Belarusian Medical Academy of Postgraduate Education

1. Belarusian Medical Academy of Postgraduate Education The Choice of Septumplasty Technique and Anatomical Variations of Nasal Septum Merkulava A. KobakhidzeA. Budva 2017

5. (DNS) • Deviated nasal septum is a physical disorder of the nose involving a displacement of the nasal septum. • It may involve only cartilage, bone or both. • Affecting 70% of people • Any sex and age • Male>female

6. Etiology

7. Trauma

9. Development error • Inconsistency between growth of nasal septum and nasal cavity. Nasal septum growths quicker then nasal cavity • Unequal growth between the palate and the base of skull –>buckling of nasal septum • Adenoid hypertrophy- >high arched palate ->DNS • palate and dental abnormalities

10. Racial factors

11. Hereditary factor

12. Deviated Nasal Septum TYPES: • Anterior / caudal dislocation • C - shaped • S - shaped • Nasal septal spur • Thickened & impacted nasal septum

13. Anterior / caudal dislocation

14. C - shaped

15. S - shaped

16. Nasal septal spur

17. Thickened & impacted nasal septum

18. Clinical features • Nasal block • Recurrent cold: due to associated sinusitis • Headache: due to contact with lateral wall (Sluder’s neuralgia), sinusitis • Epistaxis • Hyposmia: seen in high D.N.S. • External nasal deformity

19. Complications • Acute and chronic rhinitis (hypertrophy), vasomotor rhinitis; • Acute and chronic sinusitis (due to deterioration of sinuses aeration and drainage); • Acute and chronic otitis media (due to dysfunction of eustachian tube); • Acute and chronic pharyngitis (due to breathing through the mouth); • Acute and chronic laryngitis; • Conjunctivitis (due to dysfunction of nasolacrimal canal); • Reflex disorders of internal organs (bronchial asthma, asthmatic bronchitis, enuresis, and headache)

20. Diagnosis • History :trauma • General examination of nose,face and oral cavity • Anterior and posterior rhinoscopy • Probing of the nose after anemization • X-ray • CT scan

24. Computed tomography examinations 3D-CT (N = 70) were analyzed according to the proposed own "triangle" scheme, which allows us to set variants of the block ostiomeatal complex and nasal septum deviation. • The proposed scheme has allowed to define the structure of nasal septum, caused by OMC block.

25. OMC block is promoted by various anatomical variants of the nasal septum deviation • In most cases nasal septum deviation represented in the triangle middle part of the nasal septum in front of the OMC (N= 35\70; 50%) • The deviation of a triangle involving perpendicular plate of ethmoid bone were found in 48.6% (N= 34\70) cases • Vomer deviation in 43% (N= 30\70) • Quadrangular cartilage in 37% (N= 26\70) cases (p= <0.05)

26. Treatment • Minor degree->no treatment • Treat->deviated symptoms produces mechanical nasal obstruction or the symptoms given above • Medical :decongestants,antihistamines,nasal steroid sprays • Mechanical: nasal strips • Surgery: Submucous resection (SMR) operation • Septoplasty

27. Thus, the performed analysis, including an anatomical variation of the septum of the nasal cavity and the functional state of the maxillary sinus with the OMC block, makes it possible to choose a technique for performing septumplasty.