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)
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Stop cocaine use.
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Stop or minimize use of topical nasal decongestants.
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Run a humidifier in the bedroom.
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Frequently use nasal saline sprays.
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Use nasal emollients (especially before bedtime).
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Decrease digital nasal trauma. Parents may want to place mittens on their young children's hands at night.
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Discontinue the use of aspirin or nonsteroidal anti-inflammatory drugs.
Physician-related prevention techniques
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Prescribe heated, humidified continuous positive airway pressure devices for patients with obstructive sleep apnea.
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Minimize steroid use in patients.
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During septoplasty, minimize resection of cartilage and use meticulous technique to avoid bilateral tears in the mucosa.
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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.
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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.
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When cauterizing the nasal septum for epistaxis, avoid cauterizing both sides simultaneously.
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Proposed algorithm for a systematic evaluation of newly diagnosed septal perforations.
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A simple technique to modify an oxygen nasal cannula that helps to prevent the cannula tip from rubbing against the nasal septum. Two wooden sticks are taped to the hub of the nasal cannula. This technique can also be used in patients with preexisting septal perforations to decrease crusting and epistaxis.
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To assess the size of a perforation, barium paste is applied to the edges of the perforation and a lateral 6-foot plain film is obtained of the head. Technique described by Rettinger and Rosemann.
