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Combined Septal Perforation Repair with Revision Rhinoplasty
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For most revision rhinoplasty patients who also are found to have a septal perforation, the cause of the perforation is unfortunately iatrogenic. Simple questioning of the patient usually will determine whether the perforation was present prior to the initial rhinoplasty. Some patients will not have been told by the initial surgeon that the nasal obstructive symptoms they have are secondary to a perforation, and the surgeon whom they have sought out for revision rhinoplasty will have the unpleasant task of informing the patient of this further complication. If the perforation was present prior to any nasal surgery, then the patient must be questioned to check for nasal cautery, cocaine use, significant nasal trauma with or without septal hematoma or abscess, over-use of nasal vasoconstrictive or steriod sprays, nose picking, or chemical inhalation of noxious chemicals, such as chromic acid. If no clearcut cause is determined, the surgeon must investigate further for possible medical causes such as collagen vascular disorders, vasculidities, syphilis, granulomatous disorders such as sarcoid, tuberculosis, Wegener’s and midline lethal granulomatosis.4 If all laboratory, bacteriologic, and radiologic studies (i.e., CT scan of the sinuses and a chest radiograph) are normal, biopsy of the posterior end of the perforation may be advisable prior to any repair.
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