1. DNS ITS MANAGEMENT AND COMPLICATIONS

2. 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.

3. ANATOMY

5. 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.

6. SEPTAL CARTILAGE

7. 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

8. ANATOMY

9. 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

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

11. Caudal Dislocation

12. C – Shaped Deviation

13. S- Shaped Deviation

14. SPUR

16. 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

17. COTTLE Test

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

22. 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

23. SMR

24. 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

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

28. SEPTAL HEMATOMA