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

1.
2.
3.
4.
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.
ANATOMY
Etiology
• Trauma
– 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
– 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)
 > 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