of the nose and fused with them in the upper third, and for this reason septal deviation may lead to nasal deformity.
Causes of DNS Trauma Developmental Racial factors Hereditary factors
Types of DNS The deviation may involve only cartilage or bone or both. 1- anterior deviation: nasal cartilage may be dislocated into one of the nasal chambers
Types of DNS 2- C- shaped deformit: septum deviated in a simple curve to one side, result on one side more wide than the other, which result on compensatory hypertrophy of inferior turbinate of the wide side.
Types of DNS 3- S- shaped deformit: the septum show S- shaped curve which either in vertical or anteroposterior plans. Such deformity may cause bilateral nasal obstruction
Types of DNS 4- Spurs: is a shelf-like projection often found at the junction of bone and cartilage. -Spur may press on the lateral wall and give rise to headache (contact headache). - It may also predispose to repeated epistaxis from the vessels stretched on its convex surface.
Types of DNS 5- thickening: it may be due to organized hematoma or over-riding of dislocated septal cartilage fragments.
Clinical feature 1- nasal obstruction: It may be unilateral or bilateral Respiratory currents pass through upper part of nasal cavity, there fore high septal deviation cause nasal obstruction more than lower one.
Clinical feature When examining a case of nasal obstruction one should ascertain the site of obstruction in the nose. It could be: -vestibule: caudal septal dislocation, synechia, or stenosis. -Nasal valve: synechia, usually post RP
Clinical feature -Attic : Along the upper part of nasal septum due to high septal deviation. -Turbinat: Hypertrophic turbinate or concha bullosa. - choanal atresia
Cottle test: Check is down laterally while the patient breathes quietly. If the nasal airway improves on the tested side.. The test positive and indicate abnormality In the valve.
Clinical feature 2- headache: Deviated septum, especially spur may press on the lateral wall of the nose giving rise to pressure headache.
Clinical feature 3- sinusitis : Deviated septum may obstruct the ostia resulting in poor ventilation of the sinus.
Clinical feature 4- epistaxis: Due to : -Caudal dislocation -Spur.
Clinical feature 5-Anosmia: Failure of inspired air to reach the olfactory area. 6- External deformity: