Nasal septum

Nasal septum

The nasal septum is the medial wall of each nostril. The basic components of the nasal septum are a quadrangular cartilage, perpendicular plate of ethmoid and the vomerine bone. The quadrangular lamina thickens at the upper region and is in continuity with the perpendicular plate of ethmoid making an osseo-cartilaginous continuity.

 

Anatomy of the nasal septum

The infero-posterior margin is firmly in the groove and terminates at the rear with a caudal extension. The anterioro superior margin of the quadrangular lamina joins at its extreme cephalic end with the caudal end of the median suture of the nose bones.
Perpendicular lamina of ethmoid bone is a structure that articulates in the posterior third with the front edge of the vomerine bone and the front 2/3 joins the upper border of the quadrangular cartilage.

 

Deformity of the nasal septum

In the adults, nasal septum it is never perfectly straight and center , but often presents with thickening and describes curves and angles that give rise to those objective manifestations generally defined as a deformity of the nasal septum.
Deformities of the septum should be divided into deformity cartilage, bone, and bone and cartilage. A further deformities particularly frequent in the newborn is represented by the dislocation of the septum, in which the cartilaginous septum presents dislocated with respect to the bone in the shower which runs normally. In rare cases it is possible to appreciate cartilage supernumerary portions, defined parasettali cartilage, related to the persistence of a portion of the cartilage of the embryo capsule.
The different objectives of the so-called square deviation of the nasal septum is frequently associated to the arched palate: both the event would be an expression of constitutional factors.
In the great majority of cases the septal deviations were traumatic, and in good proportion are a result of birth trauma or even mild childhood trauma and often forgotten and ignored. Many cases would have to be linked with the incorrect position of the fetus in utero, resulting in compression of the nose and jaw.

 

Symptomatology

The subjective symptoms is linked above the nasal respiratory obstruction unilateral or bilateral, on the one hand due to the deviation of the septum, and on the other side of the compensatory hypertrophy of the turbinates. The nasal respiratory flow will be altered, concentrated in a small area of ​​the mucosa, with consequent evaporation of the nasal mucus and crusting, whose removal may be accompanied by small hemorrhages. The protective action of nasal mucus will be missing in some areas, resulting in increased susceptibility to infection. The pressure from the septum on the nerve endings contained in the nasal mucosa can cause algic phenomena.

 

Diagnosis

A careful collection of data on the patient's clinical symptoms, together with data collected from a rhino-endoscopy and rinomanometrico, are needed in order to assess the possible surgical indication. With the help of fiber optics it is now possible to make an endoscopic examination, and appreciate in detail the anatomy of the nasal septum, possibly documentandola photographically. The rinomanometrico examination allows us instead to objectively assess the performance of nasal inspiratory and expiratory flows, and the resistors inside the nasal passages.

 

Therapy

The septal deviations of therapy is surgical. The septoplasty carried out following the surgical technique devised by Cottle still represents the most comprehensive surgical and improved method, allowing you to systematically obtain excellent results whatever the deformity to be treated.
The surgery begins with the incision of the mucosa and perichondrium of one side, at the level of the lower border of the quadrangular cartilage. It then proceeds to the dissection sottopericondrale creating a sort of pocket or side tunnel that can extend for the entire length of the septum cartilage and bone. At this point, if you are in the presence of significant obstacles, such as scars, fractures or deformities that prevent continuing, there is a need to broaden the surgical field and to find a way of aggression that it remains under the control of view.
Then we proceed to the subperiosteal detachment of the mucosa of the floor of the nasal cavity, creating a lower tunnel, to be joined to the side tunnel already made to achieve a wider operating field. It will then proceed the execution of one lower condrotomia and rear cutting the quadrangular cartilage hugging the ploughshare to all'etmoide, so as to free it from the bone deformations lower and rear. It will at this point the bony portion of the septum that if deflected will be well visible removed.
Minor deviations of the quadrangular cartilage will be resolved by going to remove the cartilaginous portion involved, or to weaken it with cross cuts to correct the curvature. In cases of major septal deviation you can proceed to the complete removal of the cartilaginous septum, its modeling, and its repositioning and fixation points. At the end of surgery the nostrils are plugged with a swab per nostril to remove after about 48 hours.