Revision Septum Peforation (3x2 cm) Repair Before and 3 Months After

Septal Defect Closure

The patient, who had a septum defect (nasal septum perforation) after a previous nose operation in France, underwent perforation closure procedures twice in the same country. In the patient's examination, a 3x2 cm, ellipsoid-shaped septum perforation with dry and bleeding edges was detected. The patient also had purulent secretions inside the nose as seen in the video. The patient stated that drying and crusting inside the nose increased gradually after each operation. The patient underwent septum perforation repair surgery using open technique, rib cartilage and temporal fascia. Internal silicone splints were kept inside the nose for 3 months. In the subsequent control, the silicone splints were removed and a control endoscopic nasal examination was performed. As seen in the video, it was seen that the entire perforation was closed, there was a thin mucosa on the placed cartilage graft and the septum was in the midline. The patient was recommended intranasal irrigation with a mixture of rifampicin + saline for a few months. In this early period after septum perforation repair, patient care is still very important. It is beneficial for the patient not to put tissues or fingers into the nose, to wash the inside of the nose regularly with ocean water, to eat a healthy Mediterranean diet, and not to drink salt and strong tea and coffee. It is best to take into consideration the recommendations of your operating surgeon.

Challenges of Revision Septal Perforation Closure

Revision septal perforation closure is a complex surgical procedure that presents significant challenges due to altered nasal anatomy, scar tissue formation, increasingly unhealthy nasal mucosa, and diminished vascular supply. Unlike primary septal perforation repair, revision cases often involve patients who have had previous unsuccessful closure attempts, leaving behind fibrotic tissue and compromised mucosal integrity. Some patients may also have localized mucosal infections. These factors make successful closure more difficult and increase the risk of further complications such as incomplete healing, recurrent perforation, or deteriorating nasal function.

One of the primary challenges in revision cases is the limited availability of healthy, well-vascularized tissue to cover the defect. Scar tissue and thinned mucosa may not provide adequate support for grafts or flaps, necessitating the use of advanced reconstructive techniques. The nasal cavity is already an area exposed to outside air and prone to contamination. It is not easy to transplant grafts or flaps to an area that has suffered repeated surgical trauma. Surgeons may need to harvest tissue from other parts of the body, such as the temporalis fascia or rib cartilage, which adds complexity to the procedure and prolongs recovery time. In addition, meticulous microsurgical techniques are required to ensure adequate flap viability, prevent necrosis, and promote long-term healing.

Another challenge is managing patient expectations, as those seeking revision surgery often present with persistent symptoms such as nasal crusting, dryness, whistling, and difficulty breathing. Given the complexity of revision closure, there is always a risk of partial success, meaning that some symptoms may persist despite surgical intervention. Patients should be well informed about possible limitations and risks. Postoperative care is also critical, as appropriate hydration of the nasal mucosa, avoidance of trauma, and long-term follow-up are important to optimize healing and prevent recurrence.

Search result link where you can find articles prepared by Dr. Murat Enöz on nasal septum perforation and published on this website (you can also access previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=nasal+septum+perforation

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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