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Nasal Septum Explained

Overview

The nasal саvitу iѕ dividеd intо twо hаlvеѕ bу a раrtitiоn саllеd thе nasal ѕерtum, whiсh iѕ mаdе оf cartilage in its frоnt twо-thirdѕ and bоnе in itѕ bасk third. the nasal septum begins from the nostrils: the external openings of the nasal cavity, and ends posteriorly at the choanae (the posterior openings of the nasal cavity ). Apart from separating the nostrils it also helps humidify and clean the inhaled air. 

Graphic illustration of the nasal septum. Image by OpenStax College

Structure

            The nasal septum is composed of bones and cartilage covered with a mucous membrane called squamous epithelium. The bones contributing to the formation of the nasal septum can be classified as paired or unpaired. The paired bones are the: nasal, maxillary, and palatine bones. The ethmoid and vomer bones are unpaired.  

Thе nаѕаl ѕерtаl саrtilаgе, also knоwn аѕ ԛuаdrаngulаr саrtilаgе fоrmѕ mоѕt оf thе аntеriоr portion оf thе nasal septum. It is composed оf the hуаlinе tуре оf саrtilаgе. Thе fleshy external end of the nаѕаl ѕерtum is саllеd thе columella or columella nаѕi, аnd is mаdе up оf саrtilаgе аnd soft tiѕѕuе. Apart frоm ѕераrаting the nоѕtrilѕ, thе septal cartilage provides ѕtruсturаl ѕuрроrt tо thе еxtеrnаl nоѕе. Thеrе iѕ ѕignifiсаnt vаriаbilitу in thе thiсknеѕѕ оf аnу ѕinglе ѕерtаl саrtilаgе, with mаximаl thiсknеѕѕ аt thе bаѕе оf thе ѕерtum. Thiсknеѕѕ rаngеѕ frоm 0.7-3.0 mm.

            

Blood Supply

The nasal septum has an extensive blood supply from a number of different arteries. It is supplied via the:

  • Sphenopalatine artery – a branch of the maxillary artery
  • Anterior ethmoidal arteries – branches of the ophthalmic artery
  • Posterior ethmoidal arteries – branches of the ophthalmic artery
  • Superior labial artery (supplying the front part) – a branch of the facial artery 
  • Greater palatine artery (supplying the back part) – a branch of the maxillary artery

The superior labial artery supplies the blood through its septal branch. Interestingly, all the arteries above anastomose (join each other) at the lower frontal part of the nasal septum. The area is of special clinical importance and is called the Kiesselbach area. 

Blood supply to the nasal septum. Image by FirstAdmiral

Nerve Supply

The nasal septum is innervated by the following nerves:

  • Anterior ethmoidal nerve – it supplies the upper back portion of the nasal septum
  • Nasal branches of the greater palatine nerve – supplying the posteroinferior (lower back) area of the nasal septum 

Nasopalatine nerves (a branch of the maxillary nerve CN V2) – supply the cartilaginous part of the nasal septum. 

Clinical Relevance and Associated Disorders

Deviated Nasal Septum

A deviated septum occurs when the nasal septum is displaced to one side. It is a fairly common condition and many people experience narrowing of one of the nostrils. The severity can vary from little or no obstruction to nasal congestion and nose bleeding. The deviation can also reduce the humidifying effect of the nostril leading to dryness in the nose and bleeding. The symptoms of deviated symptoms present as flu-like symptoms nasal congestion, facial pain, nasal irritation, and nose bleeding.  

The correction of the nasal septum requires surgery. Other symptoms like nasal swelling can be treated with different medications. 

Medical image of a deviated septum. Image by Leineabstiegsschleuse

Nosebleeds (Epistaxis)

Epistaxis is the clinical term used for nosebleeds. Some causes of epistaxis include: 

 – a trauma 

 – sinus infections

 – rhinitis (nasal cavity inflammation)

 – an arid and less humid environment 

 – hypertension 

 – neoplasm (abnormal growth of cells) 

            The most common form of nosebleed is the one originating from Kiesselbach’s plexus. It is an extensively vascularised point in the front part of the nose that can be damaged easily leading to nosebleeds. Injury or irritation of the maxillary artery can also result in a subsequent episode of epistaxis. 

Nasal bleeding can affect people of any age and usually occurs in children over 10 years old, people working in dry and dusty areas, etc. The treatment for epistaxis depends upon the site of bleeding and the cause leading to it. Usually, preventive measures or treatments are used e.g., using humidifiers indoors, icing the nose if it bleeds, etc.

Rhinitis

A stuffy nose is clinically known as rhinitis. It is an inflammation of the nasal cavity causing nasal congestion, sneezing, or a runny nose. the most common cause is allergic rhinitis which is known as hay fever. Decongestants, anti-allergic or steroidal therapy can be used for the symptomatic treatment of rhinitis. 

Graphical illustration of allergic rhinitis. Image from the Medical gallery of Blausen Medical 2014

Nasal Perforation

Nasal perforation is a condition in which a hole develops in the nasal septum making a connection between the two nostrils. This can be acutely (suddenly) caused by nasal piercings or other practices that can cause pathological perforation of the nasal septum. 

 People abusing drugs like cocaine, methamphetamine, etc. by sniffing, can develop a nasal perforation in long-term use. 

The size of the nasal aperture (hole) and location varies determining its severity. It can appear asymptomatic (without complications) or cause several severe symptoms. Whistling is a common symptom of small septal perforations and as the size increases severity usually increases. 

The definitive treatment for septal perforation is surgery, however, a silicone button is sometimes placed for less severe and small-sized perforations. 

References

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