DEVIATED NASAL SEPTUM
Nasal septum deviation or deviated nasal septum
(DNS) is a physical disorder of the nose involving a
displacement or deflection of the nasal septum
Some degree of displacement is common.
Affecting 80% of people unknowingly
CAUSES
Trauma – blow to the face
Congenital disorder – compression of nose
during child birth
Genetic connective tissue disorders – marfan
syndrome
Pressure from massess
PATHOPHYSIOLOGY
Nasal septum in the nose separates the nasal
cavity into two nostrils
Normally septum lies centrally and thus the nasal
passages are symmetrical
A deviated septum is an abnormal condition in
which the top of the cartilaginous ridge leans to
the left or the right causing obstruction of the
affected nasal passage
SIGNS AND SYMPTOMS
Only more severe cases of deviated septum
will cause symptoms
Difficulty breathing
Infections of the sinus
Sleep apnea
Snoring
Repetitive sneezing
Facial pain
Nose bleeds
Mild to severe loss of the ability to smell
DIAGNOSTIC MEASURES
History collection
Physical examination – nose examination with
a pen torch
X ray
MANAGEMENT
In mild cases – symptomatic
treatment
Medications – decongestants,
antihistamines and nasal spray
Medications will relieves only the
symptoms but does not correct
the underlying condition
Nasal strip - A nasal
strip, external nasal dilator
strip or nasal dilator strip is a
type of adhesive bandage with
embedded plastic ribs or splints
that is applied across the bridge
of the nose and sides of
the nostrils, to assist in keeping
the airway open.
NASAL
INHALATION
Remove cap form the nasal inhaler
Shake the container well
Hold the inhaler between the thumb and forefinger
Tilt the head back, slightly and insert the end of the inhaler
in to the nostril, mean while close the other nostril.
Press down the container to release one dose and at the
same time inhale gently
Ask the patient to hold the breath for a few seconds then
breath out slowly through mouth
Withdraw the inhaler from the nostril and repeat with other
nostril
Replace the cap after usage
Surgical management –septoplasty (1-2
hours) – complete healing occur within 2 days to 4
weeks
The surgeon makes a incision through the mucosa at the
caudal end of the septal cartilage, elevates the septal
mucous membranes, and separates the septal cartilage
from its bony attachments and straightens it .
After that nasal septal splints made of plastic is inserted
Nose may be packed for several days to prevent
hematoma formation
Complications of septoplasty –
Infection
Bleeding
Hole (perforation) of the septum
Loss of the ability to smell
Rhinoplasty – cosmetic surgery
A plastic surgery procedure for correcting and
reconstructing the form, restoring the functions
Open and closed rhinoplasty is there
Rhinoseptoplasty – combined cosmetic and septal
corrective surgery
NURSING MANAGEMENT
Assess the signs of hemorrhage – excessive blood
on nasal dressing, bright red vomitus, repeated
swallowing(check back of throat with a pen light for
blood running down throat), rapid pulse,
restlessness
Assess for signs of infection- fever, elevated white
blood cell count.
TAKEMEASURES TO RELIEVE DISCOMFORT AND
PROMOTE EFFECTIVE BREATHING
Place patient in mid – fowler’s position to decrease
local edema
Provide cool mist via face tent
Apply ice compresses over nose for 24 hours
Provide psychological support and sedation if
needed
Use flashlight or penlight to examine back of
throat to check packing has not slipped to back
Provide frequent oral care
Change dressing under nose as needed
Promote good nutrition – provide increased
amount of fluid
Instruct the patient to :
Avoid blowing nose for 48 hours after packing
has been removed
Avoid constipation and straining
Expect stools to be tarry
Expect face to be discolored around eyes and
nose for several days