CC: Understanding The Nasal Septum

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Clinical concept video on the nasal septum.

Dr. Skarada. Modern Nose Clinic.

So what is the nasal septum, and what do I need to know? Here's a picture I drew of the nose, and if we could take the head and turn it this way and look straight into the nostrils, we'd be looking on to the inside into the nostrils here, and this space here, which I'll color in a moment, represents the space to which air will flow. The septum is a structure going right down the middle, and this is looking straight.

Here I indicate the space at which air flows, something very very important, with the hash marks and the lines. I also have delineated the turbinates, which are structures that droop into the nasal airway space like branches from a tree. So there's a lower set that we call inferior. There's a middle set we call middle, and those are the two most important on each side. There's also a superior turbinate, which is not as clinically important. Now we've got a side view – and I have drawn in blue – a side view of the septum. The septum consists of cartilage along the front (which I have delineated here) and bone behind that (which I've delineated with three additional spaces). Not if, but when a patient is struck in the nose, the blow will not be transmitted through the cartilage into the bone into the anterior skull base, leading to a catastrophic outcome; rather, it will flex into the right, into the left, and commonly along these different lines I've drawn that we refer to as suture lines. For those who are interested, I have gone ahead and indicated the name of each of these different plates. And for those who are particularly observant, you will notice that the cartilage itself even has a small area called the vomeronasal cartilage that interacts or interdigitates with the maxillary crest. If a surgeon has a good understanding of the nasal anatomy – of the nasal septum, they can predict the places that there will be most likely to have a septal deviation and correct it as delicately as possible. For surgeons who may not be as familiar with all the details, they will take a more rudimentary approach to fixing a septum which will involve a hammer and a chisel, going to the operating room, and breaking bones. I would advise that you identify a surgeon who is familiar with the anatomy and can offer you a very delicate approach. Now we're gonna make it a little bit fun and present a quiz to help you to understand some clinical concepts.

First question:

Who, that you know, has a deviated nasal septum?

I may be exaggerating when I say everyone, but truly, almost everyone has some septal deviation. Even if you've had a surgery – a septoplasty to straighten your nasal septum, there could still be some remaining deviation. This is because your nose is supposed to flex when you are struck in the nose so as to protect your anterior skull base, ie your brain.

This leads to the second question.

If everyone has a deviated nasal septum, who is it that needs to worry about their deviated septum? Who would benefit from doing something more about that?

The short answer is not everybody, but some people definitely benefit from addressing their deviated nasal septum and other nasal issues. If you're unable to breathe smoothly through your nose so that you breathe through your mouth during the day or especially when you breathe through your mouth at night, you should consider what needs to be done to establish what we call physiologic nasal airflow. Feel free to watch our video on that.

Thank you from the Modern Nose Clinic. We know your nose.