DEVIATED NASAL SEPTUM
DNS is a physical disorder of the nose, involving a
displacement of nasal septum.
Deviation of septum occurs very frequently but it
requires treatment only if it produce symptoms.
AETIOLOGY:
1. Age: Usually it starts around puberty and reaches full
development by the age of 20yrs.
2. Sex: Both sexes are affected.
3. Heredity: Many cases may be hereditary.
4. Developmental: The septum should grow at the same rate
as that of the face. If the septum starts growing at a rapid
rate, it becomes buckled to accommodate itself. This is
commonest cause.
5. Congenital: Abnormal intrauterine posture may result in
compression forces acting on the nose and upper jaw.
6. Trauma may lead to deviated nasal septum.
7. Secondary: The septum may become deviated secondary to
a tumour, mass or polyp in the nose.
PATHOLOGY: The septal deformation is of follwing types:
1. Deviations are smooth deflections which are upper or
lower, anterior or posterior.
2. Spurs are isolated thickening on the bony septum, often at
the junction of the bone and the cartilage. These are short
or long.
3. Thickening may result from trauma due to overriding of
the cartilaginous fragments, which are grow later in double
layer.
4. Dislocation – The anterior edges of the septal cartilage
may be displaced to one side causing the widening of the
columella of the nose or there may be displacement of the
lower edge of the cartilage from maxillary crest and vomer
due to trauma.
TYPES OF DEVIATION:
1. C – shaped deviation
2. S – shaped deviation
3. Displacement of the lower edge of the septal cartilages from
the maxillary crest with the spur formation.
SYMPTOMS:
1. Asymptomatic: There may be no symptoms.
2. Blockage of the nose is the common symptoms, and
blocking may be present on both sides.
3. Headache may be due to different causes:
a) Sinusitis: Headache may be due to sinusitis secondary to
obstruction to the drainage of the sinuses.
b) Vaccum headache: More often there may not be
sinusitis, but the headache may be caused by the vaccum
created in the paranasal sinus due to obstruction to the
drainage of the sinus.
c) Neurological headache may be produced when the
septum touches a sensitive part on the lateral wall of the
nose.
4. Reccurent cold: As a result of obstruction, there is
stagnation of nasal secretions, which may get infected and give
rise to recurrent rhinitis.
5. Epistaxis: Little’s area on the deviated side of the septum is
exposed to the atmosphere directly, predisposing to drying and
crusting of the mucosa and tendency to pick the nose.
6. Anosmia
7. Deformity of external nose may accompany the deviation of
the nasal septum.
SIGN:
1. External nose may be deformed.
2. Anterior Rhinoscopy reveals the deviation of the nasal
septum. Secondary hypertrophy of the turbinates may be
present.
3. Posterior Rhinoscopy reveals no abnormality.
COMPLICATIONS:
1. Recurrent sinusitis
2. Middle ear infection
3. Mouth breathing
4. Asthma
5. Atrophic rhnitis
DIFFERENTIAL DIAGNOSIS:
1. Hypertrophic turbinates
2. Polyps
3. Septal haematoma
TREATMENT:
Treatment is required only if the patient has persistent
or recurrent symptoms due to the deviated septum.
Permanent relief is obtained by the Submucosal Resection
of the nasal septum ( SMR) or Septoplasty.
