Operation. When it has been decided to produce a perforation it is carried out with the nasal saw, as described for the removal of spurs (see [p. 595]). The saw is introduced so as to embrace as much as possible of the projection.
After-treatment. The drying and scabbing of discharge along the margin of the perforation is apt to give trouble for some weeks. This inconvenience is the more marked the nearer the perforation approaches to the anterior nares. It must be met by careful and repeated cleansing and lubrication of the nasal chambers. Any scabs should be carefully softened with hydrogen peroxide, lifted off the edge of the perforation, and any underlying ulceration treated with applications of nitrate of silver, argyrol, &c.
OPERATIONS FOR SIMPLE DEVIATION
It is very rare to find a deviation of the nasal septum without some accompanying spur or ledge. It is still more rare to meet with a deviation which is entirely limited to the cartilaginous septum; there is nearly always some bony formation in the deformity, contributed by the nasal spine of the superior maxilla, the vomer, or the perpendicular plate of the ethmoid, or by all three. Hence the limited field of application for the various operations which have been designed for ‘straightening the cartilaginous septum’. In the few cases where the deformity is almost entirely cartilaginous these operations are only partially successful in overcoming its resiliency. They will therefore be only briefly considered.
Gleason-Watson operation. For a thorough performance this operation requires a general anæsthetic. The scheme of the operation is to make a U-shaped incision around the convexity, leaving it attached above. The flap of cartilage is then pushed through the U-shaped opening into the concave side. As its bevelled edge is larger than the button-hole in the septum it will be to some extent prevented from slipping backwards (Fig. 296). This tendency may also be combated by an attempt to snap through the base of the flap of cartilage, and by careful packing of the formerly obstructed nostril. The operation is performed with a nasal saw, carried from below upwards, and maintained carefully in the antero-posterior axis of the septum.
Fig. 296. The Gleason-Watson Operation for Deformity of the Septum. a shows the incision made from the stenosed nostril, and below the convexity; b represents the septum as pushed into the free nostril; and c shows the result after subsequent removal of the spur.
Asch’s operation. The resiliency of a deviated cartilaginous septum is more completely overcome by this method of operating. It requires a general anæsthetic.
