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1. Deviated nasal septum Lobsang Rabgye rollno.-25

2. Particulars of patient Name: Achim Nich Age: 17 years old Gender: Male Occupational:Student Marital status:Unmarried Religion: Buddhist Date of admission:5/7/24 Date of examination:6/7/24 Informant: Patient himself

3. Chief complaint: Nasal obstruction alternately to right and left nostril since childhood

4. History of present illness: Patient came into to the ORL clinic with complaint of alternating right and left nasal blockage since childhood. He denies any nasal discharge and bleeding from the nose. No headache, sinusitis, no loss sense of smell, and no earache. He also denies any episodes of fever, allergic rhinitis and no frequent upper respiratory tract infection symptoms.

5. Past medical history: The patient has no known illnesses (Diabetes, TB, brochialasthama and HTN) Past surgical history: The patient has never undergone any type of surgical procedure. Allergy: The patient is not known to be allergic to any food and drugs. Patient’s family also denies any allergy to food and drugs. Personal history: Mixed diet Non smoker and non alcoholic Bowel and bladder pattern are normal. Denies any promiscuous sexual activity and high risk behaviours.

6. Family history: 8 members in the family. Mother and father Two elder sisters and two elder brothers. One younger sister. None of the family members is experiencing same symptoms as him. No history of any chronic illness in the family. Socioeconimic status: Pukka house Well sanitised attached bathroom Filter water source Middle income family

7. General examination: Appearance: Conscious and well oriented to time, place and person Body built and nutritional status: Average body weight and nutrition Cooperation: cooperative Vitals: Pulse rate 70 beat/min Blood pressure 122/82mmHg Respiratory rate 18breath/min Temperature 37 degree Celsius Oxygen saturation 99%

8. Examination of nose Inspection of external nose Nasal bridge deformity Absent swelling Absent ulcers Absent sinuses Absent Growth on skin Absent scars Absent Broadening of nose Absent Inflammation/cellulitis Absent

9. Palpation of external nose Crepitation Absent Tenderness Absent Temperature normal

10. Internal examination of nose Nasal tip Normal Nostril and airflow Reduced in left side Mist flow More in right nostril Condition of mucosa inside vestibule Normal Furuncle Absent Fissure Absent Dislocated septum S-shaped nasal deviated septum tumour Absent

11. Anterior rhinoscopy Nasal secretion Normal Swelling of turbinates Hypertrophied seen in B/L ( Compensatory mechanism) Properties of the mucosa surface Normal Position of the nasal septum Deviated s –shaped septum Ulcerations or presence of foreign bodies Absent

12. Nasal passage Narrow in the both side due to septal deviation Septum Position s-shaped deviated septum,no crusting, no spur,ulcer , perforation and swellings(haematoma or abscess)

13. Floor of the nose Defect(cleft palate or fistula) Absent Swelling(dental cyst) Absent Neoplasm(haemangioma) Absent Granulations(foreign body or osteitis) Absent

14. Lateral wall of nose structures are normal. Posterior rhinoscopy: all structures are normal in position, size and shape. Posterior margin of bony septum Posterior end of inferior,middle and superior turbinate Posterior nares/choanae ET opening Fossa of Rosenmuller Root of Nasopharynx Adenoids Nasal surface of soft palate and uvula.

15. Functional Examination of nose Patency of nose: Spatula test- more mist formation in right nostril side Cotton wool wisp test- More movement of cotton on right nostril than left nostril Sense of smell: Better in right nostril than left one

16. Examination of PNS On inspection and palpations of anterior group of PNS Maxillary, frontal , anterior ethmoidal No redness, swelling, mass , tenderness is found.

17. Differential Diagnosis nasal obstruction : Structural: DNS, Inf. Turbinate hypertrophy, concha bullosa Infection: sinusitis Polyps Foreign body Neoplasm Trauma allergy

18. Probable Diagnosis: My probable diagnosis is congenital s-shaped nasal deviated septum .

19. Treatment Minor deviation with no symptoms require no treatment When deviated septum produces nasal obstruction, an operation is indicated: Submucous resection(SMR) Septoplasty

20. Thank you