Deviated Nasal Septum and Turbinate Hypertrophy
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Direct answer
Deviated nasal septum (DNS) is displacement of the partition between the two nasal cavities, formed by the septal cartilage, the perpendicular plate of the ethmoid and the vomer, producing unilateral or alternating nasal obstruction, recurrent sinusitis, epistaxis and headache. Symptomatic deviation is treated by septoplasty, the modern conservative operation that straightens the septum through the mucosa, while submucous resection (SMR) — the older radical removal of cartilage and bone — is now reserved for selected cases. Hypertrophied turbinates accompanying DNS are reduced medically or surgically.
What you must remember
- Septal skeleton: quadrangular septal cartilage in front, perpendicular plate of the ethmoid above and behind, vomer posteroinferiorly, with the maxillary crest below.
- Types of deviation: caudal dislocation, C-shaped or S-shaped deviation, spur and thickening; trauma and birth moulding are the usual causes, and deviations grow with the face.
- Symptoms: unilateral nasal obstruction, mouth breathing and snoring, recurrent sinusitis from ostial blockage, epistaxis over the spur, external deformity, and referred headache from contact points.
- Examination: anterior rhinoscopy with a nasal speculum shows the deviation, spur and compensatory hypertrophy of the contralateral inferior turbinate; endoscopy assesses the posterior septum.
- Septoplasty: raising a unilateral mucoperichondrial flap and repositioning or conservatively resecting cartilage and bone while preserving the dorsal and caudal struts; the operation of choice today.
- SMR: resection of the septal cartilage and bony partitions leaving dorsal and caudal rims; complications include septal perforation, saddling of the nose, adhesions and anosmia, which is why septoplasty is preferred.
- Turbinate hypertrophy: medical treatment with intranasal corticosteroids and saline first; procedures include submucous diathermy, turbinoplasty and partial turbinectomy when medical therapy fails.
Common confusion
DNS is often blamed for every blocked nose, but the examination must separate septal deviation from turbinate hypertrophy, polyps and allergic rhinitis, which coexist and need their own treatment. Students also confuse septoplasty with SMR — remember septoplasty corrects and conserves, SMR resects, and the perforation and saddling risks of over-resection are precisely why the conservative operation replaced it.
Exam-focused takeaway
For theory, write the septal skeleton, types of deviation, symptoms, indications for surgery, and a comparison of septoplasty with SMR including complications. In viva, expect the bones forming the septum, why septoplasty is preferred, and how a compensatorily hypertrophied turbinate is managed alongside. In the posting, perform speculum examination on every obstructed nose and describe the deviation side, type and the state of the turbinates — that description is practical-exam material.
Frequently asked questions
What forms the nasal septum?
The septal (quadrangular) cartilage, the perpendicular plate of the ethmoid, the vomer and the maxillary crest beneath.
What are the indications for septal surgery?
Significant obstruction, recurrent sinusitis or polyposis preventing access, epistaxis from a spur, and correction of deformity during septorhinoplasty.
Why has septoplasty replaced SMR?
Because septoplasty conserves cartilage and the supporting struts, avoiding the perforation, saddling and anosmia that followed radical submucous resection.
What is a septal spur?
A sharp, spike-like projection of cartilage or bone, usually into the inferior meatus, causing obstruction, contact headache and bleeding over its mucosa.
How is compensatory turbinate hypertrophy treated?
First with intranasal corticosteroids and saline; surgical reduction such as turbinoplasty is added when the turbinate itself obstructs the airway.
Can DNS cause headaches?
Yes, through a contact point pressing on the lateral nasal wall, and by obstructing the sinus ostia producing sinusitis; such headaches often improve after correction.