DNS (Deviated Nasal Septum)

Any deviation in the normal nasal septum is called DNS (Deviated Nasal Septum).

Deviated Nasal Septum may be caused by mechanical trauma and may be

associated with some developmental defects.

It has genetic disposition and many members of same family may be affected with

DNS. DNS is more common among Caucasians than the black Africans.

DNS is an important cause of nasal obstruction.

Etiology Any trauma and errors in the development of nasal septum are the two important

factors causing DNS.

1) Trauma

2) Developmental Defects

There may be some racial factors as well as hereditary factors.

3) Racial Factors

4) Hereditary Factors

1) Trauma A blow on the lateral aspect of the nose may cause displacement of septal

cartilage from maxillary process and vomerine groove, while a blow from the

front may cause twisting and fracture of nasal septum. Injuries of the nasal bone

mostly occur in the childhood. Trauma may also occur at birth during difficult

labour.

2) Developmental Defects Nasal septum is formed by the tectoseptal process which descends to meet the

two halves of the developing palate bone in the midline. Unequal growth

between the palate and base of the skull may cause deviation of nasal septum.

3) Racial Factors Caucasians are more vulnerable to be affected by DNS than the Black Americans.

4) Hereditary Factors Several members of a same family may have deviated nasal septum.

Types of DNS Deviation of nasal septum may involve only cartilage or bone or may involve both

cartilage and bone. DNS is of following types.

1. C-Shaped deformity

2. Anterior dislocation

3. S-shaped deformity

4. Spurs

5. Thickening of nasal septum

1. C-Shaped deformity Septum is deviated in a simple curve on the one side. Nasal chamber on the

concave side of the nasal septum will be wider and may show compensatory

hypertrophy of turbinates (conchae).

2. Anterior Dislocation Septal cartilages may be dislocated into one of the nasal chambers. This is better

appreciated by looking at the base of nose when patient’s head is tilted

backwards.

3. S-shaped Deformity S-shaped deformity occurs either in vertical or anterosuperior plane. Such a

deformity may cause bilateral nasal obstruction.

4. Spurs A spur is a shelf like projection often found at the junction of bone and cartilage.

A spur may press on lateral nasal wall and give rise to headache. It may also

predispose to repeated epistaxis from the vessels stretched on its convex surface.

5. Thickening of Nasal Septum It may be due to organized haematoma or overriding of dislocated septal cartilage

fragments.

Clinical Features Patients with DNS may show following clinical features.

1. Nasal obstruction depends upon the type of septal deformity. Nasal

obstruction may be unilateral or bilateral.

2. Deviated septum especially a spur may press on the lateral wall of the nose

giving pressure headache.

3. Deviated nasal septum may block the sinus ostia resulting in poor

ventilation of sinuses leading to the sinusitis.

4. Mucosa over the deviated part may be exposed to the drying effects of air

leading to crust formation. When these crusts are removed, it causes

bleeding leading to epistaxis of nose.

5. DNS may also cause anosmia because of the failure of the air to reach the

olfactory epithelium. There may be partial or complete loss of sense of

smell.

6. Deviated nasal septum may be associated with deviation of bone or

cartilage or both leading to the external deformity.

7. Patients of DNS are at increased risk of getting middle ear infection.

Treatment Minor degrees of nasal deviations with no symptoms are commonly seen in most

of the patients and require no treatment usually. Treatment is usually required in

cases of nasal obstruction.

Sub mucous Resection (SMR) Operation SMR is done in adults under local anesthesia. It consists of elevating the

mucoperichondrial and mucoperiosteal flaps on the either side the nasal septum

by giving a single incision on one side of septum, removing the deflected parts of

the bony and cartilaginous septum and then repositioning of the flaps.

Septoplasty Septoplasty is a conservative and more efficient approach of septal cartilage

surgery. In this surgical operation most of the septal framework is retained and

only most deviated portion is removed while rest of the septal cartilage

framework is recorrected and repositioned. Mucoperichondrial and

mucoperiosteal flap is generally raised only on the one side of the septum and

retaining the blood supply as well as septal attachment on the other side of the

septum.

Septal Surgery is usually done after 18 years so as not to interfere with the growth

of nasal cartilages. However if a child has a severe DNS causing marked nasal

obstruction, conservative septal surgery i.e., septoplasty is done to provide a

patent airway.

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