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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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Convexity–Concavity of the Cartilaginous Septum (▶
Fig. 2.112)
Fig. 2.112Convexity–concavity of the cartilaginous septum.
The cartilaginous septum is bent. When a convexity occurs
at the valve area (area 2), it usually causes severe
breathing obstruction.
Vomeral Spur or Spine (▶ Fig. 2.113)
Fig. 2.113Vomeral spur or spine.
A spur or spine is a sharp and localized pyramid-like
protrusion usually located on the vomer (vomeral spur). A
spur is generally the prolongation of a basal crest on the
same side. It is often combined with a high bony deviation
to the other side. A vomeral spur mainly consists of bone.
On its cranial side, some cartilage derived from the
sphenoidal process of the septal cartilage is frequently
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present. A spur rarely interferes with breathing. However,
it frequently causes a nasal hyperreactivity syndrome with
pain or pressure feelings (Sluder syndrome, see ▶
Pterygopalatine Neuralgia (Vidian Neuralgia or Sluder Syndrome))
when it impinges in the inferior turbinate.
Basal Crest (▶ Fig. 2.114)
Fig. 2.114Basal crest.
A crest is a sharp ridge. Septal crests are most frequently
located on the septal base (basal crest), particularly at the
chondropremaxillary and the chondrovomeral junction.
They usually continue posteriorly into a vomeral spur. A
basal crest is often combined with a high deviation of the
septum to the other side. It usually consists of an inferior
bony part (premaxilla, maxillary crest, and vomer) and a
superior cartilaginous part. Crests rarely interfere with
breathing. When they are in permanent contact with the
inferior turbinate, they may cause symptoms of
hyperreactivity (mucosal swelling with hypersecretion,
obstruction, and sneezing) and homolateral pain or
pressure feelings.
High Bony Deviation (▶ Fig. 2.115)
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Fig. 2.115High bony deviation.
The cranial part of the perpendicular plate is deviated. This
is usually combined with deformity of the septal cartilage, a
basal crest, and deviation of the bony and cartilaginous
pyramid.
Septal Perforation (▶ Fig. 2.116)
Fig. 2.116Septal perforation.
For a discussion of the pathology and the symptoms of
septal perforation, we refer to page 200.
2.2.8Turbinates
Compensatory Hyperplasia
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Compensatory hyperplasia is a well-known turbinate
symptom. It is a physiological reaction that serves to
diminish the size and normalize the configuration of the
breathing space in the pathologically wide nasal cavity (▶
Fig. 2.117). In patients with a septal deviation, it is a
characteristic observation. It occurs both in the inferior
and middle turbinate.
Fig. 2.117Hypertrophy of the head of the right inferior turbinate.
Protrusion of the Turbinate
Protrusion or abnormal medial position of the turbinate is a
rather frequent normal anatomical variant. It is sometimes
not easily diagnosed on rhinoscopy. Generally, a coronal CT
scan clearly reveals this type of variation.
In the inferior turbinate, the position of the turbinate is
more horizontal than average. The angle between the
turbinate bone and the lateral nasal wall is larger than
normal, even up to 90° (▶ Fig. 2.118).
Fig. 2.118Protrusion of the right inferior turbinate due to the horizontal position of the
turbinate bone.
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In the middle turbinate, a number of variations may occur,
such as medial (“paradoxical”) curving of the caudal or
ventral end, and duplication (▶ Fig. 2.119).
Fig. 2.119Paradoxically curved right middle turbinate.
Concha Bullosa
The turbinate bone contains a cell that is filled with air and
lined with mucosa. It may have an ostium.
In the middle turbinate, one or more cells are present in
about a quarter of the population. In fact, we are dealing
with ethmoidal cells. Such cells may be very large, hence
the name bulla. Usually, a bulla is filled with air (▶ Fig.
2.120). However, as a result of infection, its ostium may
become closed so that it fills with mucus or pus. A bullous
middle turbinate may cause obstruction of the middle
meatus and cause symptoms as mentioned earlier (see also
▶ Middle Meatus Obstructive Syndrome).
Fig. 2.120Bullous middle turbinate on the right. Note the ostium at the lower end.
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