Large Septum Perforation Repair With Rib Cartilage - Examination 4 Month After Surgery

4th Month Examination After Nasal Septal Hole Closure

 

Video description: Four months ago, we performed septum perforation repair operation with rib cartilage to our patient with large septum perforation . In holes with diameters greater than 2 cm, the possibility of a complete closure with a surgical procedure is very low. It is difficult to perform large septum perforation operations depending on the very different factors such as the perforation of the interposed graft or any piece of tissue by the patient's breathing, the opening of chronically dry and infected mucosal areas at the perforations, or the reduction of tissue feeding; a full successful outcome (even if the millimetric hole is considered to be a failure) is less likely.

What Causes Nasal Septal Hole?

Nasal septum perforation may occur due to surgical trauma, mechanical trauma, cocaine use, or various drugs and diseases. Here, hole formation is one of the most common causes, usually after surgical trauma. It occurs when the cartilage on both sides of the nasal septum is damaged after a septoplasty operation performed for the treatment of a simple nasal septum deviation. In this case, the surgeon's repair of the perforation during the operation and the closure of the nasal septum using cartilage or mucosal flap techniques prevent the formation of perforation in the late period. A nice detailed articles on this topic that you can read >> Septal Perforation - StatPearls - NCBI Bookshelf / What are the Factors Leading to Nasal Septal Perforations after Septoplasty?

Nasal Septum Perforation Causes "Intranasal Hyperventilation"!

In patients with nasal septum perforation, varying amounts of intranasal airflow changes and acceleration in intranasal air passage velocity may occur, depending on the diameter of the nasal septum perforation and the location of the hole. Small and posteriorly located septum perforations are less common (sometimes asymptomatic) and more prominent in large anterior nasal septum perforations. The airflow passing through the nasal septum is linear, and instead of the circular "rolling" flow in the normal nose, there is a rapid linear airflow emerging. For this reason, changes in the mucosal epithelium at the edges of the perforation, drying and crusting, enlargement of the hole, drying and crusting in the nasal and lower respiratory tracts of the patients, and sometimes nosebleeds may occur. This is the reason for the hole diameter enlargement over time in untreated septal perforations.



Nasal Cavity Consists of Two Separate Cavities Working Separately!

The nasal cavity is divided into two separate cavities on the vertical axis by the nasal septum. Inside each of the right and left nasal cavities, there are structures called turbinates, which enable the air flow to rotate, slow down, heat, humidify and pressurize. When the nasal septum is pierced, that is, when there is nasal septum perforation, there is an acceleration in the air flow entering the nose and the transformation of both nasal cavities into a single nasal cavity. In large perforations, negative effects on nasal functions are inevitable due to a single cavity and accelerated - altered airflow velocities. In the posterior side of the nasal septum and in small perforations, the airflow change is minimal; In anteriorly located and large perforations, intranasal airflow changes are maximum.

After Nasal Septum Perforation Operation, Inappropriate Foods and Drugs to Use

After the nasal septum perforation closure operation, it is ideal to limit the consumption of the following foods and drugs that may cause drying of the nasal mucosa, cause loss of moisture in the nose, or decrease or thicken the nasal secretion:

- excessively salty foods

- strong tea and coffee

- diuretics

- nasal cortisone, decongestant spray and decongestant tablets that can reduce secretion production

- antidepressant drugs that cause dry mouth and nose

After the Nasal Septum Perforation Operation, Drink Plenty of Water and Don't Pick Up Your Nose

After the closure of the nasal septum hole, after the healing in the graft area is completed, it is very important not to insert fingers, napkins, cotton swabs into the nose and irrigation of the intranasal mucosa with regular sprays containing ocean water.

Again, after the operation, drinking plenty of water and consuming fruits and vegetables with high water content can contribute to both the increase in the secretion of intranasal mucus secretion and the acceleration of mucosal healing. After large perforation closure operations, it takes months for the mucosa in the nose to transform into a normal expressing healthy nasal mucosa.

It May Not Be Appropriate to Use Oil or Vaseline Based Nose Moisturizers in the Early Period After Nasal Septum Perforation Operation!

Vaseline or oil-containing nasal moisturisers may increase the risk of mucosal infection in patients who have undergone intranasal mucosal incision, cartilage graft placement and hole repair. After nasal septum perforation closure surgery, I usually recommend my patients intranasal irrigation with a mixture containing rifampicin + saline, re-irrigation of the nose with ocean water sprays 10 minutes after that, and then application of antibiotic-containing eye pomades into the nose.

Smoking Before and After the Operation May Affect the Success of Nasal Septum Perforation Surgery!

In case of exposure to cigarette smoke or smoking, the following adverse effects on the nasal mucosa may occur:

- Narrowing in vessel diameters, decrease in tissue blood supply due to nicotine effect

- increased risk of mucosal infection due to contact with burn products

- Decreased tissue oxygenation, decreased healing rate or adversely affected by carbon monoxide

Considering the above effects, it is ideal for patients with nasal septal hole to stop smoking at least 1 month before the operation and not to smoke for at least 6 months after the operation. There is a very good article that emphasize the effects of smoking on the nasal mucosa >> The effect of smoking on perforation development and healing after septoplasty

Physical Examination and Patient Evaluation Before Nasal Septum Perforation Closure Surgery

In the examination of patients with septum perforation, the location of the nasal septum perforation, its size, and the condition of the mucosa are evaluated. Generally, endoscopic nasal examination is sufficient, but paranasal sinus tomography can also be requested before the operation as an auxiliary imaging tool. If the mucosa of the patients is dry, crusty and bleeding, nasal irrigation with local ocean water sprays, application of antibiotic-containing eye ointments or nasal irrigation with anti-biotic saline may increase the chance of success of the operation, starting 1 month before the operation. In patients with an infected nasal septal button, removing the button and starting nasal irrigation before the operation is also beneficial. The underlying cause of the perforation (surgical nasal trauma, cocaine or drug use, granulomatous disease, infections ...) should be questioned. The patient should be informed about the technique to be applied during the operation and the use of additional grafts (rib cartilage, temporal muscle fascia ...) and the success of the operation. In perforations larger than 4 cm, it is not possible to obtain millimetric complete closure with a single operation.

Link group where you can find articles and different photos about "nasal septum perforation" on this website >> https://www.ent-istanbul.com/search?q=nasal+septum+perforation

The link where you can see the operation images of the patient 4 months ago and the dimensions of the nasal septum perforation >>
http://www.muratenoz.com/2017/05/kaburga-kikirdagi-ile-septum-perforasyonu-ameliyati.html

Before and 3 Months After Nasal Septum Perforation (4x3cm) Surgery Video

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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