The bony nasal septum is formed by the perpendicular plate of the ethmoid bone superiorly and posteriorly, and the vomer inferiorly and posteriorly, with the quadrilateral cartilage occupying the anterior portion. The bony septum divides the nasal cavity into left and right chambers and provides attachment for the mucoperichondrium and mucoperiosteum of the septum.
Deviated nasal septum (DNS) at the osseocartilaginous junction or vomeroethmoidal junction is the most common cause of nasal obstruction. Submucous resection (SMR) and septoplasty correct the deviation by repositioning the cartilage and removing excess bony spurs. Septal haematoma from nasal trauma separates the mucoperiosteum from the bony and cartilaginous septum, interrupting chondrocyte nutrition and risking avascular necrosis of the septal cartilage (saddle nose deformity) if not drained within 24 hours.
Blunt nasal trauma tears septal mucosal vessels producing a haematoma between the perichondrium and septal cartilage that must be drained within 24 hours to prevent cartilage necrosis from ischaemia, presenting as bilateral smooth midline nasal swelling that fluctuates on palpation.
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