Septal Foreign Body, Abscess and Nose Deformity

Nasal Septal Abscess - Foreign Body Reaction

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The patient, who had previously undergone rhinoplasty operations in different clinics, had his last operation one and a half years ago. The patient applied to our clinic with complaints of odorous discharge in the nose, enlargement and pain in the nose, and increasing nasal congestion, which started right after the last surgery in the patient's history. In the examination of the patient, it was observed that the nasal septum was enlarged and the nasal passage was completely closed in contact with the outer nasal wall in both nasal valve regions. The patient said that a silicone or plastic-based material was used during this previous operation, that these complaints started right after the operation, and that these problems gradually increased despite the long-term antibiotic treatment.

The photo above shows a thickening of the nasal septum (septal abscess), which causes the nostrils to close from the inside. The patient has stated for a long time that "my nose started to become permanently blocked and there is a bad smell around", and observed that there was inflammatory discharge from the nose from time to time. In the tomography examinations of the patient, an image compatible with the thickening and granulation of the nasal septum was obtained. The problem here is that materials that cause tissue reaction and remain in the closed cavity (inside the nasal septum) cause the formation of chronic inflammation, organized inflammation and granulation tissues over a long time.

In the two photos above, septal aspiration was performed with a needle inserted through the columella before the operation and when the injector piston was pulled back, it was seen that inflammatory discharge came from the septum. It was observed that the aspirated secretion had an anaerobic odor, and a culture-antibiogram was planned.

In the photos above, it is seen that after the columellar incision and upward dissection of the skin, reaching the abscess sac after the midline incision, evacuation of the septal abscess, and a plastic or hard silicone-like material with granulation tissues and inflammation around it and around the nasal septum. It was observed that the cartilages in the patient's nasal septum were almost completely dissolved and there were changes due to chronic inflammation.

Nasal Septal Abscess Aspiration Video

The video above shows abscess aspiration with a syringe before the operation. During the trial of local anesthetic injection into the patient's nasal septum, it was also understood that the needle did not pass through the septum and there was an object in the nasal septum that the needle could not pierce.

Nasal Septal Abscess Evacuation Video

Video of opening the septal abscess sac. After the incision made in the video above, it is seen that the abscess sac is opened with scissors and the inflammatory discharge comes out.

Nasal Septal Abscess Evacuation and Foreign Body Removal From Septum Video

The video above shows the plastic-silicone-based material coming out of the organized abscess sac after vertical dissection. There is dense granulation tissue and inflammatory discharge around this material.

In the photos above, after evacuation of the nasal septal abscess and cleaning of the foreign body and granulation tissues in the septum, there are images of total septal reconstruction with rib cartilage, before and after revision rhinoplasty operation. In the patient, functionality and minimal surgical trauma were aimed instead of aesthetic perfection.

Link group with previously published articles on revision rhinoplasty on this website >> https://www.ent-istanbul.com/search?q=revision+rhinoplasty

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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