The symptoms of obstruction do not differ from those due to nasal stenosis from other causes.
In some sigmoid deformities both nos trils may be obstructed. The contact between a deviated septum and the tur binated side of the nose produces a chronic congestion probably quite as much from irregular atmospheric press ure-effects as from simple irritation, which give rise to repeated attacks of rhinitis. As a result of a general nasal catarrh, pharyngeal and laryngeal in flammations develop. The local disorder progressing slowly, the patient does not consult the rhinologist until lie suffers °Teat inconvenience from nasal obstruc b tion.
In addition to the ordinary deformity, —one side of the nose being more prominent than the other, and the tip of the nose turned from the middle line of the upper lip,—the anterior cartilage is so enlarged and bent as to show promi nently in one or other of the nostrils.
The character of the deviation can be determined by using the nasal speeii lum: a convexity will be found in ono nostril, its long axis running vertically, horizontally, or obliquely, and a corre sponding concavity in the other. There is usually a large amount of extra thick ening at the point of greatest convexity. In the concave nostril prominent spurs and crests are frequently soon rnnning r... r ta::% along the sutural ridge ?? Lind: tin septum to the superior Etiology.—In spite of the fact that rhinologist constantly sees abnormal n litions of the nasal septum. and has au unlimited opportunity for studying tlo nt, it remains true that in the ma j-ritv of instances it is difficult to deter mine the exact causes of septal devia t ens. Sir Morell Mackenzie examined :2150 skulls, and of these a little more than ".'f; per ecnt. presented some degree dtviation: 38 per cent. to the left, QS to the right. and the remainder ir r?zular.
It is usually a matter of more or less c,,njceture whether in a given case the deviation has been occasioned by con Lenital causes or errors of development in very young life, or the pressure-effects of hypertrophy of some other bony por tion of the nose,—as, for instance, press ure of the middle turbinated upon the ,eptum.—or whether it is caused by the large variety of traumatic influences.
I-ndoubtedly, in many instances several of the factors named have exerted an in fluence. In a large majority of the cases of thickening of the partition resulting in spurs and crests, the etiolog:y cannot uell be defined unless we are willing to be satisfied with the results of simple catarrhal inflammation. Many observers are content to believe that traumatic causes are the most frequent. Hardly a case appears in which there is not some I.istory of a blow or fall. But actual fracture or dislocation of the septum is not a common occurrence, and blows are rarely so severe at the time as to pro duce deformity. Still, the fact that men 3re much more commonly affected than women, would tend to sustain the tran rnatizrn hypothesis.
Post-nasal adenoids and the subse quent frequent attacks of acute catarrhal rhinitis are probably the most potent factors in causing deviation of the sep tum, the sequence of injurious results being as follows: The post-nasal space filled with lymphoids; nasal stenosis; chronic mouth-breathing; the cheek muscles extended and pressing hard upon the superior maxilla diminish the lateral diameter of this bone, force up ward the arch of the hard palate, and so shorten the vertical measurement be tween the base of the skull and the roof of the mouth in which the nasal parti tion must develop. The shortened di ameter necessitates curvature of the nasal partition upon itself in one of the many forms. Perhaps traumatism is frequently added as a cause to the above conditions.
When a nasal septum is widely devi ated from the median line and there is no history or evidence of post-nasal ade noids, and the roof of the mouth is not high, we may believe that traumatism has probably been the cause of the mis chief. Enlargements of the middle tur binated bone are sometimes sufficient to push over the bony part of the nasal partition. Hypernutrition of any por tion of the septum, especially along the sutural lines, produces congestion and local thickness: spurs and crests. Ir regular development from different cen tres of growth would be sufficient to dis tort the nasal septum from a straight line.