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Full text of "Diseases Of The Nose Throat And Ear"

EXTERNAL NOSE, NASAL ORIFICES AND SEPTUM         27

In traumatic cases there may be twisting of the dorsum or the tip of the
external nose. In most deviations (Fig. 20) the septum presents a convex
surface on the narrow side, while it is concave on the other. Not infrequently
the inferiqr_concha on the concave side is enlarged to compensate for the
wideningT The anterior edge of fEe~septal cartilage is sometimes dislocated to
project into one side of the nose, usually opposite that to which the rest of the
septum is deflected. There are often ridges or crests on the septum, usually

Fig, 20. Simple angular deviation of nasal septum to the left.

low down, near the attachment of the septum to the maxillary spur, or at the
junction of the cartilage with the vomer. On occasion the deviation is high up
on the septum, so that it presses on the middle concha.

SYMPTOMS. Deviations of the septum may be syjnptornless, but may cause
unilateral or bilateral nasal obstruction to a greater or lesser degree. A
deflected septum may interfere "with drainage from, or air entry into, the
anterior group of sinuses. Sinus radiography shpuld be performed in order to
discover the extent of this. A deviated septum "may occasionally cause pain,
either neuralgia of the anterior ethmoidal nerve (p. 17) or the so-called
'vacuum headache' which results from jDbstructing the air entry into the
frontal sinus. ~~                                    " ~~                                             .....~~

TREATMENT. This is essentially operative if the obstruction is causing the
patient discomfort, or if neuralgic pains are complained of. Surgery of the
nasal septum may be called for as a preliminary to plastic reconstruction of
the shape of the external nasal framework, or it may be performed as part
of the rhinoplastyoperation. The operation is called a submucous resection of
the septum, and the principle is to remove the deviated or cresTecTparts of the
septum, while_cgnservingt not only, thft-p^rhondrium, peripstenm Arid
muraus^mernbrane on either side, but also those parts of the cartilaginous or
bony septum which are not deflectedJxom the midline. The complete removal
of all the cartilaginous and osseous septum is not frequently done now. The
operation of septoplasty aims at jconserving much of the septum, and by
plastic meansMrepositioning it into whichever sulcus it has been dislocated
fromiaruTmig^rprevious injury. Septal surgery in children must belSdferiaken
with caution, becauseoFthe growth of the nasal skeleton. A radical operation
removing the greater part of the septum should not be performed in the
child. The indJcalionS-for surgery are stringent^ and operationjsjonly advised
if the_deyiation is so severe as to ca^u^hejLdac^es ^r^rossjnterference with
breathing wMle_playing ga^es^Minimarremoval is performed in order to give
the child a bilateral airway, and reposition of dislocated and deflected
structures is attempted.

POSTOPERATIVE CARE. The patient need only lieupjbr 3 or 4jja^s. The
packs which are inserted at the end of the operation~are removed on the