Fig. 310. Semi-diagrammatic Transverse Section of the Nose. Shows the compensatory hypertrophy of the inferior turbinal in the unobstructed nostril. Part of this frequently requires removal after the septum has been straightened.
Complementary operations. As a rule the formerly patent nostril is found after this operation to be the more obstructed of the two. The reason of this is readily explained by a reference to Fig. 310. The now redundant hypertrophy in the formerly good nasal chamber is removed—according to its degree and extent—by one of the methods described on [p. 587].
From long disuse marked alar collapse may interfere with the good results of the operation.
Difficulties. Insufficient illumination is a difficulty that can easily be provided against by using a frontal photophore or Clar’s mirror (see [p. 571]).
Hæmorrhage presents no difficulty if patients are prepared as directed (see [p. 574]), unless one happens unexpectedly on a patient with a hæmophilic tendency. In one such case I had no trouble at the time of operation, but bleeding gave great annoyance for a fortnight afterwards.
The incision I have described has always proved sufficient. In some cases this straight incision is unintentionally converted into an L-shaped one, when the flap is torn over a sharp low-lying spur. Beginners may find it easier to start with an L-shaped incision, but it is unnecessary and does not leave so small and clean a wound.
The perichondrium should be raised with great care, for it is more easy than one would think to leave it adhering to the septum, while separating only the mucous membrane.
Previous operations always increase the difficulties of the proceeding. The old-fashioned ‘shaving off’ of spurs often removed the entire thickness of the cartilage at one part, without perforating the concave mucosa. The submucous resection (window operation) is not infrequently not carried far enough. In either of these circumstances we are confronted with the great difficulty of trying to separate the two muco-perichondria—now closely united to one another.
OPERATION FOR PERFORATION OF THE NASAL SEPTUM
When a perforation of the nasal septum is situated at some distance within the nasal orifice it seldom gives any trouble. A perforation may also be situated close to the anterior nares without even making its presence known. But in some cases—no matter what the original cause of the perforation—constant annoyance is given to the patient by the crusting and bleeding which takes place along its margin. When these crusts have been carefully removed inspection will show that the cause of the trouble is the projecting free edge of the cartilage which prevents the edges of mucous membrane from each nostril from closing over it. When this circular edge is healed over smoothly, secretions cease to adhere to it, and the patient is not troubled by the annoying crust formation.