Nose Flashcards
Openings of inferior turbinate
Nasolacrimal duct
Openings of middle turbinate
Anterior ethmoid, maxillary, frontal sinuses
Openings in superior turbinate
Posterior ethmoid
Sphenoethmoidal recess
Sphenoid sinus
Sphenopalatine foramen location
1 cm behind middle turbinate
Nasal valve borders
Lateral : lower border of upper lateral cartilage, inferior turbinate
Medial : Nasal septum
Patency of nasal valve is tested by
Cottle’s test
Parts of nasal septum
- Septum proper
- Membranous septum
- Columellar septum
Septum proper contents
1.Perpendicular plate of ethmoid bone
2. Vomer bone
3. Quadrilateral cartilage
4. Frontal bone
5. Nasal bone
6. Rostrum of sphenoid
7. Horizontal plate of palatine bone
Types of nasal septum
Anterior dislocation, c shaped, s shaped, spur, septa, thickening of nasal septum
Symptoms of DNS
Nasal obstruction
Headache
Epistaxis
Sinusitis
Anosmia
External deformity
Middle ear infection
Treatment of DNS
SMR, Septoplasty
Incision given in SMR
Kilian’s incision
Incision given in septoplasty
Freer’s incision
Kilians incision
A slightly curvilinear incision, 2-3 mm above caudal end of septal cartilage on the concave side
Freer’s incision
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Tests to diagnose DNS
Anterior rhinoscopy, Cold spatula test, Nasal endoscopy, Cottle’s test
Tests done: Cold spatula test, Cotton wool test, Examination of sense of smell, Examination of PNS
Anterior rhinoscopy examination
Passage, floor, septum, mucosa, external wall
Indications of septoplasty
- DNS causing nasal obstruction, headache, sinusitis, sleep apnoea/hypopnoea syndrome
- Recurrent epistaxis from spur
- For approach of middle meatus or frontal sinus for endoscopic sinus surgery when DNS obstructs the view and access to these areas
- As a part of septorhinoplasty
- As an approach to pituitary fossa
- Access to endoscopic dacryocystorhinostomy
Septoplasty procedure
- 1% lignocaine with adrenaline 1:100000
- Freer’s incision
- Raise mucoperichondreal flap on one side only
- Separate septal cartilage from vomer and ethmoid plate and raise mucoperiosteal flap on the opposite side of septum
- Remove maxillary crest
- Correct the bony septum by removing deformed parts. Further manipulations like realignment of nasal spine, separation septal cartilage from ULC, implantation of cartilagenous strip in the columella or dorsum of the nose
- Transeptal sutures
- Nasal pack
Post operative complications of septoplasty
Bleeding
Septal hematoma or abscess
Septal perforation
Supratip depression
Saddle nose deformity
Columellar retraction
Persistence of septal deviation
CSF rhinorrhea
Toxic shock syndrome
Contraindications of septoplasty
Acute nasal or sinus infection
Bleeding diathesis
HTN or uncontrolled DM
Post operative care for septoplasty
- Avoid sternous exercise
- Not to blow the nose or sneeze hard if the pack is removed. Secretions can be drawn backwards by snorting rather than blowing the nose
- Saline spray or steam inhalation - encouraged
- Xylometazoline or oxymetazoline drops for nasal stuffiness
- Nasal splints, if used, are removed on fourth to eighth day and gentle suction of nose is done
- Wipe the nose gently
Position for septoplasty
Reclining position with headend of the table raised
