We Performed Revision Septum Perforation Repair Operation (Sizes 5x3.5 cm)

Revision Septal Hole Closure Before and After Video

The patient, who had a septal hole after a nasal septum deviation operation previously performed in a different clinic, had a septum perforation repair performed in a different clinic and was admitted to our clinic after the existing septal defect did not close. In the endoscopic examination of the patient (as seen at the beginning of the video above), a septum hole of 5 x 3.5 centimeters in size is seen in the nasal septum, close to an ellipsoid. It can be seen in the video that the mucosa around the perforation, where a piece of the previously placed graft is visible on the upper side, is quite dry and crusty. For treatment purposes, the patient underwent an open technique nasal septum perforation repair using rib cartilage and temporal muscle fascia, and internal nasal silicone splints were placed in the patient's nose. During this process, the patient was recommended to rinse the nose with rifampicin and saline. During the follow-up examination of the patient 2.5 months later, the silicone splints in the nose were removed and a control endoscopic examination was performed. As seen in the last part of the video above, it can be seen that the defect in the nasal septum is completely closed and there is no perforation.

Understanding and Treating Revision Nasal Septum Perforation: A Comprehensive Guide

Revision nasal septum perforation (NSP) is a condition that requires careful management. In patients who have undergone surgery on the nasal septum twice before, as here, the chance of surgical success decreases due to decreased tissue circulation and fibrotic and unhealthy tissue covering the perforation edges. The small diameter of the perforation, which is the main criterion for success in classical perforation surgeries, is also valid for revision NSP operations. As in the patient shared here, the rate of successful closure is low in septal holes larger than 4 cm.

Understanding Nasal Septum Perforation

The nasal septum is the thin wall of cartilage and bone that separates the nostrils. A perforation in the septum is a hole that can develop due to various factors, including trauma, surgery, or chronic inflammation. Revision NSP refers to a perforation that has not healed or has recurred after previous treatment.

Symptoms of Nasal Septum Perforation

Symptoms of NSP can vary depending on the size and location of the perforation. Common symptoms include:

• Nasal congestion
• Nosebleeds
• Whistling sound during breathing
• Crusting or scabbing inside the nose
• Nasal discharge
• Pain or discomfort
• Difficulty breathing through the nose

Treatment Options for Revision Nasal Septum Perforation

The treatment of revision NSP depends on the size and location of the perforation, as well as the underlying cause. Some common treatment options include:

Medical management: This may include the use of nasal sprays, ointments, or oral medications to reduce inflammation and promote healing.

Surgical repair: In some cases, surgical repair may be necessary to close the perforation. This can be done using various techniques, including septal flaps, local tissue flaps, or synthetic grafts.

Biologic grafts: Biologic grafts, such as acellular dermal matrix or amniotic membrane, can be used to repair the perforation and promote healing. I do not like to use these grafts. I prefer to use patient-owned temporal fascia and ribs to repair a nasal septum perforation, which is a dirty and unhealthy area.

Prevention of Nasal Septum Perforation

To prevent the development or recurrence of NSP, it is important to avoid factors that can cause damage to the nasal septum. This includes:

• Avoiding trauma to the nose
• Using protective gear during sports or activities that may cause nasal injury
• Avoiding the use of nasal decongestant sprays for prolonged periods
• Avoiding the use of products that reduce nasal bleeding, such as cocaine.
• Seeking prompt treatment for nasal infections 

Revision nasal septum perforation is a challenging condition that requires careful management. By understanding the symptoms, treatment options, and prevention strategies, patients and healthcare providers can work together to achieve the best possible outcomes.

Precautions Before The Septum Perforation Closure Surgery

Remember that nasal septum perforation can cause increasing deterioration in nasal functions. If you are planning a surgical procedure to close the perforation, please pay attention to the following suggestions in order to ensure that the perforation edges in the nose are healthy and to increase the success of the surgery: 

• increase the amount of water you drink daily, this may increase the humidity of the mucosa
• consume vegetables and fruits with high water content, limit the salt in foods as much as possible
• reduce the consumption of black tea and coffee, which can dry the mucosa
• avoid using foreign objects such as buttons that temporarily close the septal hole in the nose
• because silicone septal buttons can cause the nasal septum perforation to grow, chronic infection at the perforation edges and increase the formation of dead tissue 
• regularly wash the inside of the nose with ocean water, this way the mucosa is cleaned and the possibility of infection decreases.
• Do not insert tissues, fingers or any foreign objects into the nose and do not cause further irritation of the mucosa. 
• Avoid using nasal cortisone sprays, nasal decongestant medications, oral antihistamines and other allergy medications, which may cause further drying of the mucosa inside the nose.

On this website, the link group where you can read previously prepared and published articles about nasal septum perforation >> https://www.ent-istanbul.com/search?q=nasal+septum+perforation

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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