Rakesh K Chandra1, Grant T Rohman, William E Walsh. 1. Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. rickchandra@hotmail.com
Abstract
BACKGROUND: This study was performed to present a series of patients who experienced anterior palatal sensory impairment after nasal septal surgery. This phenomenon has not been reported in the English literature to date. METHODS: We reviewed 107 septal surgeries done by the same surgeon over a 3-year period. One hundred one surgeries were septoplasty by technique of submucous resection, three surgeries were septal perforation repairs using a mucosal advancement flap from the nasal floor, two surgeries were excisions of benign septal neoplasms, and one surgery was a closed reduction of a nasal septal fracture. RESULTS: Overall, 3/107 patients (2.8%) experienced postoperative numbness of the anterior palate. Two of these patients underwent septoplasty, and the third patients underwent repair of septal perforation. A chisel was used to resect a portion of the maxillary crest posterior to the nasal spine in 11 patients, including the 3 patients who reported postoperative numbness. Suction cautery was also used in one of the 3 patients to address bleeding of the nasopalatine artery. Two patients reported concomitant palatal paresthesias with numbness, and both had recovery of normal sensation at 3 months follow-up. The third patient, in whom cautery was used, continued to experience numbness 1 year postoperatively. CONCLUSION: Sensory impairment of the anterior palate may result from surgery of the nasal septum and appears to be associated with chisel of the maxillary crest. Cautery should be avoided near the nasopalatine foramen. The relevant surgical anatomy of the nasopalatine nerve is reviewed and discussed in the context of these cases.
BACKGROUND: This study was performed to present a series of patients who experienced anterior palatal sensory impairment after nasal septal surgery. This phenomenon has not been reported in the English literature to date. METHODS: We reviewed 107 septal surgeries done by the same surgeon over a 3-year period. One hundred one surgeries were septoplasty by technique of submucous resection, three surgeries were septal perforation repairs using a mucosal advancement flap from the nasal floor, two surgeries were excisions of benign septal neoplasms, and one surgery was a closed reduction of a nasal septal fracture. RESULTS: Overall, 3/107 patients (2.8%) experienced postoperative numbness of the anterior palate. Two of these patients underwent septoplasty, and the third patients underwent repair of septal perforation. A chisel was used to resect a portion of the maxillary crest posterior to the nasal spine in 11 patients, including the 3 patients who reported postoperative numbness. Suction cautery was also used in one of the 3 patients to address bleeding of the nasopalatine artery. Two patients reported concomitant palatal paresthesias with numbness, and both had recovery of normal sensation at 3 months follow-up. The third patient, in whom cautery was used, continued to experience numbness 1 year postoperatively. CONCLUSION:Sensory impairment of the anterior palate may result from surgery of the nasal septum and appears to be associated with chisel of the maxillary crest. Cautery should be avoided near the nasopalatine foramen. The relevant surgical anatomy of the nasopalatine nerve is reviewed and discussed in the context of these cases.