《耳鼻喉科学 Otolaryngology》课程教学课件（PPT讲稿）nose_4 nasal septum disease

Nasal septum and its diseasesAnatomy1.Columellar septum: It is formed of columellacontaining the medial crura of alar cartilages unitedtogether by fibrous tissue and covered on either side byskin.2.Membranous septum: It consists of double layer ofskin with no bony or cartilaginous support .3.Septum proper: It consists of osteocartilaginousframework,covered with nasal mucous membrane

Anatomy 1.Columellar septum: It is formed of columella containing the medial crura of alar cartilages united together by fibrous tissue and covered on either side by skin. 2.Membranous septum: It consists of double layer of skin with no bony or cartilaginous support . 3.Septum proper: It consists of osteocartilaginous framework,covered with nasal mucous membrane. Nasal septum and its diseases

Nasal septum properMedial Nasal Wall[Septum]Bones and CartilagesSquama ofrontalCristagallofCribriformplateofethmoidboneethmoidboneFrontal sinus Cartilage of nasalPerpendicularplateofpalatineCrestofsphenoidboneSpineoffrontalboneBodyof sphenoidboneseptumSphenoidalsinusNasalboneMedial plate of pterygoid proces:(part of sphenoid bone)Vomer.Perpendicular plateLateralplateofpterygoicNasopaiatinegrooveorocesscpartofsphenoid bone)of ethmoid boneSeptal cartilageGreateralarBasilarpartorcartilage (medialoccipitalbone Vomer bonePharyngeal tuberclePerpendicularplate of ethmoidAnteriornasal-Nasal crestofpalatinebonespineofmaxillaPosteriornasalspineofpalatineNasal crestofmaxdllaLesserpalatineIncisivecanaf ofmaxillaGreater palatineforamenHorizontalplateofpalatinebonePalatine process ofmalla boneDCE-EIS

Nasal septum proper ◼ Cartilage of nasal septum ◼ Perpendicular plate of ethmoid bone ◼ Vomer bone

Deviation of nasal septum(DNS) This is an important cause of nasal obstructionAetiology:Trauma and errors of developmentfrom the two important factors in the causation ofdeviated septum.1.Trauma2.Developmentalerror3.Racial factors4.Hereditary factors

Deviation of nasal septum(DNS) ❑ This is an important cause of nasal obstruction Aetiology:Trauma and errors of development from the two important factors in the causation of deviated septum. 1.Trauma 2.Developmental error 3.Racial factors 4.Hereditary factors

Types of DNS1.Anterior dislocation: Septal cartilage may bedislocated into one of the nasal chambers2.C-shaped deformity: Septum is deviated in asimple curve to one side.3.S-shaped deformity: Septum may show a S-shaped curve either in vertical or anteroposteriorplane

Types of DNS 1.Anterior dislocation: Septal cartilage may be dislocated into one of the nasal chambers. 2.C-shaped deformity: Septum is deviated in a simple curve to one side. 3.S-shaped deformity: Septum may show a S￾shaped curve either in vertical or anteroposterior plane

Types of DNS4.Spurs: A spur is a shelf-like projection often foundat the junction of bone and Cartilage.5.Thickening: It may be due to organisedhaematoma or over-riding of dislocated septalfragments

Types of DNS 4.Spurs: A spur is a shelf-like projection often found at the junction of bone and Cartilage. 5.Thickening: It may be due to organised haematoma or over-riding of dislocated septal fragments

Types of DNS北北业（3）"S形偏曲(2）"c"形偏曲正常(1)业（5）靖（6）粘膜肥厚（4）棘（矩状突）

Types of DNS

Clinical Features 1.Nasal obstruction 2.Headache 3.Sinusitis 4.Epistaxis. 5.Anosmia 6.External deformity 7. Middle ear infection

Clinical Features ❑ 1.Nasal obstruction. ❑ 2.Headache ❑ 3.Sinusitis ❑ 4.Epistaxis. ❑ 5.Anosmia ❑ 6.External deformity ❑ 7. Middle ear infection

Treatment Minor degrees of septal deviation with nosymptoms are commonly seen in patients andrequire no treatment.It is only when deviatedseptum produces mechanical nasal obstructionor the symptoms given above, that anoperation is indicated

❑ Minor degrees of septal deviation with no symptoms are commonly seen in patients and require no treatment.It is only when deviated septum produces mechanical nasal obstruction or the symptoms given above, that an operation is indicated. Treatment

TreatmentSeptal surgury is usually done after the age of 17so as not to interfere with the growth of nasalskeleton Submucous resection(SMR) operation:It is generally done in adults under localanaesthesia. Septoplasty:It is a conservative approach to septalsurgery. In this operation,much of the septalframework is retained, only the most deviatedparts are removed

❑ Septal surgury is usually done after the age of 17 so as not to interfere with the growth of nasal skeleton. ❑ Submucous resection(SMR) operation: It is generally done in adults under local anaesthesia. ❑ Septoplasty:It is a conservative approach to septal surgery. In this operation,much of the septal framework is retained, only the most deviated parts are removed. Treatment

Complications Septal Haematoma Septal abscess: Bridge of nose collapse: perforation of nasal septum

❑ Septal Haematoma ❑ Septal abscess: ❑ Bridge of nose collapse: ❑ perforation of nasal septum Complications