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Post-operative swelling
30%
30/101
A septal hematoma causing a perforation
41%
41/101
A deviated septum that is now straight, resulting in altered nasal airflow
13%
13/101
Excessive columellar show resulting in increased nasal airflow
9%
9/101
A fracture of the bony septum
7%
7/101
Select Answer to see Preferred Response
The patient in this vignette most likely has a septal perforation as a result of a septal hematoma which was initially undiagnosed, untreated, and eventually self-resolved. Septal perforation, particularly following rhinoplasty, presents with a whistling noise heard during respiration. The nasal septum derives its blood supply from the the surrounding mucosa. If the mucosa is compromised during nasal surgery, the septum can undergo necrosis and result in a perforation. Perforations in the setting of nasal surgery are usually caused by either a septal hematoma or septal abscess. Illustration A displays a schematic of a unilateral septal hematoma. Illustration B is an example of a septal perforation. Incorrect Answers: Answer 1: Post-operative swelling would not cause a whistling noise with nasal breathing. Post-operative swelling after rhinoplasty takes months to resolve. Answer 3: A deviated septum that is now straight should improve, not impair, nasal airflow. Answer 4: Excessive columellar show should not affect nasal airflow Answer 5: A fracture of the bony septum is generally performed during septoplasty, and in the absence of a hematoma (the majority of cases), should not result in a whistling nose.
2.9
(7)
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