Bones That Form The Nasal Septum

Bones That Form the Nasal Septum: A Comprehensive Guide

The nasal septum, the partition separating the two nostrils, is a complex structure crucial for proper breathing and facial aesthetics. Its formation involves several bones and cartilages, intricately interwoven to create a functional and supportive framework. Understanding the bony components of the nasal septum is vital for anyone interested in anatomy, rhinology (the study of the nose and its diseases), or facial surgery. This comprehensive guide will delve into the specific bones contributing to the nasal septum, their individual roles, and the clinical implications of septal deviations or abnormalities.

The Key Players: Bones of the Nasal Septum

The nasal septum isn't solely composed of bone; it's a sophisticated combination of bone and cartilage. While cartilage provides flexibility, the bones offer structural integrity and support. The primary bony contributors are:

1. Vomer: The Central Support

The vomer, a thin, ploughshare-shaped bone, forms the posterior and inferior portion of the nasal septum. This bone is situated centrally, acting as a keystone in the septal architecture. Its superior border articulates with the sphenoid bone, while its inferior border joins the palatine bones and maxillae. The vomer's role is critical in maintaining the vertical alignment of the septum. Deviations or fractures of the vomer can significantly impact nasal airflow and contribute to septal deviations.

Clinical Significance: Fractures of the vomer, often resulting from trauma, can lead to nasal obstruction, epistaxis (nosebleeds), and even cerebrospinal fluid leaks if the fracture extends superiorly. Surgical correction, often involving septoplasty, may be necessary to restore proper nasal function and aesthetics.

2. Perpendicular Plate of the Ethmoid: The Superior Support

The perpendicular plate of the ethmoid bone forms the superior part of the nasal septum. This thin, vertical plate of bone extends downwards from the cribriform plate, which sits at the base of the brain. Its superior attachment to the cribriform plate is crucial, anchoring the septum securely and providing stability. Its inferior edge meets the vomer, forming a critical junction. The perpendicular plate's contribution is significant to the superior stability and overall structural integrity of the nasal septum.

Clinical Significance: Damage to the perpendicular plate, particularly fractures, can result in septal deviations and nasal obstruction, often accompanied by headaches due to proximity to the brain. Surgical intervention might be required to correct these issues and alleviate related symptoms.

3. Maxilla and Palatine Bones: The Inferior Support

While not directly forming the septal cartilage, the maxilla and palatine bones contribute to the inferior bony margins of the nasal septum. The maxilla, forming the upper jaw, contributes to the anterior nasal spine. The palatine bones form the posterior hard palate and articulate with the vomer and maxilla, providing support to the lower aspect of the nasal septum. Their influence is indirect, offering structural foundation to the bony framework in which the septum is embedded. Their integrity is crucial for maintaining the overall stability of the nasal structure.

Clinical Significance: Fractures to the maxilla or palatine bones, often resulting from high-impact facial trauma, can affect the nasal septum indirectly, causing instability and potentially septal deviation. These fractures often necessitate surgical intervention to restore facial structure and nasal function.

The Cartilaginous Component: Completing the Puzzle

It's essential to remember that the nasal septum isn't entirely bone. The septal cartilage, primarily the quadrangular cartilage, plays a significant role. This cartilage forms the anterior and inferior part of the septum and is responsible for the flexible portion of the nasal septum. It interacts with the vomer and perpendicular plate, bridging the bony components. The septal cartilage's flexibility is crucial for allowing for nasal dilation during breathing and for adapting to minor impacts without fracture.

Septum Deviation: A Common Issue

A septal deviation occurs when the nasal septum is displaced from its midline position. This deviation can range from minor to severe, and it may affect only a small section of the septum or the entire length. Many septal deviations are present at birth (congenital), while others result from trauma or injury.

Causes of Septal Deviation

• Congenital factors: Genetic predisposition and developmental anomalies during fetal growth can lead to septal deviations present at birth.
• Trauma: Blunt force trauma to the nose, such as a blow to the face, is a common cause of acquired septal deviation. This trauma can fracture the bones and cartilage of the septum, causing displacement.
• Inflammatory conditions: Infections and inflammatory processes in the nasal cavity can, in rare cases, contribute to septal deviation.

Symptoms of Septal Deviation

• Nasal obstruction: The most common symptom is difficulty breathing through the nose, particularly on the side of the deviation.
• Nosebleeds: The deviated septum can make the nasal mucosa more vulnerable to injury, leading to increased frequency of nosebleeds.
• Sinus infections: Chronic sinus infections can result from poor drainage due to septal deviation.
• Facial pain: In severe cases, pressure from the deviated septum can cause facial pain.

Diagnosis and Treatment of Septal Deviation

Diagnosis typically involves a physical examination of the nose, including a visual inspection and palpation of the septum. A nasal endoscopy might be performed to obtain a more detailed view. Treatment for septal deviation depends on the severity of symptoms and the extent of the deviation. Many individuals with mild deviations experience no symptoms and require no treatment. However, if symptoms are significant, surgical correction known as septoplasty may be necessary.

Septoplasty: Restoring Nasal Functionality

Septoplasty is a surgical procedure performed to correct septal deviations. It involves reshaping and repositioning the deviated septum to improve nasal airflow. The procedure is usually done under general or local anesthesia and involves:

• Exposure of the nasal septum: The nasal mucosa is carefully elevated to expose the underlying cartilage and bones.
• Resection of deviated segments: Parts of the deviated cartilage or bone are removed to straighten the septum.
• Reshaping and repositioning: The remaining septal cartilage and bone are reshaped and repositioned to create a straight and functional septum.
• Closure of the nasal mucosa: The nasal mucosa is carefully repositioned and sutured back in place.

Septoplasty is generally a successful procedure, significantly improving nasal breathing in most patients.

Conclusion: The Intricate Anatomy and Clinical Relevance

The nasal septum, a seemingly simple structure, exhibits intricate anatomical complexity. The interaction of the vomer, perpendicular plate of the ethmoid, maxilla, and palatine bones, together with the septal cartilage, creates a robust yet flexible partition essential for respiration and facial aesthetics. Understanding the bony components of the nasal septum is crucial for diagnosing and managing septal deviations, a common condition that significantly impacts quality of life for many individuals. The surgical intervention of septoplasty offers a highly effective solution for correcting these deviations and restoring nasal function. Further research continues to enhance our understanding of this fascinating anatomical structure and improve surgical techniques for septal correction.