Septum
Septal deformities are very common. They may cause nasal obstruction on the deviated side. On the other side, compensatory inferior turbinate hypertrophy may cause obstruction. The most common cause of a septal perforation is previous septal surgery. Othe
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2.9 Septum
Septum
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Fig. 2.9.1 (a) Septal deviation to the left side. (b) Compensatory inferior turbinate hypertrophy on the opposite side
Fig. 2.9.2 Septal spur at the anterior septal area completely obstructing the airway
Fig. 2.9.3 Severe caudal dislocation of the septum to the right
E A R N O S E T H R O AT A N D N E C K
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Chapter 2 Nose
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b Fig. 2.9.5 Synechia between septum and inferior turbinate
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b Fig. 2.9.4 (a) Septal deviation to the right, which narrows nasal valve area. (b) Coronal CT shows narrowing of the nasal valve area Fig. 2.9.6 Septal perforation. There are many causes of septal perforation. The most common cause is previous septal surgery. Other causes include chronic trauma such as nose-picking, use of cocaine, septal hematomas, and infections like tuberculosis. The majority of perforations are located in the anterior cartilaginous portion of the septum. However, syphilitic infection involves the posterior bony septum. In small perforations a whistling sound may be heard during inspiration. Crusting may cause obstruction. As the crusts break off, bleeding occurs. Steam inhalations, nasal douching, and softening ointments may decrease the crusting. (a) Septal perforation after submucous resection. (b) Septal button to close the perforation temporarily. Small and medium-sized perforations can be closed by surgery. For bigger perforations, a silastic nasal septal button can be used for occlusion
2.9 Septum
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Fig. 2.9.7 (a, b) Saddle nose deformity. This was due to dorsal collapse of the nose as a result of cartilage destruction in a patient with tuberculosis
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Fig. 2.9.8 External rhinoplasty. (a) A transverse incision across the columella, (b) elevation of the nasal skin superiorly. (c) Suturing lower lateral cartilages
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Chapter 2 Nose Fig. 2.9.9 (a) Cartilage and bony hump removal. (b) To rotate the nasal tip superiorly, the septal cartilage, lower and upper lateral cartilages may be shortened. (c) Medial and lateral osteotomies to narrow the nose
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Fig. 2.9.10 Infected cartilage graft at the nasal dorsum after rhinoplasty
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