SUBMUCOUS RESECTION OF NASAL SEPTUM (SMR OPERATION)

SMR

1. SMR Operation ear, nose AND THORAT

2. SUBMUCOUS RESECTION OF NASAL SEPTUM DR ABDUL SAMI MPHIL EASTERN MEDICINE The Islamia University of Bahawalpur Pakistan

3. INDICATIONS Deviated nasal septum (DNS) causing symptoms o f nasal obstructions. DNS causing obstruction to ventilation

4. CONTRAINDICATIONS Patient below 17 year of age Acute episode of respiratory infections Bleeding diathesis Untreated diabetes Hypertension

5. ANAESTHESIA Local anaesthesia is preffered general anaesthesia is used in children and apprehensive adults.

6. POSITION Reclining position with head end of the table raised

7. STEPS OF OPERATION There are following steps of operation

8. 1.INFILTRATION OF NASAL SEPTUM This is done with 2% xylocine 1:50,000 adrenaline

9. 2.INCISION A curvilinear incision with forward convexity is made at mucocutaneous junction on left side of the septum.

10. 3.ELEVATION OF MUCOPERICHONDRIAL AND PERIOSTEAL FLAP It should beneath the perichondrium and periosteum

11. 4.INCISION OF CARTILAGE Cartilage is incised just posterior to the first incision

12. 5.ELEVATION OF OPPOSITE MUCOPERICHONDRIUM AND PERIOSTEUM With the elevator passed through cartilage incision Mucoperichondrium and periosteal flap is raised from opposite side of the septum

13. 6.REMOVAL OF CARTILAGE AND BONE Now cartilage and bone are removed between two flaps Cartilage can be removed with Ballenger swivel knife Bone with L uc’s foreceps Bony spur or rigde can be removed with gouge and hammer

14. 7.STITCHING One or two catgut or silk stitches are applied in the initial mucoperichondrial inscision

15. 8.PACKING Ribbon gauze, smeared with furacin ointment or liquid paraffin is packed in each nasal cavity to prevent collection of b lood between two flaps

16. POST-OPERATIVE CARE Patient is placed in semi sitting position to prevent oozing blood A soft diet should be taken to minimize active mastication that cause bleeding

17. Analgesic should be taken to treat pain Antibiotics should be taken for 5-6 days

18. Nasal packs should remove gently Decongestant nasal drops and steam inhalations are given daily for 5-6 days

19. Silk stitch should remove on 5 or 6 th day Patient should avoid trauma to the nose for several days

20. COMPLICATIONS Bleeding Septal heamatoma Septal abcess Perforation Depression of bridge (due to too much removal of cartilage) Persistence of deviation Flapping of nasal septum Toxic shock syndrome

21. THANK YOU

22. “a person gain more satisfaction who is satisfied” ( tabassum )