eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Septal Perforation: Medical Aspects: Follow-up

Author: Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Coauthor(s): James F Chmiel, MD, Clinical Assistant Professor, Department of Otolaryngology, State University of New York at Buffalo
Contributor Information and Disclosures

Updated: Jan 2, 2009

Follow-up

Deterrence/Prevention:

  • Prevention of nasal septal perforations is directed at removing or minimizing stressors known to irritate the nasal septum. These preventive measures need to be tailored to the individual patient.
  • Patient-related prevention techniques (alteration in social habits)
    • Stop cocaine use.
    • Stop or minimize use of topical nasal decongestants.
    • Run a humidifier in the bedroom.
    • Frequently use nasal saline sprays.
    • Use nasal emollients (especially before bedtime).
    • Decrease digital nasal trauma. Parents may want to place mittens on their young children's hands at night.
    • Discontinue the use of aspirin or nonsteroidal anti-inflammatory drugs.
  • Physician-related prevention techniques
    • Prescribe heated, humidified continuous positive airway pressure devices for patients with obstructive sleep apnea.
    • Minimize steroid use in patients.
    • During septoplasty, minimize resection of cartilage and use meticulous technique to avoid bilateral tears in the mucosa.
    • Minimize nasal trauma during the insertion of nasogastric tubes by (1) decongesting the nose with oxymetazoline or phenylephrine prior to nasogastric tube insertion, (2) inserting the nasogastric tube along the floor of the nose parallel to the hard palate and perpendicular to the plane of the face, and (3) lubricating the tip of the nasogastric tube.
    • Modify the nasal cannula in patients on long-term supplemental oxygen and humidify the supplemental oxygen. Taping 2 wooden toothpicks to the hub of the cannula (the thickened plastic part where the prongs are attached) modifies the nasal cannula. This directs the oxygen straight into the nose and away from the nasal septum.
    • When cauterizing the nasal septum for epistaxis, avoid cauterizing both sides simultaneously.

Miscellaneous

Medicolegal Pitfalls

Failure to diagnose a disease entity is a common medicolegal pitfall. The physician who diagnoses a nasal septal perforation must assess the patient for an underlying causative medical disorder or refer the patient to a physician who can perform this evaluation. For example, a patient with sarcoidosis may have a nasal septal perforation. Knowing this before attempting surgical repair is important. The physician can inform the patient preoperatively of the decreased chance of success of the surgery because of the patient's disease. Based on this information, the patient may decide to not proceed with surgery.

Special Concerns

Septal perforations may be a diagnostic challenge for the physician. A thorough history is essential to identify the cause of the perforation. If indicated, laboratory data may assist in further evaluation of those individuals in whom the cause of the perforation remains elusive. For patients with symptomatic septal perforations, medical management may significantly benefit the patient.

 


More on Septal Perforation: Medical Aspects

Overview: Septal Perforation: Medical Aspects
Differential Diagnoses & Workup: Septal Perforation: Medical Aspects
Treatment & Medication: Septal Perforation: Medical Aspects
Follow-up: Septal Perforation: Medical Aspects
Multimedia: Septal Perforation: Medical Aspects
References
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References

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Further Reading

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Keywords

septal perforation, septum, nasal septal perforation, perforated septum, nose trauma, cocaine use, nose picking, nasal trauma, nasal spray, lupus erythematosus, Wegener granulomatosis, illicit drug use, sarcoidosis, nasal silastic buttons, sinonasal malignancy, septal hematoma, nasal-septal fracture, septoplasty, sinonasal tumors

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Contributor Information and Disclosures

Author

Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Rami K Batniji, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, California Medical Association, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

James F Chmiel, MD, Clinical Assistant Professor, Department of Otolaryngology, State University of New York at Buffalo
James F Chmiel, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy and American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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