Author Topic: Septoplasty Forum - Large Piece Tissue Covering Septum Came Off  (Read 6420 times)

Offline DrBermant

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Dear Dr. Bermant,
 
I am 57 and have had septoplasty 3 weeks ago to straighten an deviated septum. Fifteen days after the surgery a large piece of the skin covering the left side of my septum came off. It was dead tissue. I can clearly see the septum now.
 
What options do I have now?
 
Sincerely yours,

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

The septum of the nose Rhinoplasty Nasal Anatomy consists of cartilage sandwiched inside of a mucosa layer critical for blood supply and protection. Exposed, the cartilage has a major risk of death. Loss of cartilage can be a major Rhinoplasty Complication resulting in Septal Perforation hole in septum, or even worse, collapse of the nose support similar to this discussion about Collapse of Nose After Cocaine Use

Prevention is so much better than trying to fix such horrible problems. That is part of the art of the surgery itself, and Rhinoplasty After Surgery Care and why picking an experienced surgeon so critical with this surgery. That is why I spend so much time during surgery with techniques that decreased such risks and was very careful when considering such surgery to very high risk patients with poor blood supply issues. I never had to deal with such a problem for my own patients, but would have considered such a problem an emergency for evaluation and consideration of any possible protection option even flap coverage. However, too much missing information.

Once the mucosa has been lost, options depend on the original problem, what was done during surgery, size of the defect, risk factors before surgery, and many other factors best discussed with an experienced surgeon who can review all critical details leading up to the problem and examine the actual problem. How critical time is for intervention also depends on many factors and best determined as soon as possible. Some small defects can close on their own if given the protection optimizing survival. Other times it can be wait and see what happens. Reconstruction can be quite difficult depending on what is left.

Why not share what your doctor said about this problem, plan of treatment, and what has been done so far.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Rhinoplasty, Septoplasty, and Sculpture
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Offline DrBermant

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Re: Septoplasty Forum - Large Piece Tissue Covering Septum Came Off
« Reply #1 on: March 14, 2013, 03:34:21 PM »
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Dear Doctor Bermant,
 
Thank you for your informative reply. I had read about the surgery prior to my operation and as you mentioned, it is the mucosa which supplies the blood supply to the septum so I was very disturbed when I realized what had happened. The surgeon is a UK ENT surgeon with over 25 years experience. During the surgery he also had to deal with extensive polyp removal. I do have to say that it is a pure joy to be able to breath through both nostrils again and to be able to sleep throughout the night without drowning in post nasal drip. Seriously, it has changed my life.
 
The area of exposed septum is approximately 10mm x 5mm in the back of my nose. It crusted over after the dead tissue came out and then this also came off after about a week which was the day before I saw my surgeon for follow up (3 days ago). The exposed area seems to have gotten smaller as if it is closing itself up, but that may just be wishful thinking.
 
My surgeon just said that it happens occasionally, don’t worry about it, it will grow back.
 
It has crusted over again. I will wait and see if the exposed area has reduced again when the crust falls off again and then make a decision either to wait and see or to see another doctor.
 
Thanks again for your reply and best regards,

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Septum surface area is quite large and a 10mm x 5mm is a small fraction of total surface area unless talking about a newborn's nose. Loss of protection is much more of an issue when a large loss has occurred. By large I thought you were talking about several cm of tissue gone. Smaller defects do tend to close on their own depending on many factors that can be discussed here. However, that would be for someone who comes here to post vs just emailing me.

Thank you for your further information. Why not consider talking more on the forum itself about how the breathing has changed your life. This forum gives the public the power to help others understand problems, complications, and issues involved with surgery.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Rhinoplasty, Septoplasty, and Sculpture
Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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