ENT (Otorhinolaryngology) · MU Sofia

26. Deviation of the nasal septum and deformities of the external nose. Hypertrophy of the turbinates. Septoplasty and rhinoseptoplasty.

Covers septal deviation and external nasal deformities, their causes from trauma, congenital and inflammatory conditions, and a classification into saddle, tension and crooked nose. It then walks through clinical features, endoscopic and CT assessment, and treatment, followed by turbinate hypertrophy with its mucosal and bony forms, medical and surgical options, septoplasty stages and complications, and rhinoseptoplasty. A differential diagnosis list is included.

Inside: 5 sections · 3 labelled pictures · 15 flashcards · 10 min

Topic 26 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 5 sections, about 1,417 words (10 min of reading), with 15 flashcards.

In this note

  1. Deviation of the nasal septum and deformities of the external nose. Hypertrophy of the turbinates. Septoplasty and rhinoseptoplasty.
  2. Deviated Nasal Septum (DNS) & External Nasal Deformities
  3. Hypertrophy of the Turbinates
  4. Septoplasty
  5. Rhinoseptoplasty

Deviated Nasal Septum (DNS) & External Nasal Deformities

1. Definition

  • Deviation of the Nasal Septum (DNS): A condition where the cartilaginous and/or bony wall dividing the nasal cavity into two halves is displaced from the midline, causing functional nasal obstruction.
  • External Nasal Deformities: Any structural abnormality of the external nose (bone, cartilage, or soft tissue) that affects function (breathing) or aesthetics.

2. Etiopathogenesis

Deviated Nasal Septum (DNS)

  1. 1. Trauma (Most Common): Blunt trauma to the nose is the leading cause. The septum buckles or fractures upon impact.
  2. 2. Developmental/Congenital: Uneven growth between the septum, the palate, and the skull base during development, leading to buckling or displacement of the septal cartilage and/or bone.
  3. 3. Birth Trauma: Pressure on the nose during passage through the birth canal can cause septal displacement.
  4. 4. Compensatory deviation due to turbinate hypertrophy

External Nasal Deformities

  1. 1. Trauma: Fractures of the nasal bones and septum (most common).
  2. 2. Congenital: Cleft lip and palate deformities, absence of nasal bones, or saddle nose deformity (can also be acquired).
  3. 3. Infectious/Inflammatory: Destruction caused by conditions like Granulomatosis with Polyangiitis (GPA/Wegener's), syphilis, or leprosy, leading to saddle nose or septal perforation.
  4. 4. Surgical: Iatrogenic deformities resulting from aggressive or poorly executed nasal surgery.

3. Classification

Deviated Nasal Septum (DNS)

External Nasal Deformities

  • Saddle Nose Deformity: Loss of support for the nasal bridge, resulting in a sunken or 'saddle-like' appearance. Caused by septal collapse (eg, trauma, GPA).
  • Tension Nose: Over-projecting or long nose.
  • Crooked Nose: Deviation of the nasal pyramid off the midline.

4. Clinical Picture

Deviated Nasal Septum

  • Nasal Obstruction: Primarily unilateral/bilateral. Worsens on the side of the concavity due to compensatory turbinate hypertrophy.
  • Recurrent Epistaxis: Bleeding often occurs over the sharp spur or ridge due to mucosal drying and rupture.
  • Facial Pain/Headache: Contact Headache due to the spur pressing against the lateral wall structures.
  • Snoring/Sleep Apnea: Severe obstruction can contribute to sleep-disordered breathing.
  • Recurrent Rhinosinusitis: The deviation or spur obstructs the drainage pathway (OMC).

External Deformities

  • Airway Compromise: Collapse of the nasal valve (area just inside the nostril) on inspiration.
  • Aesthetics/Psychological Issues.

5. Paraclinical and Radiological Examinations

Physical Examination (Anterior Rhinoscopy/Endoscopy)

  • Nasal endoscopy (gold standard): Use an endoscope to directly visualize the deviation, spurs, and ridges.
  • Cottle Maneuver: Tests the external nasal valve. The cheek is pulled laterally, and if breathing significantly improves, nasal valve collapse is indicated.

Radiological Examinations

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