30630 Repair nasal septal perforations

Name of the Procedure:

Repair of Nasal Septal Perforations
Common names: Septal Perforation Repair, Nasal Septum Repair

Summary

Repair of nasal septal perforations is a surgical procedure to close holes in the nasal septum, which is the cartilage and bone that separates the two nostrils. The surgery aims to restore the normal structure and function of the nasal passages.

Purpose

Nasal septal perforations can cause symptoms such as nasal congestion, nosebleeds, crusting, and breathing difficulties. This procedure aims to alleviate these symptoms by closing the perforation, thereby improving nasal airflow and overall nasal health.

Indications

• Persistent nosebleeds
• Chronic nasal congestion
• Frequent nasal infections
• Crusting inside the nose
• Whistling sound while breathing
• Discomfort or pain in the nose
• Significant nasal deformity or deformity impacting quality of life

Preparation

• Patients may be asked to fast for several hours before the surgery.
• Preoperative assessments, including a physical examination and imaging tests like nasal endoscopy or CT scans, may be performed.
• Patients should inform their doctor about any medications they are taking, as adjustments might be necessary, especially blood thinners.
• Smoking cessation is highly recommended prior to and after the surgery for optimal healing.

Procedure Description

1. Anesthesia: The procedure is performed under general anesthesia or local anesthesia with sedation.
2. Incision: The surgeon makes incisions inside the nose to access the septum.
3. Closure: Depending on the size and location of the perforation, various techniques such as grafting with tissue from the patient’s own body (e.g., from the ear or rib) or flaps from the nasal lining may be used to close the hole.
4. Stabilization: Splints, stents, or packing may be placed inside the nostrils to support the repair and reduce bleeding.
5. Completion: The incisions are sutured closed, and sometimes dissolvable stitches are used.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity of the perforation.

Setting

The surgery is usually performed in a hospital or surgical center, mostly as an outpatient procedure, meaning the patient can go home the same day.

Personnel

• Otolaryngologist (ENT surgeon)
• Anesthesiologist
• Surgical nurses
• Postoperative care team

Risks and Complications

• Infection
• Bleeding
• Persistence or recurrence of the perforation
• Scarring
• Altered sense of smell
• Adverse reactions to anesthesia
• Nasal obstruction or deformity

Benefits

The primary benefit is the resolution of symptoms associated with the perforation such as improved breathing, reduced nasal crusting and bleeding, and relief from discomfort. Benefits are typically realized within a few weeks after the procedure as healing progresses.

Recovery

• Patients may experience some discomfort, swelling, or congestion post-operatively.
• Nasal packing or splints are typically removed within a week.
• Avoid strenuous activities for several weeks.
• Follow-up visits are important to monitor healing.
• Patients should avoid blowing their nose and follow all care instructions provided by their surgeon.

Alternatives

• Non-surgical management: nasal saline irrigation, moisturizers, and protective ointments.
• Septal buttons or prostheses: temporary devices to cover the perforation.
• Pros: Less invasive options may provide symptom relief without surgery.
• Cons: Non-surgical methods may not provide a permanent solution and may not be suitable for all patients.

Patient Experience

During the procedure, patients won’t feel pain due to anesthesia. Post-surgery, there may be swelling, crusting, or mild pain managed with medications. Nasal congestion is common initially, but it typically improves as healing progresses.