IN THE NEWS
Congrats to Dr. Kridel
Dr. Russell Kridel has been installed as the President of the Harris County Medical Society for 2013. The Harris County Medical Society is the largest county medical society in the United States, representing more than 11,000 Houston area physicians.
He was recently quoted on Page 9 in the January 11th issue of the Houston Business Journal regarding rising health care costs.
http://digital.bizjournals.com/launch.aspx?eid=86529539-1206-4acf-bf7b-c970f3ed047f&loc=pcmod
Dr. Kridel's commitment to the highest standards in medical care continues to inspire us all. Please join us in congratulating Dr. Kridel.
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Septal Perforation: A Complex Problem
By Dr. Russell Kridel
 What is a septal perforation? It is a hole known as a 'perforation' in the nasal septum --- the tissue that separates the nostrils in your nose. Many patients are not familiar with this insidious, yet complex problem. It can occur as a result of previous nasal surgery, or as a result of a nasal fracture or other trauma, steroid nasal sprays, drug use and many other causes.
This drawing is an example of a perforation of the nasal septum.
When a septal perforation is present, a patient can have any number of uncomfortable and irritating symptoms that make their daily life much more challenging. Symptoms of a perforation include:
- Frequent crusting
- Bleeding
- Whistling while breathing
- Nasal obstruction
- Rhinorrhea (runny nose)
- Some perforations can actually cause collapse of the external nose.
Repairing a septal perforation is also very complex. A perforation in the nasal septum is not just a one-layered hole. It is a hole in the cartilaginous and/or bony portion of the septum that separates your nose into two distinct sides, as well as a hole in both membranes that cover the septum. Unfortunately, I cannot just insert a cartilage graft, because the hole also extends into the covering membranes both on the right and the left sides of the septal cartilage. Therefore, when I repair the hole, I must repair three layers of hole: one membrane on one side, the cartilage in between and then the membrane on the other side.
The surgery to repair the perforation takes approximately three hours under general anesthesia. However, often there are other problems associated with the underlying causes for the perforation. For example, in many cases where a septoplasty was done previously, I find that the septum is still crooked and I must not only go through the scar tissue and repair the perforation, but we must go further back and remove further cartilage or bone to make the airway open. This is another procedure. Or there may be additional structural issues which need to be addressed that will require additional time in surgery.
I always reiterate to patients that this is a very difficult surgery that requires a skilled and experienced surgeon in this particular procedure. I have written more than 20 peer reviewed medical journal articles on this subject and given talks all around the world to help other surgeons recognize and treat this problem.
If you or someone you know has any of these symptoms, they should seek a consultation as soon as possible. Left untreated, a septal perforation can get larger. And the larger the hole, the more difficult it is to close.
For more information about Septal Perforation:
Functional Nasal Surgery (AKA: Septoplasty)
By: Dr. Angela Sturm-O'Brien
 Do you have trouble breathing? And, you are not sure why? Did you have an injury to your nose? Or maybe you had some sort of traumatic impact when you were a young child, but don't remember the event.
Nasal obstruction or difficulty breathing is one of the most common complaints I see as a surgeon specializing in the head and neck area. And, septal deviation is the most frequent structural cause. As a result, surgical correction of septal deviation is the third most common head and neck procedure in the United States
Certainly, if you injure your nose in an accident, you will quickly notice any difficulty breathing. However, patients often don't realize they have a septal deviation because they had a nasal injury or traumatic impact when they were very young. Childhood trauma can cause severe nasal obstructive problems in adult life because any degree of septal deviation usually becomes much more pronounced over time.
In rare cases, the septal deviation may be congenital, or simply the way it developed. Trauma to the nose during birth may result in a deviation, as well. Often a patient will have had several incidences of minor trauma that they may or may not remember that cause "microfractures" and result in bending of the septum over time.
Depending on the direction and force of the nasal injury, septal cartilage can fracture horizontally or vertically, with single or multiple fracture lines. Usually, the junction of the bony and cartilaginous septum is the area of greatest deviation due to trauma.
The primary goal of functional nasal surgery is to create open and even passageways on both sides of the nose so that you can breathe in a normal fashion and improve your quality of life. This is a corrective surgical procedure, known as Septoplasty, done to straighten the nasal septum, which is the partition between the two nasal cavities.
Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it impedes airflow by narrowing that cavity, and often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Not only can a deviated septum be extremely uncomfortable, but it can lead to nasal obstruction and certainly difficulty breathing.
During a septoplasty, the entire procedure is done on an out-patient basis under general anesthesia and takes about 1-2 hours, not including recovery time. There is very little to no bruising from Septoplasty and patients can resume activity within a week or ten days if turbinates are also repaired. Functional nasal surgery is traditionally covered by all of the multiple insurance carriers that I accept.
Many patients want to improve the external appearance of their nose at the same time as the internal structural repair of the septum. This is known as a Rhinoplasty and is considered a cosmetic, rather than functional, procedure. Insurance does not cover cosmetic nasal surgery, but may cover some functional aspects, like repairing nasal valves which can also improve breathing. If you are considering rhinoplasty, there is the advantage of undergoing anesthesia and recovery just one time and some surgical efficiencies.
There are several factors which need to be taken into consideration when deciding which surgical approach is ideal for your nasal surgery, so it is extremely important to have a thorough examination of your nose. During your consultation, I also perform a special test, called Rhinometry, to measure the degree of the obstruction.
No two noses are alike. The way the septum is crooked is unique to each person. I am passionate about making sure that I tailor a treatment plan specific to each patient so that they can achieve the most successful outcome. |
"I am always so humbled by the kind words and accolades from patients and other surgeons. I love what I do. All of us in the practice are so passionate about providing our patients with the best possible care,” said Dr. Kridel.
Dr. Kridel has been named a 2012 Castle Connolly Top Doctor and a Castle Connolly Top Doctor: Southeastern Texas. Each year, Castle Connolly surveys thousands of physicians and other healthcare professionals and asks them to identify excellent doctors in every specialty in their region and throughout the nation. They follow an extensive screening process to identify the top doctors and to provide consumers with detailed information in the Castle Connolly Top Doctors printed guides, online directories and published features. Check out more about the 
Through an additional peer-review process, Dr. Kridel has been selected as a “Best Doctor” — a prestigious roster that represents the top five percent of experts across more than 400 specialties and subspecialties of medicine across the nation. It is the third year in a row that Dr. Kridel has received the distinguished award. Best Doctors® was founded in 1989 by Harvard Medical School affiliated physicians with the purpose to provide patients with access to the best minds in medicine. More 
From 2005-2012, Dr. Kridel has also been designated a Super Doctor in Texas Monthly’s annual Super Doctors list. Candidates are selected based upon surveys of physicians, a medical panel review and additional research analysis. Key Professional Media performs the process, with the goal of finding doctors who have acquired both a “high degree of peer recognition and professional achievement.” 
In addition to these recent 2012 accolades, Dr. Kridel has received numerous prestigious honors and awards throughout his years in practice, including the two highest honors from the 
