Download IaTROgEnIC PaLaTaL PERfORaTIOn afTER SEPTOPLaSTy

2015
TÜRK
PLASTİK REKONSTRÜKTİF
ve ESTETİK CERRAHİ
DERGİSİ Cilt 23 / Sayı 2
EDİTÖRE MEKTUP
LETTER TO THE EDITOR
Iatrogenic Palatal Perforation After Septoplasty
Septolasti Ameliyatı Sonrası İyatrojenik Damak Perforasyonu
*Burak Kaya, *Emrah Aslan, **Cem Çerkez, *Savaş Serel
*Ankara Üniversitesi Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, Ankara
**Girne Dr. Akçicek Hastanesi, Plastik Rekonstrüktif ve Estetik Cerrahi Kliniği , Girne, KKTC
Dear Editor;
Nasal septoplasty is a corrective surgical procedure performed very frequently in otolaryngology and
in plastic surgery. Nasal septal surgery is frequently
done for the relief of nasal airway obstruction.1 Although 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 anatomic 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 radiographic studies have a leading role in order to prevent
common surgical complications.
In addition to the main complications after septoplasty; 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 presented to our clinic with a complaint of liquids expelling 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 disease or drug abuse. The patient underwent a von Langenback palatoplasty with mucoperiosteal for repair of
Geliş Tarihi : 01.02.2014
Kabul Tarihi : 15.04.2014
Tablo I. Complications in septoplasty1,3
- Septal cartilage defects and
deformities
- Hemorrhage
- Alar base deformity
- Endocranial
complications
- Nerve injuries
- Mucosal bridging
- Blindness
- Sagging of nasal dorsum
- Inefective results
- Infectious problems
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 operation (Figure 2).
Complications after septoplasty significantly decrease a patient’s functional and aesthetic postoperative
results. Postoperative results can be less than optimal in
the setting of incomplete resection, extended nasal trauma, or even overcorrection of the septum. As a result
every nasal surgeon performing this procedure must
be careful and meticulous. With an extensive knowledge and experience, correct surgical technique, and preoperative planning complications can be minimized.3
Palatal defects generally occur as a result of congenital processes, but they can also be acquired. Occasionally, a palatal perforation has been reported secondary to a discreet event such as a cocaine abuse,
infection, systemic disease or trauma.4-7 To our knowledge 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 after 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
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Turk Plast Surg 2015;23(2)
Iatrogenic palatal perforation
Dr. Burak kaya
Ankara Üniversitesi Tıp Fakültesi,
Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, ANKARA
E-posta: [email protected]
REFERENCES
1.
Siegel NS, Gliklich RE, Taghizadeh F, Chang Y. Outcomes of septoplasty. Otolaryngol Head Neck Surg. 2000;122(2):228-32.
2.
Rettinger G, Kirsche H. Complications in septoplasty. Facial Plast
Surg. 2006;22(4):289-97.
3.
Bloom JD, Kaplan SE, Bleier BS, Goldstein SA. Septoplasty complications: Avoidance and Management. Otolaryngol Clin North
Am. 2009;42(3):463-81.
4.
Silvestre FJ, Perez-Herbera A, Puente-Sandoval A, Bagán JV. Hard
palate perforation in cocaine abusers: a systematic review. Clin
Oral Investig. 2010;14(6):621-8.
5.
Ramstad T, Traaholt L. Destruction of the soft palate and nose
by tertiary ‘benign’ syphilis. A case report. J Oral Rehabi.
1980;7(2):111-5.
6.
Kasifoglu T, Cansu D, Korkmaz C. Clinical images: perforation of
the nasal septum and palate due to Wegener’s granulomatosis.
Arthritis Rheum. 2008;58(8):2564.
7.
Vincent RD Jr, Wimberly MP, Brockwell RC, Magnuson JS. Soft palate perforation during orotracheal intubation facilitated by the
GlideScope videolaryngoscope. J Clin Anesth. 2007;19(8):619621.
history of drug abuse that may create a substrate for
perforation.
8.
Muhammad IA, Nabil-ur Rahman. Complications of the surgery for deviated nasal septum. J Coll Physicians Surg Pak.
2003;13(10):565-8.
Although septoplasty is widely performed operation with well established techniques complications are
inevitable. Palatal perforation, although extremely rare,
should be kept in mind especially if the patient complains of liquids expelling through their nose.
9.
Ersoy B, Yilmaz S, Sirinoğlu H, Celebiler O, Numanoğlu A. A rare
complication after septoplasty procedure in a misdiagnosed
submucous cleft palate case: palatal fistula. J Plast Reconstr Aesthet Surg. 2010;63(8):1382-4.
Figure 1. Intraoperative view of the fistula
Figure 2. The view of the palate 3 months after the operation
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