Perforation of the nasal septum: causes, symptoms, treatment methods and consequences

Perforation of the nasal septum is a through hole in the nasal septum (its bone or cartilaginous part), which occurs against the background of mechanical damage or ongoing disease processes. For a long period, such a pathology may not manifest itself, but all this time the likelihood of breathing problems or infection increases.

Causes of perforation of the nasal septum

The reasons can be caused by both mechanical damage, such as trauma to the nose, the consequences of surgical intervention in the nose (septoplasty or rhinoplasty), and various diseases.

Diseases that cause perforation of the nasal septum include:

• infections that destroy cartilage - tuberculosis, syphilis, staphylococcal infection;
• malignant neoplasms in the nose;
• systemic diseases that destroy connective tissue - vasculitis, lupus erythematosus; sarcoidosis, rheumatoid arthritis;
• frequent use of vasoconstrictor drugs (for example, based on xylomethozoline);
• chronic diseases of the nasal mucosa - atrophic rhinitis;
• toxic effects – drugs inhaled through the nose or harmful substances inhaled in working conditions (lime dust or acids).

An otolaryngologist can diagnose perforation through rhinoscopy and a detailed history. To identify the cause of perforation, additional examination methods can be prescribed, which include:

• general blood analysis;
• blood for rheumatoid factor;
• blood on RW;
• chest x-ray;
• biopsy of the mucosa along the edges of the perforation.
• blood for glucose;
• computed tomography of the paranasal sinuses;
• blood for angiotensin-converting enzyme;
• test for antibodies to the cytoplasm of neutrophils.

After diagnosis, etiotropic treatment is prescribed, that is, aimed at eliminating the cause or reducing its effect on the body.

Treatment of perforation can be conservative or surgical.

Conservative treatment is resorted to if there are no severe symptoms or discomfort. It, as prescribed by a doctor, is carried out at home, according to the recommended scheme.

The main principles of conservative treatment:

• Moisturizing the nasal mucosa with ointments containing Vaseline.
• Rinsing with solutions of sea salt (at the rate of 1 teaspoon of salt per 1 liter of water) with the addition of glycerin.
• The use of antibacterial ointments in the nasal cavity for chronic infections.

Treatment with surgical methods

When the symptoms are significant and cause discomfort, surgical intervention is resorted to.

Elimination of perforation does not involve intervention on bones and cartilage and is carried out only using mucous tissue.

If the perforation is no more than 1 cm, simple suturing of the nasal mucosa is possible.

There are a number of techniques to eliminate large holes:

• Tardi method. A mucous flap is used, taken from under the upper lip. This flap is applied to the perforation site. The method is used with perforations up to 5 cm.
• Fairbanks method. Flaps of the nasal mucosa are used, formed on two legs. This method is applicable for perforations up to 2 cm.
• Friedman's method. A flap from the inferior turbinate is used, formed with one pedicle in front. This method is applicable for perforations up to 5 cm.

For defects up to 2 cm, artificial implants can be used.

In addition to restoring the integrity of the nasal septum, it is also necessary to restore the physiological function of the nasal cavity.

In the first two days you must stay in the hospital under the supervision of a doctor.

At this time, there may be an increase in temperature, which can be relieved with antipyretics. Medications aimed at reducing swelling are also prescribed.

2 weeks after surgery, the patient returns to work.

Then, for a month, you must follow the following instructions:

• Minimal physical activity.
• Avoid mechanical damage to the nose.
• Avoid temperature changes.
• Careful care of the nasal cavity.
• A diet that excludes very cold and very hot foods.
• Giving up bad habits to speed up tissue fusion.

In cases where appropriate treatment has not been carried out, the following consequences are possible:

• impaired sense of smell;
• cough, sneezing;
• migraine;
• eye diseases;
• laryngospasms;
• cartilage inflammation;
• enlargement of the opening in the nasal septum;
• nasal deformity;
• apnea syndrome

Preventive actions are aimed at eliminating the causes that have a destructive effect on the nasal septum:

1. Stop inhaling toxic and narcotic substances.
2. Use nasal vasoconstrictors minimally.
3. Use a humidifier in your living space.
4. Prevention of upper respiratory tract infections.
5. Timely treatment of inflammatory diseases of the nasopharynx.
6. Regular follow-up with a doctor regarding the treatment of autoimmune systemic diseases.

Possible causes of perforation of the nasal septum

The cartilage tissue that forms the nasal septum can be affected in the following situations:

1. During surgery (septoplasty), during various injuries, after cauterization of blood vessels during nosebleeds, as well as in the case of a long-term presence of a foreign object in the nasal cavity - a probe, intranasal cannula or foreign body (the latter is especially common in childhood).
2. Destruction of the septum can also be caused by some infectious agents, such as, for example, tuberculosis or syphilis.
3. Atrophic rhinitis, if prolonged enough, can also lead to the formation of a hole in the cartilaginous tissue of the nasal septum.
4. The presence of malignant or benign neoplasms.
5. Long-term exposure to the mucous membrane of certain chemicals and drugs. Similar consequences can result from long-term local use of steroid drugs, drug use (primarily cocaine), as well as contact with chromium compounds.

How to recognize damage

In cases of damage to the nasal septum, an accurate diagnosis can only be made by a qualified otolaryngologist after an individual examination.

However, there are a number of signs that signal the possible appearance of this defect:

1. The formation of dry crusts that cause severe discomfort.
2. Frequent nasal bleeding.
3. Characteristic wheezing and whistling when inhaling and exhaling.
4. Painful sensations in the nasal cavity, disruption of its patency.
5. Frequent liquid discharge from the nose, sometimes with traces of pus and an unpleasant odor.

Symptoms of the disease are more pronounced if the perforation is located closer to the tip of the nose. If it is located further, then signs of the disease may be completely absent, and only a doctor can identify them.

Perforation of the nasal septum can cause chondritis, an inflammation of the cartilage. To restore the natural outflow of air, a special plug can be inserted into the patient or damaged tissue can be regenerated.

The main symptom of perforation is a characteristic whistling sound when breathing. Since the uncontrolled entry of air onto the nasal epithelium dries it out, crusts may form in the nasal cavity at the site of damage.

In some situations, a person may suffer from frequent and heavy nosebleeds. If the damage to the septum is too extensive, the patient may experience deformation of the shape of the nose (for example, it “sinks inward”).

Inconveniences caused by perforation of the nasal septum, consequences:

1. Frequent occurrence of inflammation of the nasal cavity and paranasal sinuses. They form because a hole in the septum prevents air from flowing normally through the upper respiratory tract.
2. Loud snoring, which prevents others from sleeping peacefully.
3. The appearance of apnea syndrome - stopping breathing due to too much ventilation of the upper respiratory tract.
4. Oxygen starvation of brain tissue.
5. Noticeable deformation of the nose, its curvature to the side, or “sagging” inward.
6. Constant shortness of breath with any physical activity. The appearance of this symptom in such a situation is usually not associated with pathologies of the heart or lungs.
7. A person often experiences pain and dizziness, and there is memory loss, which is caused by oxygen deprivation.

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A perforation of the nasal septum is a through hole in the bony or cartilaginous part of the septum. This is a serious defect that causes physical discomfort and reduces the quality of life. Its main symptoms:

• frequent nosebleeds;
• specific whistle when breathing through the nose;
• pain in the nose;
• Loud snoring;
• shortness of breath even with little physical activity;
• purulent and bloody discharge from the nose;
• deformation of the shape of the nose;
• the appearance of a large number of dry crusts in the nose.

Symptoms and diagnosis

Signs:

• frequent nosebleeds;
• discharge of pus;
• the appearance of an unpleasant odor;
• dried crusts of blood in the nose;
• characteristic whistle while breathing.

Nasal congestion may also occur, accompanied by difficulty passing air through the nose.

If the hole in the nasal septum is small, then there may be a violation of nasal patency. If the lumen is large, the symptoms are supplemented by pain and fluid discharge from the nasal sinuses.

The larger the perforation, the more noticeable the external deformation of the nose.

The location of the perforation also matters. The front of the nose is much drier. If the lumen is located in the posterior nasal sections, then the disease, especially at the beginning, does not have pronounced symptoms. In this case, detection of pathology is possible only after a thorough examination of the patient.

It is possible to conduct a high-quality diagnosis through rhinoscopy - a professional examination of the nasal cavity. Additional examination includes a blood test for syphilis and a general clinical examination.

Causes of otitis media and how to treat it Dr. Komarovsky

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Last Wednesday evening, February 29, my daughter took off her headband (the edges are not sharp, rounded), and put it in an arc down under her chin, putting the ends in her ears. I tried to pick it up, my daughter ran away, fell and the headband hurt her ear. Immediately blood started coming out of my ear. We live next to the hospital and immediately took the child to the ENT department.

The doctor examined the baby. He diagnosed a scratch in the ear canal and a small hole in the eardrum.

He said that you shouldn’t get your ear wet, don’t wash your hair yet, and don’t under any circumstances put anything in it, except that if the pain is severe, you can take Otipax, but it’s better not to. I didn't drip after seeing it in the instructions. that drops are strictly contraindicated if the membrane is ruptured. If the temperature rises or the pain intensifies, consult a doctor immediately. In a week it should heal, and you need to come for an examination to a pediatric ENT specialist.

The first days the child was bleeding from his ear, then the ichor was a little speckled on the pillow. On the 4th day, a blood clot the size of about 2 match heads fell out of my ear.

Today we had an appointment with a pediatric ENT specialist. An ENT doctor, when examining the patient’s ear, did not reveal any perforation, but said that there was a blood clot near the membrane, and there could be a hole behind it. I found a plug of wax in my healthy ear. My daughter has never complained about her hearing, the healthy ear hears well, but the sick ear now hears poorly, and this frightens the child greatly.

The doctor was skeptical about his colleague’s previous prescriptions. He says that it was necessary to drip. He made a face at my remark about the contraindications of the drops. The pediatric ENT specialist said that he can’t see anything right now, and we need to instill 3% hydrogen peroxide in both ears 3-4 times a day until Monday, then cover the ears for a few minutes with cotton wool. Both the clot and the plug should go away by Monday. If there is anything left, the peroxide will soften it, and the ENT will wash out the remains.

I'm at a loss! Which doctor to believe?

I'm afraid that my actions (or inaction) will jeopardize the child's hearing.

Is it possible to drip something during perforation? Can the hole heal on its own and the hearing be completely restored? Are drops needed? Can my daughter's ears be washed? Where did the wax plug come from?

Treatment of perforation of the nasal septum

Conservative methods of eliminating the symptoms of pathological changes in the nasal septum help in cases where the problem does not cause severe manifestations in the patient. Doctors recommend several effective methods of therapy:

1. Moisturizing the mucous membrane

Since most often a patient with nasal perforation feels constant dryness and discomfort, and also suffers from the formation of dry crusts with an unpleasant odor, special Vaseline-based ointments can be used to eliminate this problem.

You can also keep your nose moist by regularly rinsing it with mild saline solutions. To prepare the medicinal liquid, use only 1 tsp. salt crystals per liter of water. Glycerin is sometimes added to the solution to further moisturize the mucous membrane and prevent the formation of dry crusts.

1. Use of antibiotics

If there is a risk of bacterial growth, for example, staphylococcus, then prepare a solution of 1 tsp. vinegar, which reduces the growth of infection. And for chronic infectious lesions of the nose, antibacterial ointments such as Bactroban or Bactracin are used.

1. Introduction of prostheses

Another effective way to eliminate the symptoms of perforation is the use of silicone prostheses, which are placed in the hole and restore normal air flow. Such plugs are installed under local anesthesia, but from time to time they need to be removed for disinfection. The extraction procedure is carried out once a year. This treatment is excellent for those patients in whom perforation occurs due to systemic diseases of the body.

Symptoms and diagnosis

A small hole formed in the nasal septum may not manifest itself for quite a long time, showing up only at a doctor’s appointment during a routine examination or when dealing with any disease. Against the background of this condition, the risk of infections entering the body and the appearance of diseases of the respiratory system significantly increases.

The following conditions are usually considered the main symptoms of a violation of the integrity of the septum:

• the appearance of whistling sounds during natural nasal breathing;
• frequent difficulty breathing and a feeling of nasal congestion;
• the presence of purulent discharge from the nasal passages that has an unpleasant odor;
• nosebleeds;
• a large hole can also affect the external shape of the nose; it becomes saddle-shaped, with the back slightly sagging inward.

Only a doctor can diagnose damage to the nasal septum by conducting a visual examination. In addition, the doctor must conduct a complete examination of the patient in order to detect diseases that can lead to worsening of the condition and recurrence of the problem.

It is important to establish the cause of perforation.

Main causes and symptoms of pathology

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Deformation of the nasal septum can occur for the following reasons:

1. Deviation of the septum due to a previous nasal injury that was not treated in time.
2. Uneven growth of the facial part of the skull, which led to the formation of a growth on the nasal plate and its general curvature.
3. Congenital underdeveloped or crooked cartilage, which has led to the formation of a growth.
4. Very rapid growth of the vestigial Jacobson's organ, which is located at the back of the nose. This, in turn, leads to deformation of the cartilage and the entire nasal septum.
5. Enlargement of the nasal concha, which leads to displacement of the cartilage.
6. The development of pathology due to a previous nasal disease.
7. The presence of tumors or polyps in the nasal mucosa.
8. A nasal fracture in which the bone tissue was not healed correctly.
9. Hypertrophy of one side of the nose, when the muscle that lowers the nasal septum becomes greatly enlarged.

Symptoms

Most often, with a deviated nasal septum, a person suffers from the following symptoms:

1. Difficulty in normal nasal breathing. In more severe cases, a person cannot breathe through his nose at all. Also sometimes there is unilateral congestion of the nasal passages (on the left or on the right).
2. Snoring develops due to severe disruption of nasal breathing.
3. Frequent runny nose that occurs for no reason. In this case, a person may think that this is an allergy and treat it specifically, although in fact the cause of the pathology will be a problem with the nasal septum and cartilage.
4. Dryness in the inner cavity of the nose.
5. The presence of chronic diseases of this organ, when the muscle that lowers the nasal septum cannot cope with protecting this organ from infections. This could be severe sinusitis, sinusitis, frontal sinusitis, etc.

These diseases will regularly worsen, even with active treatment.

Such signs indicate pathology, so you should pay attention to them in time.

1. Changing the overall shape of the nose. This usually happens when bone tissue does not heal properly (after injuries and fractures) and forms an unsightly growth (hump). Also, sometimes the cartilage “moves” to the side, moving to the right or left. In this case, the person’s nose will be crooked; even without a medical examination, this defect is visually very visible.
2. Formation of bruises under the eyes.
3. Chronic fatigue and weakness.
4. Lack of air can lead to problems with memory and sleep.
5. Frequent nosebleeds.
6. Absent-mindedness.
7. Inflammation in the middle ear.

Treatment

The type of perforation influences the choice of treatment tactics. Slit-like PPN in the lower and posterior sections often does not cause complaints and does not require surgical intervention. Perforations in the anterior parts of the PN, which cause the greatest concern to the patient, usually require plastic closure by surgery.

When planning an operation, it is important to exclude the presence of severe systemic diseases in the patient, the early manifestation of which may be the formation of perforation of the nasal septum, such as Wegener's granulomatosis. For this purpose, the complex of preoperative examination includes a blood test for antibodies to the cytoplasm of neutrophils - c-ANCA

Before the operation, an endoscopic examination of the nasal cavity, computed tomography of the paranasal sinuses, and a study of the microflora of the nasal cavity are performed.

Diseases

Perforations of the septum can be a consequence of severe systemic processes, and also occur with neoplastic, inflammatory or infectious diseases. If the exact cause is not established, the doctor must exclude the presence of serious illnesses. Renal failure and kidney diseases, vasculitis, collagenoses such as systemic lupus erythematosus, rheumatoid arthritis and polychondria can predispose to perforation of the nasal septum.

Unfortunately, some of these conditions may recur after remission

Therefore, it is important to contact your doctor before attempting to repair such perforations. The patient must be informed that, even if the restoration of the septum is successful, relapse is possible if the underlying disease worsens

Russel WH Kridel observed this in several patients with kidney and small vessel diseases.

Less common causes of perforations are Wegener's granulomatosis, sarcoidosis and other granulomatous diseases, which can be ruled out by computed tomography (CT) of the nose and paranasal sinuses. Examination of patients with perforation of unknown etiology with negative results of examination of the head, neck and negative CT data should include laboratory diagnosis of collagenosis, vasculitis and kidney diseases. It should also include fluorescent Treponema antibody testing, FTA-ABS, laboratory tests for sexually transmitted diseases, anti-neutrophil cytoplasmic antibody (C-ANCA) testing, and Epstein-Barr virus testing.

In the presence of an inflammatory process, diagnostic information can be obtained by culture for fungi and bacteria. Skin tests for allergies, tuberculosis and fungal infections are also useful. If all these tests are negative and a clear cause of perforation has not been established, then a biopsy from the edge of the perforation is indicated before any intervention. A biopsy takes material from the posterior edge of the perforation, and in a volume large enough to capture tissue away from it, giving the laboratory the opportunity to make a definitive diagnosis rather than a conclusion about the presence of chronic inflammation. It is important not to take a biopsy from the superior and inferior edges of the perforation, as this will increase its vertical dimension—the one that is most important when attempting repair. Biopsies from the anterior portion of the perforation should also be avoided because this area should be closed first to reduce the appearance of the perforation.

Russel W.H. Kridel and Hossam M.T. Foda

Perforation of the nasal septum: prevention, tactics and recovery

Surgery

It is important to understand that in some cases no medications, no matter how long they are used, will be able to eliminate the existing problem. Often, only surgical treatment methods can provide the desired effect.

Plastic surgeons today use several unique techniques to eliminate holes in the nasal septum, the choice of which depends on the size of the existing perforation.

The most popular of them are:

• Tardi method. The operation allows you to eliminate large holes (up to 5 cm). The essence of the technique is that the hole in the septum is closed with a mucosal flap taken from the patient under the upper lip.
• Friedman and Fairbanks methods, which make it possible to eliminate holes whose dimensions do not exceed 2 cm. During the operation, not only autografts (tissue taken from the patient), but also implants of the artificial category can be used to close the perforation.

If the hole in the nasal septum is small, on the order of a few millimeters, their elimination can be performed by conventional surgical suturing.

The purpose of surgical intervention is not only to eliminate the existing hole, but also to completely restore the physiological functions of the nasal cavity, as well as normalize the patient’s condition.

The procedure is carried out exclusively in an inpatient setting, after which the patient remains in the department for several more days. The duration of hospital treatment depends on the complexity of the operation performed and the condition of the patient. The total period of disability after plastic surgery is about 2 weeks. During the rehabilitation period, the patient must adhere to certain restrictions:

• It is necessary to follow a gentle regimen for a month after surgery. Possible mechanical damage, temperature changes and physical stress should be avoided.
• It is necessary to take into account all the doctor’s recommendations for caring for the nasal cavity.
• For a month after the operation, you should follow a diet: exclude spicy foods and alcohol, do not eat cold or hot foods.

Perforation of the nasal septum is a rather complex structural disorder, which often occurs as a result of serious inflammatory processes in the nasal cavity or after unsuccessful operations. In this case, a through hole is formed in the septum, which can be located not only in cartilage tissue, but also in bone tissue. This condition requires the help of surgeons.

Rehabilitation period

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As a rule, if the operation is performed correctly, not only the perforation of the septum itself is eliminated, but also the function of the nasopharynx is completely restored. The length of hospital stay depends on the complexity of the defect and the patient’s condition.

The patient is recommended to remain on sick leave for another 2 weeks.

The speed of recovery and the absence of side effects after rhinoplasty depends on how strictly the patient adheres to the restrictions during the rehabilitation period. At this time, it is recommended to limit physical activity, avoid temperature fluctuations, follow a strict diet, and exclude alcoholic beverages.

How is the operation performed?

Most often, an open rhinoplasty method is required to eliminate nasal perforation. It allows high-quality and reliable formation of mucosal flaps so that the tissue does not stretch during surgery. For transplantation, flaps of cartilage removed from the inferior conchae or the bottom of the nose are used. Thus, it is possible to close the perforation with its own membrane and restore natural blood circulation to all tissues.

An intermediate graft must be inserted between the installed flaps, which will not allow the pathology to recur in the future, and will also ensure the formation of a complete mucosa along the edges of the new cartilage. This method of operation is successful for holes with a diameter of 2-3 cm. If the perforation is larger, then the effectiveness of the procedure decreases proportionally.

Unfortunately, even surgery does not always guarantee that the problem will be eliminated. The patient agreeing to undergo surgery should be aware of this. Specialists in the field of rhinoplasty are developing tissue stretching techniques that make it possible to obtain a wide variety of flaps to cover wide septal holes. There is even a way to restore cartilage from material taken from the forearm.

If the hole in the cartilaginous septum is too large and extends over the entire area to the dorsum or wedge-shaped void, then it is almost impossible to restore it. The exception is those fabrics that have a membrane cuff to which the flap can be sutured. When there is a risk of insufficient fusion of the membrane, flaps and lateral walls of the nose, clinics can use special sheets that will allow the operation to be carried out in several stages and prevent unnecessary tissue fusion.

What to do about loss of smell

One of the types of complications that arise during the rehabilitation period after septoplasty is loss of smell. If there is no sense of smell in the first two weeks, while there is swelling, then this is quite natural. If the sense of smell does not appear even after three weeks, you should immediately go to a specialist. Such a pathology can be a serious disorder.

There are two forms of loss of smell:

• partial;
• complete.

In order to determine the possibility of restoring sensitivity to odors, it is necessary to carry out diagnostics. The cause may be damage to the mucosa or surgeon error. Pathology can also be an individual reaction of the body to surgical intervention.

In any case, if you have no sense of smell, you should contact your doctor. The sooner the problem begins to be solved, the greater the chance a person has of restoring the natural functions of the nose.

Under no circumstances should you resort to using folk remedies.

After septoplasty, the nasal cavity is very sensitive and exposure to it will only aggravate the situation, adding other complications to the existing problem.

Medications

Ear medications are designed to:

relieve inflammation and accelerate the healing of the eardrum.

For perforation, drops containing antibiotics and steroidal anti-inflammatory drugs are allowed.

Otipax - drops with lidocaine. They are used mainly for pain relief. The steroid included in their composition gives a slight anti-inflammatory effect on the membrane. If you have otitis media, then using Otipax drops alone is not enough.

Otofa is an effective remedy for perforation of the eardrum. Broad-spectrum antibiotic. It is not a pain reliever and is contraindicated for pregnant and nursing mothers.

Sofradex can only be prescribed after a medical examination. Through the hole in the membrane, neomycin, which is part of the product, enters the inner ear and can provoke a toxic effect on cells.

Symptoms

An adult, without consulting a doctor, may assume that he has a perforation. In rare cases, a hole in the septum does not manifest itself in any way.

Almost always, a defect in the nasal cavity is accompanied by symptoms:

• when breathing through the nose, there is a specific slight whistling or whistling sound;
• constantly dry nasal mucosa;
• dry crusts on the inner walls of the nose, causing discomfort;
• frequent, unexplained;
• copious mucus and purulent discharge.

First of all, you should be alert to the whistling sounds made by the nose when breathing. They are quite enough to see a doctor. There is no need to delay your visit.

Diagnostics

Diagnosis of the disease, as a rule, is not difficult - the pathology is determined by direct examination of the patient. An important role is played by a history of previous operations on the nasal septum, trauma to the maxillofacial area and other potential etiological factors. When examining a patient, the following is carried out:

• Anterior rhinoscopy.
  The otolaryngologist determines the presence of a perforation, most often in the anterior part of the nasal septum, which connects the right and left nasal passages. The surrounding tissues are often swollen and hyperemic. There are a large number of dry crusts along the edges of the hole.
• General blood analysis.
  Changes in the CBC depend on the etiology and stage of development. After surgical interventions and injuries, a slight increase in the level of leukocytes and an increase in ESR are detected. With infectious and autoimmune origin, high neutrophilic leukocytosis with a sharp increase in ESR is observed. With an active tumor process, anemia or pancytopenia may be present.
• Bacterial culture.
  If there is nasal discharge, a bacteriological examination of the samples is carried out. This makes it possible to establish the nature of the pathogenic microflora present and its sensitivity to the main groups of antibiotics.
• Specific tests.
  To confirm the autoimmune etiology, determination of specific antibodies by ELISA is indicated. If it is impossible to accurately identify the origin of the perforation, a biopsy of the mucous membrane and quadrangular cartilage is performed.
• X-ray of the nasal bones.
  Performed after injuries with subsequent deformation of the nose to avoid bone fractures. If the X-ray image is poorly informative, there is a suspicion of the development of septic complications or a tumor etiology of the disease, CT of the facial skeleton is used.

Iatrogenic causes

Unfortunately, the most common cause of a perforated nasal septum is previous nasal surgery, especially septoplasty, and treatment for epistaxis. With septoplasty, both mucosal flaps may rupture in the adjacent area where the cartilage or bone between them was removed. If this tear is not immediately repaired, the healing contraction itself will increase the perforation.

It is unreasonable to assume that a perforation will heal on its own; in fact, it is more likely to increase after surgery as the tissue shrinks. It would be prudent to not only suture the mucosal tears, but also introduce a cartilage or connective tissue graft between them as a barrier. Russel WH Kridel, when performing septoplasty, always places crushed cartilage between the septal flaps and the area from which the cartilage was removed, regardless of whether there was damage to the septal membranes.

Often, the cartilage that obstructs the nasal passages and is removed during septoplasty is discarded or sent for pathological examination. Placing it between the flaps, after straightening or crushing, makes this cartilage a barrier against perforation and also, even if it does not survive, against fibrosis between the septal flaps, which can tighten the areas weakened after cartilage removal (Fig. 2).

Rice. 2. A piece of septal cartilage is crushed in a crusher and then placed between the mucoperichondrial flaps to increase the support of the septum and prevent its perforation.

The secret to preventing symmetrical tearing of both mucoperichondrial flaps during septoplasty is to incise widely and separate the mucoperichondrial layer from the curved cartilage or septal spur before removing the spur or curve. Even when there is a large spur, in which disruption of the covering membrane is common, the mucoperichondrial membrane on the other side can usually be easily separated and kept intact. If the alkalinity of the membranes is impaired on only one side, the likelihood of through perforation is significantly reduced.

When there is a large posterior spur, the cartilage is separated from the bony septum, and then the mucoperichondrial layer is separated from the bony part of the spur, on its opposite side, before the spur is removed. Becker scissors are used to cut above and below the bone spur, then the segment with the spur is moved to the center with the tip of the nasal dilator, while the mucoperichondrial layer is pulled away from its protruding part before removing the spur.

Bilateral coincident septal membrane tears can still result in nasal septal perforation even if the cartilage between them is preserved; therefore, these tears need to be stitched. The blood supply to the cartilage comes from the mucoperichondrial layer covering it, and if it is damaged on both sides, the cartilage can become necrotic and inevitably perforate.

Postoperative period

On the first day after surgery, patients will produce bloody mucus, but then it will stop. A day after the operation, the tampons are removed from the nose, and the pads that support the membrane and septum are left in place for some time.

The patient should inject isotonic saline solutions into the nasal cavity, which will keep the pad moist and allow the resulting secretions to be suctioned out more easily over the next 10 days. It is also necessary to lubricate the mucous membrane with antibacterial ointments with cotton swabs to prevent the formation of crusts.

In the postoperative period, a person cannot use vasoconstrictor drugs and must quit smoking and inhale harmful fumes. The first month after the procedure you should not blow your nose.

The external splint and non-absorbable sutures are removed after 7 days. And for 5 days, a patch is applied to the patient’s nose. Through transparent sheets, the doctor examines the condition of the septum for 3 weeks. If it heals well, then the sheets are removed; if not, then they are left for some more time.

Prevention

Preventive actions are aimed at eliminating the causes that have a destructive effect on the nasal septum:

1. Stop inhaling toxic and narcotic substances.
2. Use nasal vasoconstrictors minimally.
3. Use a humidifier in your living space.
4. Prevention of upper respiratory tract infections.
5. Timely treatment of inflammatory diseases of the nasopharynx.
6. Regular follow-up with a doctor regarding the treatment of autoimmune systemic diseases.

Breathing problems after surgery

Septoplasty, like any other operation, is a complex operation, and various complications can develop after it is performed. Patients who decide to take such a step should know what negative consequences can be observed after surgery.

During the rehabilitation period after surgery on the nasal septum, breathing problems are a common complication. This natural process is usually hampered by cotton swabs in the nasal cavity, swelling of the mucous membrane, crusts formed and a postoperative bandage. With the help of an applied bandage, it is possible to tightly fix the cartilage and bones, which helps prevent their displacement. It causes discomfort to the patient only on the first day after surgery, and after some time the person simply does not feel it.

Swelling of the nasal mucosa persists for 5-7 days, after which it begins to decrease and completely disappears after 3 weeks. In order to quickly relieve swelling during the recovery period after septoplasty, it is recommended to follow the following rules:

• maintain bed rest;
• take medications whose action is aimed at strengthening the vascular walls;
• take antihistamines;
• apply a compression bandage with ice;
• carry out physiotherapeutic procedures;
• humidify the air in the living room;
• use nasal sprays.

After surgery on a deviated nasal septum, you may experience pain in the teeth and nose, as well as numbness in this area. The development of this pathological condition is due to the fact that nerve endings from the gums and jaw pass through the nasal cavity. During surgery, they may be stretched or damaged, and subsequently the person will experience discomfort for several months.

Often after surgery for a deviated nasal septum, a sore throat occurs and this occurs due to minor damage to the mucous membrane. After a few weeks, this unpleasant symptom disappears and no longer bothers the patient. Characteristic manifestations after septoplasty are increased drowsiness, slight dizziness and weakness. During the rehabilitation period, it is possible to develop an allergic reaction to medications, and in some cases this can occur during surgery. With such a complication, the patient is selected for a different treatment regimen or prescribed antihistamines.

How is perforation of the nasal septum diagnosed?

If you find yourself with the above symptoms, you should consult a doctor for an examination. During an individual examination, the doctor will palpate the septum to look for any damage to the septal tissue.

Examination of the nasal cavity is called rhinoscopy. In addition, the patient will need to undergo general tests.

After examination, the doctor will determine whether the cartilage remains in place. Depending on the results of the examination, the patient will be given an accurate diagnosis and possible treatment methods will be determined.

Damage to the septum can be traumatic, iatrogenic (as a result of a side effect of surgery or medication) in nature. In cases where it is difficult to determine the cause of the disease, an additional examination of the patient is prescribed.

Most perforations require septoplasty; conservative measures can rarely solve the problem.

Causes of perforation of the nasal septum

Destruction of the nasal septum is a polyetiological pathology. In the vast majority of cases, it is a complication of other conditions and diseases. The main reasons for its occurrence include:

• Surgical procedures.
  This group includes septoplasty, submucosal resection of the septum, bilateral coagulation of vessels in the Kisselbach area, nasogastric intubation, long-term and frequent repeated nasal tamponade.
• Traumatic injuries.
  Include direct injuries to the facial skull with fractures of the bones and cartilage of the nose, post-traumatic hematomas and septal abscesses.
• Infectious diseases.
  Violation of the integrity of the septum is facilitated by tuberculosis, syphilitic and diphtheritic lesions of the mucous membrane, and concomitant HIV infection.
• Autoimmune pathologies.
  The following systemic diseases can provoke the destruction of septal cartilage: sarcoidosis, dermatomyositis, Crohn's disease, systemic lupus erythematosus, rheumatoid arthritis.
• Neoplasms.
  Among oncological pathologies, carcinoma, T-cell lymphomas and cryoglobulinemia are involved in the destruction of the septum.
• Pharmacological agents.
  Atrophy of the mucous membranes and an increased risk of perforation is caused by long-term use of topical corticosteroids and vasoconstrictor drops. Similar changes develop in cocaine addicts.
• Occupational hazards.
  The occurrence of the disease is facilitated by inhalation of large amounts of lime or cement dust, chrome fumes, excessively hot, dry or cold air in the workplace.

Treatment of perforation of the nasal septum

A hole in the nasal septum can only be repaired surgically. How septal plastic surgery will be performed depends on the size of its defect.

If the size of the hole in the nasal septum is up to 5 cm, then plastic surgery of the septum is performed by closing the hole with a flap of the mucous membrane. Very small holes can be removed simply by stitching their edges.

To eliminate larger defects of the nasal septum, artificial implants or transplants of the patient's own tissue are used.

An important task in the treatment of septal perforations is not only to restore its integrity, but also to eliminate the cause of this problem. If it is impossible to completely remove the cause (for example, diabetes, etc.), you should follow all the doctor’s recommendations for the prevention of complications and the recurrence of septal defects.

Causes of perforation

Perforation of the nasal septum can be caused by many reasons:

1. The most common cause is perforation of the nasal septum after septoplasty. This operation is performed to correct nasal defects that interfere with normal breathing. This problem can arise with sinusitis, sinusitis, rhinitis, swelling of the nasal mucosa and some other diseases.
2. Infectious inflammatory processes leading to the destruction of cartilage tissue - syphilis, tuberculosis.
3. Mechanical injuries of the nose.
4. The appearance of hematomas in the nasal cavity.
5. Atrophic rhinitis.
6. Diabetes.
7. Malignant tumors.
8. The use of vasoconstrictor drugs (drops, sprays).
9. Constant inhalation of harmful impurities contained in the air, for example, at work.
10. Inhaling cocaine, which is very irritating to the nasal mucosa.