PLASTİK REKONSTRÜKTİF
EDİTÖRE MEKTUP
LETTER TO THE EDITOR
ve ESTETİK CERRAHİ DERGİSİ TÜRKwww.turkplastsurg.org
88Cilt 23 / Sayı 2 2015
Dear Editor;
Nasal septoplasty is a corrective surgical procedu- re performed very frequently in otolaryngology and in plastic surgery. Nasal septal surgery is frequently done for the relief of nasal airway obstruction.1 Altho- ugh it is usually considered as common and generally performed by incipient surgeons it carries the risk of significant complications (Table 1). Patients’ increased expectations from surgeons are orienting them to a vertical decline in life quality, after the complications of procedure.2
For a proper breathing, the most important anato- mic localization is the vestibule and the valve region.
Cranial (osseous) and posterior septal deformities like spurs are of less importance for functional benefit of this operation. Functionally, correction of the caudal (cartilaginous) part of the nasal septum is the primary goal for surgeons.2 Complications in surgery can be difficult to avoid, however they can be prevented or reduced by adequate preoperative planning and good operative technique. Preoperative analysis and radiog- raphic studies have a leading role in order to prevent common surgical complications.
In addition to the main complications after sep- toplasty; there are some unexpected complications.
Palatal perforation after nasal septoplasty procedure is extremely rare. A patient with palatal fistula formation after septoplasty procedure is presented in our case.
A 20-year-old otherwise healthy male patient pre- sented to our clinic with a complaint of liquids expel- ling through his nose 15 days after a nasal septoplasty with submucosal resection. On oral examination, a perforated palate was noticed. There was a 0.50 X 0.40 cm defect in the midline of the posterior hard palate (Figure 1). He did not have a history of any systemic di- sease or drug abuse. The patient underwent a von Lan- genback palatoplasty with mucoperiosteal for repair of
the palatal fistula. The follow-up period was without complication, his symptoms fully resolved, and he had no recurrence of the fistula three months after the ope- ration (Figure 2).
Complications after septoplasty significantly dec- rease a patient’s functional and aesthetic postoperative results. Postoperative results can be less than optimal in the setting of incomplete resection, extended nasal tra- uma, or even overcorrection of the septum. As a result every nasal surgeon performing this procedure must be careful and meticulous. With an extensive knowled- ge and experience, correct surgical technique, and pre- operative planning complications can be minimized.3
Palatal defects generally occur as a result of con- genital processes, but they can also be acquired. Oc- casionally, a palatal perforation has been reported se- condary to a discreet event such as a cocaine abuse, infection, systemic disease or trauma.4-7 To our know- ledge there are very few cases of palatal perforation after septoplasty. Muhammad and Nabil-ur Rahman reported 2 cases of palatal perforation in a series of 200 patients.8 The medical history of these patients was not mentioned. Additionally Ersoy and colleagues9 have presented a case report about a palate perforation af- ter septoplasty in whom they found a submucous cleft during the surgery. This cleft may have facilitated the occurrence of perforation. The presented patient does not have any anatomical variations, systemic disease or
Geliş Tarihi : 01.02.2014 Kabul Tarihi : 15.04.2014
*Ankara Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, ANKARA
**Girne Dr. Akçicek Hastanesi, Plastik Rekonstrüktif ve Estetik Cerrahi Kliniği , GiRNE, KKTC
*Burak Kaya, *Emrah Aslan, **Cem Çerkez, *Savaş Serel
IaTROgEnIC PaLaTaL PERfORaTIOn afTER SEPTOPLaSTy
SEPTOLaSTİ aMELİyaTI SOnRaSI İyaTROjEnİK DaMaK PERfORaSyOnU
- Septal cartilage defects and
deformities - Hemorrhage
- Infectious problems - Endocranial complications - Alar base deformity - Nerve injuries
- Mucosal bridging - Blindness
- Sagging of nasal dorsum - Inefective results Tablo I. Complications in septoplasty1,3
89
www.turkplastsurg.org
Turk Plast Surg 2015;23(2)
Dr. Burak KAyA
Ankara Üniversitesi Tıp Fakültesi,
Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, ANKARA E-posta: drburak@yahoo.com
REfEREnCES
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Rettinger G, Kirsche H. Complications in septoplasty. Facial Plast 2.
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Bloom JD, Kaplan SE, Bleier BS, Goldstein SA. Septoplasty com- 3.
plications: Avoidance and Management. Otolaryngol Clin North Am. 2009;42(3):463-81.
Silvestre FJ, Perez-Herbera A, Puente-Sandoval A, Bagán JV. Hard 4.
palate perforation in cocaine abusers: a systematic review. Clin Oral Investig. 2010;14(6):621-8.
Ramstad T, Traaholt L. Destruction of the soft palate and nose 5.
by tertiary ‘benign’ syphilis. A case report. J Oral Rehabi.
1980;7(2):111-5.
Kasifoglu T, Cansu D, Korkmaz C. Clinical images: perforation of 6.
the nasal septum and palate due to Wegener’s granulomatosis.
Arthritis Rheum. 2008;58(8):2564.
Vincent RD Jr, Wimberly MP, Brockwell RC, Magnuson JS. Soft pal- 7.
ate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope. J Clin Anesth. 2007;19(8):619- 621.
Muhammad IA, Nabil-ur Rahman. Complications of the sur- 8.
gery for deviated nasal septum. J Coll Physicians Surg Pak.
2003;13(10):565-8.
Ersoy B, Yilmaz S, Sirinoğlu H, Celebiler O, Numanoğlu A. A rare 9.
complication after septoplasty procedure in a misdiagnosed submucous cleft palate case: palatal fistula. J Plast Reconstr Aes- thet Surg. 2010;63(8):1382-4.
Iatrogenic palatal perforation
figure 1. Intraoperative view of the fistula
figure 2. The view of the palate 3 months after the operation
history of drug abuse that may create a substrate for perforation.
Although septoplasty is widely performed operati- on with well established techniques complications are inevitable. Palatal perforation, although extremely rare, should be kept in mind especially if the patient compla- ins of liquids expelling through their nose.
