Deviation of nasal septum from normal/center of the nasal cavity.
- M/C cause of nasal obstruction
Etiology
- Trauma: Birth related injuries, or injuries after birht
- Developmental defects: Assocition with cleft lip/palate
- Racial prelediction: More common in caucasians
- Hereditary factors
Classification
- Anterior dislocation
- C-shaped dislocation: Compensatory septal hypetrophy on opposite side
- S-shaped deformity: Bilateral nasal obstruction
- Spurs: May give headaches
Presentation
Septal deviation can cause symptoms such as nasal obstruction, mouth breathing with variable symptoms such as headache and olfactory disorders.
Primary manifestations
Mnemonic: NASEEM has DNS
- Nasal obstruction: Unilateral (C-shaped) or bilateral (S-shaped)
- Anosmia: Specially in bilateral obstruction
- Sinusitis: Due to obstruction and poor ventilation of nose
- Epistaxis: From vessels over spur or crusting of nasal mucosa
- External deformity
- Middle-ear infection
- Headache: Due to sinusitis or due to spur pressing on lateral wall of nose
Secondary features:
- Compensatory hypertrophy of turbinates on roomier side
- Secondary atrophic rhinitis on roomier side
Diagnosis
Cottle test
Nasal airway improves (Positive) or does not improve (negative) on test side
Management
Mild DNS requires no treatment.
Surgical management:
Indicated severe DNS with complications
- Septoplasty (preferred): Freer’s hemi-transfixation incision
- Submucous resection (SMR): Done via Killian’s incision
