CLINICAL CHALLENGE

The nose is the most commonly injured facial bone. A fractured nose must be evaluated immediately for the presence of a septal hematoma (a large blot clot involving the nasal septum). If not drained promptly a septal hematoma may lead to infection, septal perforation, and long-term nasal deformity. If a perforation has developed a corrective functional rhinoplasty and septal perforation repair must be performed simultaneously to yield the best clinical outcomes.

Figure 1: Nasal trauma commonly results in fractures of the delicate nasal bones as well as bruising, displacement, or perforation of the underlying nasal septum.
Figure 1: Nasal trauma commonly results in fractures of the delicate nasal bones as well as bruising, displacement, or perforation of the underlying nasal septum.
PROCEDURE OVERVIEW

Septal perforations may be approached via an open rhinoplasty approach facilitating septal perforation repair and functional rhinoplasty concomitantly. The septal perforation is repaired first and then the nose is reconstructed to the desired cosmetic result.

Figure 2: Nasal fractures can typically include damage to or displacement of the nasal septum.
Figure 2: Nasal fractures can typically include damage to or displacement of the nasal septum.
SURGICAL CONSIDERATIONS

Septal perforation repair via a standard open rhinoplasty approach with primary mucosal advancement flaps for repair tends to decrease projection and increase rotation of the nasal tip. In cases where there is severe ptosis(drooping) of the nasal tip this may be a desirable outcome in correcting the ptotic nose.

CLINICAL RESULTS

Rhinoplasty and septal perforation repair performed simultaneously provides the patient with the best clinical outcome and avoids unnecessary anesthesia and the compounded risk of multiple nasal surgeries.

SURGEON COMMENTS

Dr. Jason Hamilton is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute. Dr. Hamilton is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology/Head and Neck Surgery and is one of only a handful of septal perforation specialists worldwide.

For more information on the deviated septum, septoplasty, functional rhinoplasty and septal perforation repair by Dr. Jason Hamilton, septal perforation specialist, please contact the Osborne Head and Neck Institute or visit www.perforatedseptum.com.