The Deviated Nose and the Nasal Airway

The pathology of the deviated nose is discussed in relation to its bony and cartilaginous components. The importance of the interlocking stresses within the septal cartilage is pointed out especially with respect to continuing deformation after trauma. The methods of rhinometry are analysed and normal airflow through the nose is described. The effects on the nasal airway of a caudal dislocation of the septum, an angulation at the valve area, a high septal deflection and an excessively wide choana are discussed. In the treatment of a deviated bony segment the difficulties of medial and lateral osteotomies are described. The indications for a septoplasty are thought to be a dislocated caudal end, a tip deviation and an external lateral angulation. The submucous resection of the septum should be reserved for resolved haematoma and cartilage absorption. The importance of the patient's priorities in deciding what operation to do are pointed out. Finally the experimental work on the effect of cartilage and mucoperichondrium resection on nasal growth is reviewed. It is suggested that a child with a severe septal deflection and airway obstruction should be offered a septoplasty taking care not to damage the mucoperichondrium.