DNS ITS MANAGEMENT AND COMPLICATIONS

ANATOMY The nose is a pyramidal-shaped organ located in the midface, with its apex projecting anteriorly and its base attached to the facial skeleton. The upper third of the nose is supported by the paired nasal bones and the frontal process of the maxilla; the lower two thirds is maintained by cartilaginous structures.

ANATOMY

ANATOMY The nasal septum is composed of 2 major structural components: Anterior quadrangular cartilage Posterior bony portion, predominately consisting of the vomer and perpendicular plate of the ethmoid bone.

SEPTAL CARTILAGE

ANATOMY The arterial supply is a rich anastomosis of 4 major blood supplies The anterior and posterior ethmoid arteries supply the septum superiorly. Branches of the facial artery supply the septum anteriorly. The sphenopalatine artery supplies the septum posteriorly The greater palatine artery supplies the septum inferiorly. Internal carotid ----opthalmic artery-----anterior and posterior ethmoidal artery External carotid -----facial and maxillary artery Facial aretry ------superior labial artery -----septal branch supplying the anterioinferior part of the septum Maxillary artery -----branches of sphenopalatine artery and greater palatine artery

ANATOMY

Etiology Trauma Developmental Error Racial Factors Lateral blow Frontal blow Birth trauma Developmental Error Frontonasal process with developing palate Primary and secondary dentition Unequal growth b/w palate and skull base High arched palate (adenoids) Racial Factors caucasions>negroes Hereditary Factors

TYPES Anterior / Caudal Dislocation C- Shaped deformity S- Shaped deformity Spur

Caudal Dislocation

C – Shaped Deviation

S- Shaped Deviation

SPUR

Clinical Features Nasal obstruction Headache Sinusitis Epistaxis Unilateral or bilateral Ascertain site of obstruction Cottle test Headache Sinusitis Epistaxis Removal of crusts Vessles over a spur Anosmia Total or partial External deformity Middle ear infection

COTTLE Test

MANAGEMENT Submucus Resection (SMR) Septoplasty > 16 years of age Radical procedure Septoplasty < 16 years of age Conservative procedure

SUBMUCUS RESECTION (SMR) In adults Under General or Local Anaesthesia Single incision on one side Mucoperichondrial & mucoperiosteum flaps raised from BOTH sides Deflected bony & cartilaginous septum is removed Flaps repositioned and nose loosely packed

SMR

SEPTOPLASTY Flap raised on ONE side only Blood supply retained on the other side Only the most deviated part of the septum is removed Rest of the septum is repositioned by releasing the interlock stress. Flap repositioned & nose packed

COMPLICATIONS OF SMR Septal Haematoma Septal Perforation Saddle Nose Columellar Retraction Flapping Septum Bleeding Infection

SEPTAL HEMATOMA