deviated nasal septum - angelfire · • thickenned nasal septum • septal abscess • septal...
TRANSCRIPT
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Deviated Nasal Septum
Department of ENTKSHEMA
Mangalore
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Aetiology
• Trauma• Developmental error• Racial• Hereditary
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Types
• Anterior• C- shaped• S-shaped• Spurs• Thickenning
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Clinical Features
• Nasal obstruction• Headache• Sinusitis• Epistaxis• Anosmia• External deformity• Middle ear infections
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SEPTOPLASTY / SMR• DEF: Septoplasty is
the – Restructuring– Remodelling– Repositioning of
septal cartilageOnly excess cartilage inferiorly and at the chondro-osseous junction is removed
SubmucoperichondrialResection of the quadrangular cartilage except the caudal and doral strut.
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DIFFERENCESSEPTOPLASTY SMR
Incision Freer’s Killian’s(Hemi Transfixion)
Mucoperichondrial flap One side Both sides
Ideal for Anterior Deviation Posterior
Age Any age Adults
Cosmetic deformity Uncommon Common& complications
Can be combinedwith rhinoplasty
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INDICATIONS• Symptomatic Septal deviation
– Nasal obstruction– Headache– Sinusitis
• Spur causing epistaxis• Source of cartilage grafts• As an approach to sphenoid sinus ,
Pituitary ,Vidian nerve
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Surgical Procedure• Anaesthesia – Local / GA• Position – Supine Head up positionProcedure ( Septoplasty )Freer’s INCISION – at Mucocutaneous Junction
Elevation of Muco-perichondrial flap on one side ( anterior tunnel)
Mucoperiosteal flap on both sides ( Inferior tunnel)
Join the two – Remove excess cartilage along floor
Remove bony spur
Dislocation of chondro-vomerine junction
Elevation of Mucoperiosteum on both sides of bony septum ( posterior tunnel)
Removal of bony deviation
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Septal surgery
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Procedure - SMR• Killian’s incision 5 mm behind Muco-cutaneous junction
• Elevation of mucoperichondrial flap on same side
• Incision on septal cartilage
• Elevation of Mucoperichondrial flap on opposite side
• Exposure of quadrangular cartilage
• Removal of quadrangular cartilage preserving a caudal & dorsal strut ( approx. – 5 mm) – using ballenger’s swivel knife
• Exposure of Maxillary & palatine crests
• Gouging out with Killian’s bayonnet shaped gouge
• Removal of Bony deviation if present – vomer
• Suturing with chromic catgut & nasal packing
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Freer’s incisionFor Septoplasty
Killian’s incision for SMR
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COMPLICATIONS• Septal Haematoma• Septal Abscess• Septal perforation• Flapping septum• SynaechiaeCOSMETIC DEFORMITY • Columellar retraction• Supratip deformity• Saddle noseRARE COMPLICATIONS• CSF leak• Meningitis
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Septal Haematoma
• Def: Collection of blood Sub mucoperichondrially/ periosteally
• Aetiology: – Post trauma/ operative– spontaneously in bleeding diathesis
• C/F:– B/L Nasal obstruction– Frontal headache– Pressure over nasal bridge
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O/E:
Smooth round swelling on both sides of the septum
Dumbell shaped
Soft/ fluctuant mass
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Treatment of septal haematoma
• Antero-Posterior incision Parallel to nasal floor on the side.
• If B/L: an additional incision on the opposite side in the vertical plane so as not to correspond/ communicate with the other side
• Wide bore aspiration of small haematomas• Systemic antibiotics
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Complications
• Thickenned Nasal Septum• Septal Abscess• Septal Perforation
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INSTRUMENTS• Thudicums Nasal Speculum
– USES• Anterior rhinoscopy• Nasal packing• Incision during septal surgery• Antral lavage
• Holding the thudicums speculum
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Holding the thudicums speculum
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St. Claire Thomson’s Nasal speculum
• SMR• Septoplasty• Polypectomy• Nasal packing
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Killian’s self retaining nasal speculum
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Freer’s elevator
• Elevation of Mucoperichondrium / mucoperiosteal flaps
• Can be used in ear surgeries to elevate periosteum
• Uncinectomy
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Freer’s elevator
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• Excision of Quadrangular cartilage in SMR
Ballenger’s swivel knife
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Luc’s forceps ( Multipurpose forceps)
• Excision of Bony septum• Nasal Polypectomy• Biopsy• Caldwell Luc procedure• Holding tonsil
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Luc’s forceps
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Mallet & Killian’s bayonet shaped
Gouge• Excision of maxillary / Palatine crest
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Tilley’s nasal dressing forceps• Anterior nasal packing• Foreign body removal
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Septal surgeries
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