nasal septum perforation repair

Nasal septum perforation due to various reasons. Treatment of diseases: nasal septal perforation Indication Nasal septum perforation due to various reasons. Preoperative preparation 1. Trim the nose hair and clean the nasal cavity. 2. Intranasal drops of paraffin oil or compound peppermint oil to keep the mucous membrane moist, and use 0.5% gentamicin or 3% lincomycin to keep the nasal cavity clean. 3. If you want to take the temporalis fascia, you need to shave the hair above the auricle to prepare the skin. Surgical procedure There are many methods for repairing nasal septal perforation. The commonly used methods include nasal septum mucosal displacement repair, nasal septum mucosal flap repair, turbinate mucosal flap transplantation, turbinate mucosal flap transfer and fascia repair. (A) nasal septum mucosal displacement repair method This method is suitable for small perforations in the lower part of the septum, perforation diameter less than 1cm. 1. On the left mucosa of the nasal septum, use a small round knife to make a fusiform incision around the perforation, so that a triangular mucosal flap is formed on the upper and lower sides of the perforation. 2. The two triangular mucosal flaps above and below the perforation are peeled from the tip to the edge of the perforation, and the perforated edges are pedicled, respectively, which are turned up and up and sutured with a silk thread to form a mucosa on the right side of the perforation. 3. Make a loose incision behind the perforation, which is parallel to the trailing edge of the fusiform incision, and the distance between the two should be greater than the diameter of the perforation. The stripper was used to peel back from the fusiform incision to the relaxed incision. Move it forward to cover the sutured triangular mucosal flaps and suture each other. 4. Both sides of the nasal cavity are blocked with finger sleeves and gauze, so that the mucosal flaps on both sides are closely attached. (B) nasal septum mucosal flap repair method This method is suitable for small septum perforation, and there are enough mucosa to form mucosal flaps above and below the perforation. 1. On one side of the septum, a pedicled mucosal flap with a slightly larger perforation is placed over the perforation, and the pedicle is at the upper edge of the perforation, and the length should be at least longer than the diameter of the perforation. 2. On the other side of the septum, below the perforation (and if necessary to the bottom of the nose), take the same size pedicled mucosal flap with the pedicle at the lower edge of the perforation. 3. Peel the mucosal flaps on both sides to the pedicle, and turn the mucosal flap into the perforation. The left mucosal flap turns to the right side of the perforation, and the right mucosal flap turns to the left side of the perforation, so that the wounds of the mucosal flaps on both sides are opposite each other. Fit and then fix each other with sutures. 4. Cut the mucosa of the front and rear edges of the perforation (except for the pedicle), and suture 2 to 3 needles with the raised mucosal flap. 5. Put the disinfecting rubber finger sleeve into the nasal cavity, and the gauze is blocked inside, so that the mucosal flap fits closely. (C) nasal mucosa flap transplantation method, such as the nasal septum perforation site is equivalent to the level of the inferior turbinate, you can use the lower turbinate mucosa close to the perforation side to repair. 1. Use a right-angled small knife to cut the edge of the perforation about 1mm, so that the perforation edge becomes a wound. The wound surface should be funnel-shaped. The lower turbinate side should be cut more, and the other side can be removed less. 2. On the inferior turbinate prepared for repair, and the corresponding part of the perforated edge wound, a right-angled small-pointed knife is used to make a slightly larger perforated annular mucosal incision, and the surrounding mucosa is peeled off, and the center is left as a root pedicle. The exfoliated annular mucosa is perforated to the mucosal flap on the opposite side. 3. Fill the perforation of the contralateral nasal cavity with Vaseline gauze to make the nasal septum and the wound of the inferior turbinate close. Vaseline gauze was taken out after 4.3 to 5 days. Check the adhesion between the nasal septum and the inferior turbinate. If there is a small amount of adhesion, you can scrape a wound at this place to promote the healing of the adhesion. After 4 to 5 weeks, if the perforation and the inferior turbinate are completely adhered, the local blood supply is good. The lower turbinate mucosa adhered to the perforation and the inferior turbinate body can be cut open, and the Vaseline gauze is filled in the middle to push the nasal septum back to the center. (D) nasal mucosal flap transfer method, such as nasal septum perforation position is not in the lower turbinate or middle turbinate plane, you can take a pedicle mucosal flap repair on the inferior turbinate. 1. Cut the mucosa about 1 mm at the edge of the perforation, and then turn it to the opposite side after separation. 2. Make a "" shaped incision on the adjacent turbinate, peel off the mucosal flap to the pedicle, and flip the mucosal flap over the perforation. The mucosal flap should be slightly larger than the perforation and without tension. If there is tension, the pedicle can be cut longer, and the mucosal flap is then sutured to the wound around the perforation. Or fracture the lower turbinate upwards, make a "" shaped incision under the inferior turbinate, turn it over, cover the perforation, and suture it. 3. Put a disinfecting rubber finger sleeve in the contralateral nasal cavity, and the gauze is blocked inside. On the other side, the Vaseline gauze can be used to block the compression at the perforation of the mucosal flap, so that the perforated edge wound is closely attached to the mucosal flap. After 4.2 to 3 weeks, the pedicle was cut and the septum and the turbinate were separated by Vaseline gauze or plastic sheet until the wound healed. (5) Fascia repair The nasal septum perforation fascia has strong viability and can be used to repair larger perforations. 1. First, make a skin incision about 2.5 to 3 cm long at the ankle skin above the auricle to reach the temporalis fascia. Separate and expose the diaphragmatic fascia. Use a small round knife to take a fascia that is several times larger than the perforation, wrap it in saline gauze for storage, and then suture the skin incision. 2. Make a longitudinal incision in front of the perforated nasal septum and peel it off to the mucosa around the perforation with a stripper that should be about 0.5 cm from the edge of the perforation. 3. Place the spare fascia from the incision and insert it between the two layers of mucosa at the edge of the perforation, and then suture it with a silk thread. 4. Both sides of the nasal cavity are filled with sterilized rubber finger sleeves and gauze.