The nasal septum consists of cartilage, bone, and membranes that divide the nasal cavity into two air passages. Submucous resection and septoplasty are surgical procedures performed to correct a deviated septum and improve nasal breathing by removing or reshaping deformed cartilage and bone. Both procedures involve raising flaps of tissue to access and correct the septum while preserving as much of the supporting framework as possible.
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Anatomy Nasal Septum and Septoplasty - Pakistan
1.
2. NASAL SEPTAL
ANATOMY AND
SMR
Col Dr Anwar ul Haq ENT Consultant +923018513303
3. ANATOMY OF NASAL
SEPTUM
Columellar septum
It is formed of columella
Containing the medial crura of alar
cartilages united together by fibrous
tissue
Covered on either side by skin
4. MEMBRANOUS SEPTUM
It lies b/w columella and caudal
border of septal cartilage
No bony or cartilaginous support
Above two parts freely movable
from side to side
5. SEPTUM PROPER
Consist of osteocortilaginous frame work
Its main Constitutes are
Perpendicular plate of ethmoid
vomer bone
Large septal cartilage (quadrilateral) wedged
between the above two bones anteriorly
6.
7. SEPTUM PROPER
Minor contributions
Crest of nasal bone
Nasal spine of frontal bone
Rostum of spnenoid
Crest of palatine bone
Crest of maxilla and anterior nasal spine of
maxilla
8.
9. BLOOD SUPPLY OF NASAL SEPTUM
Internal carotid system
Anterior ethmoidal artery Branches of
Post ethmoidal artery opthalmic
artery
10. EXTERNAL CAROTID SYSTEM
Spheno palatine artery (maxillary)
Nasopalotine branches
Post nasal septal branches
Septal branch of great palatine artery
(maxillary)
Septal branch of superior labial artery
(Facial)
11.
12. LITTLE’S AREA (KIESSEL BACH’S
PLEXUS)
Anterior ethmoidal
Septal branch of supeior labial
Septal branch of sphenopalotine
Septal branch of greater palatine
13.
14. VENOUS DRAINAGE
Posteriorly through sephenopalatine veins
into pterygoid venous plexus
Anteriorly drain into facial veins
Superiorly in ethmoidal veins
15. NERVE SOPPLY OF NASAL SEPTUM
Olfactory nerves
Carry sense of smell
Supply olfactory region of nose
Can Carry sheath of dura, archnoid and pia
matter
16. NERVE SUPPLY
Nerves of common sensation
Anterior ethmoidal nerve
Branches of nasopalatine nerve
Branches of infra orbital nerve
17.
18. AUTONOMIC NERVES
Parasympathetic nerve fibers supply nasal
glands and control nasal secretions
Greater superfacial petrosal nerve.
Sympathetic nerve fibers
Upper two thoracic segments
Deep petrosal nerve
19. LYMPHATIC DRAINAGE
Submandibular lymph nodes
Rest of nasal cavity drain
into upper jugular nodes
directly or through
retropharyngeal nodes
20. SUBMUCOUS RESECTION OF
NASAL SEPTUM
• INDICATIONS
– DNS causing symptoms of nasal obstruction and
recurrent headache.
– DNS causing obstruction of paranasal sinuses and
middle ear.
– Recurrent epistaxis from septal spur
– As a part of septorhinoplasty
– As a preliminary step in
Hypophsectomy (Trans septal trans sphenoidal
approach)
Vidian neurectomy (Trans septal apprach)
21. CONTRA INDICATIONS
• Pt’s below 17 years age
• Acute respiratory infection
• Bleeding diathesis
• Untreated diabetes or hypertension
22. ANASTHESIA
• LA is preffered
• GA is used in children and apprehensive
adults
24. STEPS OF OPERATION
• Infiltration of nasal septum
• Incision
– A curvilinear incision with forward convexity is
made at 5mm behind the mucocutaneous
junction on the deviated side of septum
25. STPES OF OPERATION
• Elevation of mucopeichondrial and
periosteal flap.
• Incision of the cartilage
• Elevation of opposite mucopeichondrium
and periostium.
26. STEPS OF OPERATION
• Removal of cartilage & bone
– Preserve a strip of cartilage about 1cm along
the dorsal and caudal border of the septum to
prevent collapse of the nasal bridge.
• Stiching
– One or two catgut or silk stitches are applied
• Packing
– Ribbon gauze, smeared with furacin oinment
or liquid paraffin
27.
28.
29.
30.
31. POST OPERATIVE CARE
• Semi sitting position
• Soft diet
• Analgesics
• Antibiotic cover for 5-6 days.
• Nasal pack removed after 24 hours
• Decongestant and steam inhalation
• Avoid nasal trauma
32. COMPLICATIONS
• Bleeding
• Septal haematoma
• Septal abscess
• Perforation
• Depression of nasal bridge
• Retraction of columella
• Flapping of nasal septum
• Toxic shock syndrome
33. SEPTOPLASTY
• Septoplasty is a conservative approch to
septal surgery as much of the septal
framework as possible is retained
• Mucoperichondrial / periosteal flap is
generally raised only one side.
34. STEPS OF OPERATION
• Infiltrate the septum with 1% lignocaine
with adrenaline
• In case of deviated septum make a slightly
curveline incision 2-3 mm above the
caudal end of septal cartiflage on the
concave side in case of caudal dislocation
a transfixition or hemi transfixition incision
is made
35. • Raise mucoperichondrial / mucoperiosteal
flap on one side only
• Seprate septal cartilage from the vomer
and ethmoid plate and raise
mucoperiosteal flap on the apposite side
of septum.
36. • Remove maxillary crest to realign the septal
cartilage
• Correct the bony septum by removing the
deformed parts
• Deformed septal cartilage is corrected by
various methods such as
– Scoring on the concave side
– Cross hatching
– Shaving
– Wedge excision
– Trans septal sutures are put to coapt
mucoperichondrial flaps
– Nasal pack