Categories
Otolaryngeal system (ENT)

Deviated nasal septum (DNS)

Deviation of nasal septum from normal/center of the nasal cavity.

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

DNS 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
Distribution of patients according to symptoms
Distribution of patients according to symptoms | Sam, A., Deshmukh, P. T., Patil, C., Jain, S., & Patil, R. (2012). Nasal septal deviation and external nasal deformity: a correlative study of 100 cases. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 64(4), 312–318. https://doi.org/10.1007/s12070-011-0311-x

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
Persistent curved deformity after septoplasty and more chondrotomy to relieve deforming forces of the bony septum
Persistent curved deformity after septoplasty and more chondrotomy to relieve deforming forces of the bony septum. (A) Persistent curvature of the septal cartilage is observed after full exposure of the septum after separation from the upper lateral cartilages. (B) Further chondrotomy was done for correction. Partial hatching incision attempted at previous surgery is also observed at the inferior portion of the caudal septum. | Jin, H. R., Kim, D. W., & Jung, H. J. (2018). Common Sites, Etiology, and Solutions of Persistent Septal Deviation in Revision Septoplasty. Clinical and experimental otorhinolaryngology, 11(4), 288–292. https://doi.org/10.21053/ceo.2017.01788

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