Nasal Dryness Can Reduce Nasal Septum Perforation Closure Success!

If there is a hole in your nasal septum, please keep the inside of the nose moist!

Nasal septum perforation, mucosal dryness, surgical success

Nasal septum perforation definition

dry nose,mucosal dryness,Nasal Septum Perforation,
Septum perforation; refers to subsequent holes in the nasal septum consisting of bone at the back and cartilage in the front that divide the nasal cavity in two. The most common cause of septum perforation is the negativity that occurs after the nasal surgery. It is usually a complication that can be seen around 1% after septoplasty operations. Perforation of the septum after nasal surgery is a distressing situation for both the patient and the physician. In addition to nose surgeries, septum perforation may occur due to nasal trauma, various infections and rarely oncological diseases. Cocaine users may also develop septum perforation. A recently published scientific study on the subject >> Risk factors for nasal septal perforation after septoplasty operation

Classification according to the size of nasal septum perforation

Nasal Septum Perforation
Septum perforations are examined in 3 sections according to their size. Those less than 0.5 cm are called small perforation, those between 0.5-2 cm are of medium size and those larger than 2 cm are called large perforation. Nasal congestion, nosebleed, and the sound of wind while breathing are the most common symptoms in patients with septum perforation. If the perforation is small and located at the back, it usually does not cause any complaints and treatment is not required. However, perforations located in the front are the cause of complaints.

Nasal septum perforation symptoms

In patients with perforation of the nasal septum, rapid and linear airflow through the nasal septum hole may dry up, crust, and epithelial changes over time. When nasal septum perforation is located in the front, it may be more rapid to accelerate intranasal drying and airflow.

Nasal Septum Perforation
In septum perforations; symptoms such as crusting, bleeding, whistling while breathing through the nose, nasal congestion, pain, runny nose, and nasal discharge may be present in some patients. Symptoms may vary depending on the location, size and cause of perforation. A small perforation in the posterior part of the nasal septum may be asymptomatic and may cause whistling, especially when it is in the anterior part. As perforation size increases, laminar air flow in the nose deteriorates and turbulent flow occurs. This causes drying, crusting and nasal congestion. Moderate to low cartilage inflammation may cause pain in cocaine users and infectious perforations.

Nasal whistle sound due to small nasal septum perforation video

Treatment of nasal septum perforation 

There is no need to treat septum perforation without any complaint. In the treatment of symptomatic septum holes, conservative treatments such as nasal wash, softening-moisturizing ointments, septal closures (septal button) may be applied. However, these treatments are often not enough to relieve symptoms. Surgery is the ideal treatment for a permanent solution.

Surgical success in septum perforation closure

In surgical closure, the mucous membrane in the nose is removed and turned or perforated. The perforation is then closed by suturing. Performing this procedure bilaterally and putting a barrier (cartilage, bone, fascia, etc.) between them increases the success in order not to puncture again. Successful repair of nasal septal perforation depends particularly on the cause, location, size, presence of cartilage-bone tissue at the edges of the perforation, surgical technique and the experience of the surgeon. Nasal septal perforation is often the result of mucosal tears in nasal surgeries, such as septoplasty and SMR (submucous resection), and should be repaired simultaneously when reciprocal mucosal tears are noticed. Surgical treatment is less successful in septum holes caused by inflammatory diseases such as cocaine use, Wegener's granulomatosis, nasal trauma and nasal cauterisation. A wide range of approaches and techniques for nasal perforation repair have been reported. A perforation in the front has a greater chance of closing. While the probability of a small perforation (smaller than 1cm) closes to 90-100%, the closure rate in a large perforation (greater than 2 cm) is 70-80%.

In the photos above and below, an intranasal endoscopic photograph of the patient who had undergone septoplasty operation in a different clinic about 5 years ago and who developed perforation in the anterior part of the nasal septum is present. As seen in the photographs, it is seen that the mucosal edges near the perforation edge is whiter and dry and there is crusting in the nose.

The diameter of the patient's perforation 5 years ago was approximately 8 mm, but now it was evaluated as approximately 15 mm.

For patients with nasal septum perforation, it is ideal to keep the following recommendations in order to keep the intranasal mucosal health and to prevent the perforation from progressively growing:

- attention should be paid to the amount of drinking water per day and consuming an ethereal amount of water.
- reducing the consumption of products such as tea and Turkish coffee with diuretic properties
- avoiding foods with high salt content
- do not insert a napkin or finger into the nose
- regular intranasal irrigation with saline water (1 cup of tap water and 1 teaspoon of water can be washed into the nose at home or spray with ocean water can also be used)
- regular use of nasal moisturizing products (containing natural oil, containing hyaluronic acid or epitelizan) recommended by your doctor

What I have written here is that the patients who are planned to close the nasal septum perforation can start at least 1 month before the surgery and this may increase the success of the surgery. The reason for this is that in patients with nasal septum perforation, after methods such as mucosal flap shifting or cartilage graft placement, the graft is more difficult to adhere to a dry and unhealthy mucosa than to stick to a mucosa with better moisture and blood supply.

Do not extend the hole in the septum using fingers, cotton swabs, paper towels, or a different foreign object!

Patients with nasal septum perforation and increasing nasal dryness may sometimes confuse the nose by using fingers, ear cleaning sticks or any foreign body to clean the shells and to relax the nose. In this case, the diameter of the hole in the nasal septum may increase and surgical treatment may become more difficult. In patients with small and predominant septum perforation, ıs whistling "may occur, and as this hole diameter increases, whistling disappears and nasal hyperventilation signs (nasal dryness, crusting, bleeding ...) may be added.

Drugs that should not be used as much as possible in patients with nasal septum and nasal dryness

Patients with perforation of the nasal septum and dry nasal mucosa should ideally avoid drugs that may cause nasal dryness. In particular, allergy pills, nasal cortisone sprays, flu drugs and nasal decongestant drugs can be summarized briefly as diuretic drugs.

The nasal septal button is ideal as far as possible - not preferred - for patients considering surgery!

It should be kept in mind that the silicone septal button may increase the hole diameter and may cause chronic infection of the mucosal margins when left in it for a long time, especially in patients who are surgically closable and who are scheduled for surgical treatment. Surgical success rate decreases if the diameter of the perforation increases.

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

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