Nasal Septum Perforation Surgery - Before and 1 Month After

Open Technique Septal Perforation Repairing Operation



The patient, who had nasal septum perforation due to a septoplasty operation previously performed in another clinic, presented with the complaints of a whistling sound in the nose, crusting in the nose, and dryness. Rib cartilages were used. During the open technique rhinoplasty operation, subcutaneous tissue was removed from the supratip region by bilevel dissection. A vertical dissection was performed on the nasal septum perforation. A vertical cartilage graft was placed. Afterwards, it was placed on both sides in such a way that the subcutaneous tissue was the outermost, and it was sutured with self-soluble 4/0 vicryl. After the aesthetic nose operation was completed, the internal silicone splint was placed bilaterally.

Video description

It was recommended to wash the nose with a mixture of rifampicin + saline for about 1 month. After 1 month, silicone splints were removed from the nose and an endoscopic examination record was taken. In the video above

. Before the operation, there is a hole in the nasal septum (nasal septum perforation due to previous nose surgery), bleeding in the mucous membrane in the nose due to the accelerated air flow, and bleeding on the edges of the hole. The heat sound occurs due to the air flow passing through this hole.
. 1 month after the open technique perforation closure, it can be noticed that the perforation in the nasal septum is completely closed, the nasal mucosa is pink and healthy again, and 4/0 vicryl thread material is still visible in the subcutaneous tissue placed in the perforation area.

I would like to add the following information regarding nasal septum perforation:

In the case of a change in the anatomy of the nose, there is a certain level of influence on the functions of nasal purification, heating the air, and humidifying the air. For this reason, it is necessary to normalize the anatomy of the nose as much as possible, close the hole in the septum or reduce it as much as possible. In large holes, the success rate is not high with local mucosal flap shifting techniques alone. I still don't like the process of closing the nasal septum perforations by cutting the turbinates inside the nose. The reason for this is "changing the anatomy of the nose", further changing the already altered or distorted anatomy, or even; The use of turbinates, which have a unique function in the nose, may cause accelerated airflow (nasal hyperventilation).

Before the surgery, irrigation of the septum perforation area with saline water, increasing the humidity of the mucosa, and septum perforation may contribute to the success of the surgery.

I would like to explain why I keep the internal nasal silicones for a long time after the operation, especially in patients with large perforations:

After the nasal septum perforation operation, when cartilage tissue is placed in the already dried and dehydrated mucosal area, it may be beneficial to keep the silicone splinter for a long time in order to protect this area from air contact and to stabilize it mechanically. After the operation, I do not recommend the use of oil or vaseline-based moisturizers, especially inside the nose. If the cartilage tissue comes into contact with non-sterile oil-based drugs, the risk of wound infection may increase.



Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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