Nasal Septal Deviation: Causes, Types, Clinical Features and Treatment

Septal Diseases

1. Deviated Nasal Septum: This condition arises when the septum is not in the midline position and is deviated to one side. The presenting feature will be the presence of a sharp the presence of a sharp Bony projection. 

Causes of Nasal Septal Deviation

• Trauma
• Developmental deformities of the palate
  • High arching of the palate
  • Submucosal cleft
  • Cleft palate
  • Any palatal deficiencies

Also Read: Tumors of Nose and Sinuses Types

Types of Deviated Nasal Septum

• Anterior dislocation
• C-shaped
• S-shaped next line 
• Spur-sharp Bony projection
• Diffuse thickening of septum

Clinical Features

• The patient will present with nasal obstruction and infections.
• Headache
• Features of sinusitis will be recurrent
• This spur of the bone can cause epistaxis.
• Hyposmia or anosmia
• The most important feature is an external deformity.
• The patient will have a history of middle ear infection multiple times.
• Cottles line- It is a line drawn from the frontal spine to the anterior nasal spine. The clinical importance of this line is to diagnose the presence of deviated nasal septum and its treatment. If the deviations are anterior to the cottle’s line then it is treated only with septoplasty. But if the deviations are posterior to Cottle’s line then it is treated either with septoplasty or by SMR.
• The deviated nasal septum can lead to obstruction of the internal nasal valve and hence can cause breathing difficulties. Cottle’s test can help us diagnose the patency of the internal nasal valve. If we want to check the right-sided nasal obstruction then we have to place two fingers on the right side of the cheek and pull laterally. If there is improvement in breathing, this means the patient has an obstruction because of deviated nasal septum.

Also Read: Nasal Polyposis: Clinical Types, Pathogenesis and Management

Treatment of Nasal Septal Deviation

There are surgical options to treat the deviated nasal septum. Medical therapy can be given to treat compensatory hypertrophy and turbinates. These are:

• 1.Septoplasty
  • It is a conservative surgery and the elevation of flaps is done on a single side.
  • The removal of cartilage is minimal.
  • Septoplasty is avoided in children up to 17 to 18 years of age.
  • Septal perforation and supra-tip deformity are rare.
  • There is a high chance of revision surgery.
• SMR (Submucosal Resection of the Deviated Septum of the Nose)
  • It is a radical surgery and the elevation of flaps is done on both sides.
  • The removal of cartilage is done grossly.
  • Lesser chance of revision surgery.
• 2. Septal hematoma
  • It is the accumulation of blood between the septum and the overlying mucosa. The most common cause of septal hematoma is trauma which can be direct, surgical, or iatrogenic.
  • The clinical features are:
    • Bilateral nose obstruction
    • Pain
    • No fever
    • On examination, a pink-blue swelling can be observed on either side of the septum.
  • The treatment includes the removal of the hematoma:
    • Small hematomas are removed by aspiration with a wide-bore needle.
    • Large hematomas are removed by incision and drainage.
    • Compressed nasal packing following drainage to prevent reaccumulation.
• 3. Septal Abscess 
  • It presents with bilateral and symmetrical swellings.
  • These mainly occur secondary to infection in a septal hematoma. Furunculosis is another cause.
  • There are some nasal infections which can lead to this condition.

Also Read: EPISTAXIS- Anatomy, Classification and Management

Clinical Features Are:

• Nasal obstruction
• Pain
• Fever
• Headache
• Lymphadenopathy
• Treatment includes aspiration of pus or incision and drainage along with the removal of infected piece of cartilage. Compressed nasal packing is not done in this scenario. Systemic antibiotics are prescribed to avoid any infection. Septal Abscess should be treated immediately because of the risk of impending infection.
• The complications of septal hematoma are saddle nose deformity, meningitis and cavernous sinus thrombosis.

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