DNS%20ITS%20MANAGEMENT%20AND%20COMPLICATIONS

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DNS ITS MANAGEMENT AND COMPLICATIONS
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ANATOMY

• The nose is a pyramidal-shaped organ located in
  the midface, with its apex projecting anteriorly
  and its base attached to the facial skeleton.
• The upper third of the nose is supported by the
  paired nasal bones and the frontal process of the
  maxilla the lower two thirds is maintained by
  cartilaginous structures.

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ANATOMY
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ANATOMY

• The nasal septum is composed of 2 major
  structural components
• Anterior quadrangular cartilage
• Posterior bony portion, predominately consisting
  of the vomer and perpendicular plate of the
  ethmoid bone.

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SEPTAL CARTILAGE
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ANATOMY

• The arterial supply is a rich anastomosis of 4
  major blood supplies
• The anterior and posterior ethmoid arteries
  supply the septum superiorly.
• Branches of the facial artery supply the septum
  anteriorly.
• The sphenopalatine artery supplies the septum
  posteriorly
• The greater palatine artery supplies the septum
  inferiorly.

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ANATOMY
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Etiology

• Trauma
• Lateral blow
• Frontal blow
• Birth trauma
• Developmental Error
• Frontonasal process with developing palate
• Primary and secondary dentition
• Unequal growth b/w palate and skull base
• High arched palate (adenoids)
• Racial Factors
• caucasionsgtnegroes
• Hereditary Factors

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TYPES

• Anterior / Caudal Dislocation
• C- Shaped deformity
• S- Shaped deformity
• Spur

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Caudal Dislocation

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C Shaped Deviation

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S- Shaped Deviation

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SPUR

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Clinical Features

• Nasal obstruction
• Unilateral or bilateral
• Ascertain site of obstruction
• Cottle test
• Headache
• Sinusitis
• Epistaxis
• Removal of crusts
• Vessles over a spur
• Anosmia
• Total or partial
• External deformity
• Middle ear infection

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COTTLE Test
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MANAGEMENT

• Submucus Resection (SMR)
• gt 16 years of age
• Radical procedure
• Septoplasty
• lt 16 years of age
• Conservative procedure

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SUBMUCUS RESECTION (SMR)

• In adults
• Under General or Local Anaesthesia
• Single incision on one side
• Mucoperichondrial mucoperiosteum flaps raised
  from BOTH sides
• Deflected bony cartilaginous septum is removed
• Flaps repositioned and nose loosely packed

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SMR
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SEPTOPLASTY

• Flap raised on ONE side only
• Blood supply retained on the other side
• Only the most deviated part of the septum is
  removed
• Rest of the septum is repositioned by releasing
  the interlock stress.
• Flap repositioned nose packed

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COMPLICATIONS OF SMR

• Septal Haematoma
• Septal Perforation
• Saddle Nose
• Columellar Retraction
• Flapping Septum
• Bleeding
• Infection

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SEPTAL HEMATOMA
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