Iatrogenic Septal Perforation

Septal perforation is a possible complication of septal surgery. Commonly such patients complaints of dryness of nose and occasional whistling sound (very small perforation).

Various factors play a role in formation of these perforation. Most important is handling of flaps on both sides of cartilage. Ideally one septal flap should be lifted intact. (But that is no guarantee that septal perforation will not happen). next even if accidental tears happen on both side of nasal septum then they ideally should not be at same location. Even if that happens then make it sure that a good piece of septal cartilage or bone lies in between the tear.

Try to give quilting suture to hold both flaps in contact so that no dead space forms and do a soft packing so that by pressure blood supply of flap is not hampered with.

Give good broadspectrum antibiotic cover and keep both flaps lubricated or moist with saline spray.

Button batteries as foreign body in the nose

Button batteries are extremely dangerous foreign bodies in nose. Their potential lies in inducing changes in delicate and sensitive mucosa of the nose and cause damage by mechanical, electrical and chemical means. This multidimensional attack often result in septal perforation leading to saddle nose and features of Atrophic Rhinitis.

The key to limiting the complications is duration between contact of foreign body with the mucosa of the nose. The other key point after foreign body removal is management of the nose. Steroids are often required to limit the escharing. Saline irrigation, gentle debridement away from the septum and application of steroids antibiotic ointment should limit the damage. Oral steroids and antibiotics help to reduce chemical inflammation and limit the nasal damage.

I prefer general anesthesia especially in children as then copious saline irrigation can be done to wash off chemical leaked from batteries.

 

Photo of the leaked button battery

 

5 days after removal of foreign body, the child was again taken up under general anesthesia to remove a very hard crusts which was involving septum, right inferior and middle turbinate blocking right ostiomeatal complex causing right maxillary sinusitis.

 
See the other side of the septum. An imminent septal perforation is evident