NASAL SEPTUM abnormalities :

- SEPTAL DEVIATION
- SEPTAL HEMATOMA

- SEPTAL ABSCESS
- SEPTAL PERFORATION

SEPTAL DEVIATION
- Normal Septum midline divide Nasal Cavity

into 2 equal spaces

- Deviated Septum 2 inequal spaces

ETIOLOGY - Traumatic

- intra uterine
- perinatal
- accident/sport

- Mis GROWTH & DEVELOPMENT

of the nasal septum &
face

TYPES :
- Cartilagineus site bony site
- mild, moderate & severe deviation
Type :

1. C form

2. S (sigmoid form)
3. Spine & Spur forming
4. With synechiae to the middle

turbinate
- With or Without Signs & Symptoms

SIGNS & SYMPTOMS

- Mainly NASAL OBSTRUCTION Uni/Bilateral

- Headache Vacuum/Pressure
- Paranasal sinus ostia obstruction
-Nasal bleeding (epistaxis)
-Compensatory

inferior

nasal

hypertrophy
DIAGNOSIS

- Anterior Rhinoscopy

- Nasal Endoscopy

turbinate

MANAGEMENT :
- No signs & symptoms No Surgery !!
- With signs & symptoms
Necessary for SURGERY :

complications

- Sub-mucosal resection (S.M.R.)

- Septoplasty
- Functional Septal Correction Surgery
- Turbinectomy

COMPLICATIONS :

- Paranasal sinusitis
- Recurrent nasal bleeding

- Compensatory inferior nasal

turbinate hypertrophy

SEPTAL HEMATOMA & SEPTAL ABSCESS

- Usually BILATERAL !
- ETIOLOGY :
- Mostly traumatic or iatrogenic causes
- Blood dyscrasias (rare)
Hematoma/blood between Septal cartilage/bone and
the mucoperichondrium/ mucoperiostium may cause
Cartilaginous atrophy & necrosis and Blood provide a
good bacterial medium secondary infection
SEPTAL ABSCESS

SIGNS & SYMPTOMS :

- Total bilateral nasal obstruction (PANIC SITUATION)

- Nasal pain : > Septal abscess

- Headache
- Smelling loss
- Subfebrile

DIAGNOSIS : Aspiration Anterior Rhinoscopy & Palpation

MANAGEMENT/THERAPY : An URGENT Case !!

- One septal side incision for drainage & evacuation
of blood/pus
- Avoid bilateral incision or do it on different levels
- Drain
- Nasal packing (several days)
- Oral antibiotics sensitive to Staphylococcus Aureus
(TSS) and Sinusitis pathogens !

COMPLICATIONS :

- Saddle nose deformity

- Septal perforation
- Septal thickening/fibrosis
- Thrombosis sinus cavernosus
(Septal Abscess)

SEPTAL PERFORATION
ETIOLOGY : - MOST COMMON Iatrogenic & Trauma
- Septal abscess

- Specific infection Syphylis, Tuberculosis,

Leprosy & Rhinoscleroma
- Inflammatory etiologies :

- Wegeners granulomatosis
- Sarcoidosis
- Lupus
- Vascular collagenic diseases
- Neoplasms/Malignancies
- Rhinolith

SIGNS & SYMPTOMS

- Nasal irritation
- Whistling
- Epistaxis Crustae released
- Nasal foetor
- Large size perforation Hyponasality
DIAGNOSIS :

Anterior Rhinoscopy &

Nasal Endoscopy

MANAGEMENT :
- Small perforation no problem
NO SURGERY !!
- Nasal Irrigation
- Septal Buttons

- Closure with Sliding Mucosal Flaps

> 2 cm Difficult to closure !