EN4.22 | Deviated Nasal Septum — Summary & Reflection

KEY TAKEAWAYS

Deviated nasal septum is the commonest structural cause of nasal obstruction in adults. The nasal septum is a composite of the quadrilateral cartilage, perpendicular plate of ethmoid, and vomer; deviations occur as C-shape, S-shape, spur, or caudal dislocation. DNS causes unilateral obstruction (constant, not seasonal), epistaxis from mucosal desiccation or spur contact, Sluder's neuralgia headache, and recurrent sinusitis from OMC obstruction. Anterior rhinoscopy confirms the diagnosis; CT PNS is added when sinusitis is suspected. Management is surgical — septoplasty (after age 16–18) is the cartilage-conserving procedure of choice; submucous resection (SMR) is the older, more destructive alternative with a higher saddle-nose risk. The key intraoperative safeguard is preserving the L-strut (1 cm of dorsal + caudal cartilage). Compensatory inferior turbinate hypertrophy on the contralateral side frequently needs to be addressed concurrently. The major complications of septoplasty are haematoma, septal perforation (bilateral opposing mucosal tears), and saddle-nose deformity.

REFLECT

Consider a patient who comes to you frustrated after two surgeons have declined to operate on their nasal septum because 'the deviation is not severe enough.' How would you explain to this patient that surgery is indicated only when the DNS is the proven symptomatic cause — not merely because a deviation is present? What criteria would you use to decide? What would you tell a patient whose main complaint is headaches but who has a DNS on examination — and whose neurologist says the headaches are not migraine? Developing a clear decision framework for 'when to operate' in DNS is one of the most clinically important take-aways from this module.