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.

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

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

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)

12. LITTLE’S AREA (KIESSEL BACH’S
PLEXUS)
 Anterior ethmoidal
 Septal branch of supeior labial
Septal branch of sphenopalotine
Septal branch of greater palatine

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

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

23. POSITION
• Reclining position with head-end of the
table raised

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

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