Fig. 311. Operation for Perforation of the Septum. The muco-perichondrium is reflected for some distance round the opening so as to allow of the projecting rim of cartilage being removed. The exposed edge is then covered over by the mucous surfaces falling together.
This desirable condition can be brought about in crusting perforations by means of the following operation designed by Goldstein.[62] After preparation with cocaine and adrenalin (see [p. 573]), the muco-perichondrium is reflected on each side along the whole circumference of the perforation for a distance of about a quarter of an inch from the free margin. Over the greater part of the circumference this can be done with Freer’s sharp elevator, or with the small sharp elevator employed in submucous resection of the septum. In dissecting the anterior part of the circumference the same kind of elevator can be used, but with the operating edge bent forward at an acute angle (Fig. 311). A slit in the elevated mucous membrane, posterior to the perforation, will relieve tension. With a Ballenger’s single-tine swivel septum knife a rim of cartilage is then cut away around the perforation, so that the two mucous surfaces from opposite nostrils can come in contact and overlap the circular edge of cartilage. This smooth surface will prevent any further sticking and crusting of discharge. It is kept in situ for 48 hours by vaselined cotton-wool plugs, similar to those used in the submucous resection of the septum ([p. 608]).
OPERATION FOR ABSCESS
A free incision is made into it, under cocaine or nitrous oxide anæsthesia. A horizontal cut should extend right across the swelling, and as low in it as possible, to prevent the pocketing of pus. It is sufficient to make it on one side, as the pus from the other side can be pressed across through the defect in the cartilage. Any loose fragments of cartilage should be probed for and removed. The lips of the incision are kept apart by loosely tucking in a small piece of ribbon gauze. This promotes drainage of the lower part, and is changed daily. Afterwards healing takes place under simple cleansing measures.
OPERATION FOR HÆMATOMA
If the hæmatoma be small and not in a suppurating nose, evaporating lotions are applied externally and the swelling is left alone, being carefully inspected daily for early symptoms of suppuration. If the swelling be large and tense, it is safer to incise it freely as described above for abscess of the septum.