Septum, Adenoid, and Epistaxis

The nasal septum separates the nasal cavity into two half. The septum is divided into three parts in the anterior to posterior direction; columellar, membranous, and septum proper. It received blood supply from both the internal 7 the external carotid arteries. Trauma is the major cause for symptomatic septal deviation. The deviation is managed classically by two techniques; septoplasty and sub-mucosal resection. Adenoid is the lymphoid tissue of the nasopharynx. Adenoid hypertrophy can block the posterior choana and the eustachian tube. Snoring and sleep with mouth opening are the leading symptoms. Detailed history and lateral X-ray nasopharynx are used to create the diagnosis. In co-operative patients, nasal endoscopy is the good method to establish the diagnosis. Early grades of hypertrophy are managed conservatively. Surgical indications are stage 4 adenoid hypertrophy, obstructive sleep apnea, and in suspected cases of malignancies. Epistaxis is the terminology used for per-nasal bleeding. The nose has rich blood supply from both vascular systems. The most preferred line of management is the direct identification of feeder and cauterization. Nasal packing is the second line of management. Ligation of bleeder and embolization are the third and fourth line of the management. The correction of systemic cause is the most important goal of management to prevent the recurrence of epistaxis.