Home > Articles > Patient Preparation
 |
Combined Septal Perforation Repair with Revision Rhinoplasty
|
If the edges of the perforation are inflamed or swollen, a course of systemic antibiotics and steroids and a two-tothree times daily application of intranasal antibiotic ointment should be initiated. Smokers should be started on a cessation program so that postoperatively, irritating tobacco smoke does not endanger the repair. Similarly, cocaine users must abstain completely because the intense vasoconstrictive effect of cocaine, coupled with the irritants (with which “street” cocaine usually is cut), would destroy the repair.
If the patient is fortunate, his or her revision rhinoplasty will require only a dorsal or tip reduction to correct a previous surgery that failed to remove enough. Such cases are ideal for simultaneous perforation repair and may even provide more septal membrane to aid in the closure. Frequently, however, the opposite is the case, and cartilage grafts will be needed for the secondary rhinoplasty. Because most septal perforations occur after a septoplasty in which most of the septal cartilage has been removed and most perforations are in the cartilaginous portion of the septum, little if any septal cartilage generally is available for grafting elsewhere. The patient must be prepared for the harvesting of auricular or rib cartilage or for the use of an alloplastic graft or heterograft. For most perforation repairs, this author recommends the interposition of a connective tissue autograft of either temporalis fascia or mastoid periosteum, which requires another operative site. It can be disconcerting for the uninformed patient to awaken from anesthesia with a bandaged ear or chest when he or she believed that only a nose operation was being performed.
Next Page |
