Deviated Nasal Septum

Eczema Free Forever

Eczema Free Forever Ebook by Rachel Anderson

Get Instant Access

A congenital or traumatic dislocation of the septal cartilage into one nasal fossa causes unilateral nasal obstruction. If the obstruction is marked, or complicated by recurrent sinusitis, a septal correction is effective surgery.

The time-honored operation for this is a submucous resection (SMR), but a septoplasty in which cartilage is preserved and repositioned—rather than removed—is now used. The SMR operation involves removal of much of the septal cartilage and loss of nasal support with saddling, and septal perforations are occasional complications.

Nose Caudal Dislocation

Fig. 3.35 Deviated nasal septum into the columella. With caudal dislocation of the septum, an obvious deformity is coupled with nasal obstruction (a). Repositioning or excision of the septal dislocation is necessary to improve the appearance and airway (b).

Fig. 3.35 Deviated nasal septum into the columella. With caudal dislocation of the septum, an obvious deformity is coupled with nasal obstruction (a). Repositioning or excision of the septal dislocation is necessary to improve the appearance and airway (b).

Nasal Bone Spur
Fig. 3.36 Deviated nasal septum. Deviated nasal septum with a spur of septal cartilage and maxillary bone occluding the inferior meatus and causing nasal obstruction (see over).

Fig. 3.37 Septoplasty technique.

Fig. 3.37 Septoplasty technique.

Deviated Nasal Septum Xrays And Photos

Fig. 3.38 A posterior spur (arrow) on a deviated nasal septum seen with the endoscope. Most septal deviations can be seen with a speculum but are seen with greater clarity with the endoscope, and the application of a nasal vasoconstrictor to the

Fig. 3.39 The septoplasty operation.

An incision through the nasal mucosa and cartilage with elevation of the mucoperichondrium (arrow) gives access to the septal cartilage, which is partially resected and repositioned.

Child Speculum
Fig. 3.40 Deviated nasal septum in a child. The diagnosis is obvious without the use of a nasal speculum. Elevation of the infantile nasal tip suffices to give a clear view of the anterior nares.

Perforations of the Nasal Septum m k

Perforation Nasal Septum

Fig. 3.42 Prominent blood vessels appearing on the margin of the perforation, leading to epistaxis. A whistling noise on breathing is another symptom.

Fig. 3.41 A perforation of the nasal septum. This may not give rise to any symptoms, and be a chance finding on examination. Crusting usually occurs, however, causing nasal obstruction and discomfort, with episodes of scanty epistaxis.

Fig. 3.42 Prominent blood vessels appearing on the margin of the perforation, leading to epistaxis. A whistling noise on breathing is another symptom.

Perforations may result from repeated trauma to the septum (e.g., nose picking). Chrome workers are susceptible to a septal perichondritis causing a perforation. An inadvertent tear of the nasal mucous membrane on both sides during septal surgery is another cause of perforation.

Destruction of the vomer and ethmoid bone accounts for a posterior septal perforation, and may be due to a gumma. Surgical repair of septal perforations, particularly large ones, is not easy. Composite cartilage grafts taken from the concha of the ear combined with mucosal rotation flaps of the nasal mucous membrane form the basis of most techniques. Plastic flanged prostheses may be fitted to seal the perforation, but may extrude, or be incomfortable.

Fig. 3.43 Vestibulitis. When nasal discharge and skin involvement affect both nostrils, a vestibulitis (an eczema of the vestibular skin) is the probable diagnosis. This condition responds rapidly to an antibiotic ointment. The nasal swab usually grows a staphylococcus.

Fig. 3.43 Vestibulitis. When nasal discharge and skin involvement affect both nostrils, a vestibulitis (an eczema of the vestibular skin) is the probable diagnosis. This condition responds rapidly to an antibiotic ointment. The nasal swab usually grows a staphylococcus.

Fig. 3.44 Unilateral nasal vestibulitis and discharge (purulent and fetid in a) is almost always diagnostic of a foreign body in a child's nose, as is unilateral nasal vestibulitis alone (b).

Pictures Nasal Vestibulitis

Fig. 3.45 Removal of a foreign body.

Removal frequently can be managed as an outpatient, when it is necessary to hold the child securely while a probe or hook is placed posterior to the foreign body. Forceps frequently push the foreign body posteriorly, and thus should be avoided. A general anesthetic is necessary if the foreign body is impacted or inaccessible.

Fig. 3.45 Removal of a foreign body.

Removal frequently can be managed as an outpatient, when it is necessary to hold the child securely while a probe or hook is placed posterior to the foreign body. Forceps frequently push the foreign body posteriorly, and thus should be avoided. A general anesthetic is necessary if the foreign body is impacted or inaccessible.

Fig. 3.46 Rhinolith. A foreign body that is ignored accumulates a calcareous deposit and presents years later as a fetid, stony, hard mass—a rhinolith. This is well demonstrated on x-ray, and a rhinolith may become large, eroding the lateral wall and floor of the nose.

Although at first sight appearing easy to remove, the impaction may be extremely firm, particularly with the larger rhinoliths.

Was this article helpful?

0 0
Curing Eczema Naturally

Curing Eczema Naturally

Do You Suffer From the Itching, Redness and Scaling of Chronic Eczema? If so you are not ALONE! It strikes men and women young and old! It is not just

Get My Free Ebook


Responses

Post a comment