2. Aetiology
1. Trauma: blow on nose
2. Developmental:
Birth moulding
High arched palate
Unequal growth b/w skull base & palate
3. Mass in opposite nasal cavity
4. Racial factors: common in Europeans
5. Hereditary: in posterior D.N.S.
12. Clinical features
1. Nasal block: present on side of D.N.S.
C/L paradoxical nasal obstruction due to
compensatory inferior turbinate hypertrophy.
2. Recurrent cold: due to associated sinusitis
3. Headache: due to contact with lateral wall
(Sluder’s neuralgia), sinusitis
13. Clinical features
4. Epistaxis: stretched mucosa on DNS dry
crusting & bleeding on removal; stretched
blood vessels over spur.
5. Hyposmia:
seen in high D.N.S.
6. External nasal deformity
16. • Edwin Smith Surgical Papyrus (dated 17th
century BC): world's oldest surgical
document & only surviving copy of a part of
an Ancient Egyptian textbook on trauma
surgery written in 3500 B.C. Listed are 48
traumatic injury cases, with description of
examination, diagnosis & treatment.
• Treatment of DNS: fracture reduction of DNS
with internal pack using grease coated linen
& external packing with stiff rolls of linen.
18. • Bosworth operation (late 19th century): deviated
part of septum amputated along with mucosa
• Asch (1899): full thickness cruciate incisions on
septal cartilage
• Freer (1902): SMR of total septal cartilage
• Killian (1904): SMR with preservation of dorsal &
caudal portion of septal cartilage
• Metzenbaum (1929): Swinging door technique for
caudal septal dislocation
• Peer (1937): Removal of caudal septum &
replacement after its alteration
• Cottle (1948) : Maxilla-Premaxilla septoplasty
24. Cottle’s line
Drawn from frontal
spine to anterior nasal
spine. Deviations
anterior to it can be
treated by septoplasty
only. Posterior to it by
SMR or septoplasty.
43. S.M.R.
Septoplasty
Radical surgery
Conservative
Not done below 17 yr
Done after 4 yr
Killian’s incision
Freer’s incision
Cannot correct anterior DNS
Can correct
B/L mucoperichondrium elevated
One side only
Radical removal of cartilage
Only inferior strip
Rhinoplasty incision can’t combine Can
Revision surgery difficult
Relatively easy
Cartilage graft can be harvested
No
Complications common
Rare
45. Septal haematoma
Collection of blood under perichondrium
& periosteum of nasal septum.
Aetiology:
1. Nasal trauma
2. Septal surgery
3. Bleeding disorders
46. Clinical features
• Bilateral nasal obstruction
• Sense of pressure over nasal bridge
• B/L smooth, rounded septal swelling
• On palpation mass is soft & fluctuant
• Absence of raised
temperature, erythema, swelling & tenderness
of skin over nose.
50. Septal abscess
Collection of pus under perichondrium
& periosteum of nasal septum.
Aetiology:
1. secondary infection of septal hematoma
2. following furuncle of nose or upper lip
3. following typhoid or measles
51. Clinical Features
• Bilateral nasal obstruction with fever
• Skin over nose shows raised
temperature, erythema, swelling & tenderness
• B/L smooth, soft, fluctuant septal swelling
• Septal mucosa congested
• Submandibular node enlarged & tender
54. Treatment
• Abscess drained immediately
• Incision made on most dependent part
• Pus & necrosed cartilage removed
• Nasal packing done
• Systemic antibiotics for 10 days
60. Clinical features
Small perforation: whistling sound
during respiration
Large perforation: nasal crusting
nasal obstruction
epistaxis on crust removal
62. Treatment
• Treat cause of septal perforation
• Alkaline nasal douche for crusting
• Small perforation: closed by mucosal
advancement flaps
• Large perforation: Silastic
obturator, Alloderm. Results of surgery are
