Nasal Septal Perforation - Definition, Causes, Symptoms, Diagnosis and Treatment

Repair of Nasal Septal Perforation

Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair

Holes in nasal septum that divides the nasal cavity is called as nasal septum perforation. The hole can cause a direct communication between the two normally-separate sides of the nose and it can cause deterioration of physiological nasal air flow.

Definition of Nasal Septal Perforation

Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Definition of Nasal Septal Perforation

The nasal septum is a thin structure that composed from cartilage and bone. It divides the nasal cavity and it located in the middle of the nose. When the hole in the septum found, it is called as "nasal septum perforation".

Nasal septum perforation, are classified according to size in three ways:
Small holes - diameter ≤ 0.5 cm
Central holes - diameter of 0.5-2 cm
Large holes - diameter > 2 cm
 

Causes of Perforated Nasal Septum

 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Causes of Perforated Nasal Septum
 
Nasal septal perforation causes can be classified into the following main categories :
Traumatic , iatrogenic , inflammatory / malignant diseases, infectious diseases, nasal medications and occupational causes.
Causes of Nasal Perforation :

Traumatic causes:
- Foreign body
- Finger injury
- Septal hematoma
- Mucosal damage
- Aggressive nose picking

Iatrogenic causes:
- Nasal intubation
- A nasogastric tube placement
- Septoplasty (SMR ) procedure
- Rhinoplasty ( nose job ) surgery

Inflammatory / Malignant Diseases
- Wegener of granulomatous
- Churg - Strauss Syndrome
- Sarcoidosis
- Leprosy
- Leishmaniasis
- My Rhinosclero
- Squamous cell cancer

Infectious Diseases
- Tuberculosis
- Syphilis
- Septal abscess

Applied Medicines in The Nose
- Intranasal steroids ( intrnazal steroids)
- Vasoconstrictor drugs
- Cocaine use
- Decongestants

Occupational reasons
- Glass powder
- Mercury
- Ceramic chrome products
- Phosphorus
  


Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair

Cocaine using can damage the nose and cocaine cause following problems:
- Epistaxis (nosebleed)
- Infections
- Nasal septum perforation (Cocaine Nose Hole)
- Collapse of the nose
- Loss of sense of smell

Cocaine causes these blood vessels which in the lining of the septum to constrict (close down). When the blood supply drops, the lining begins to die. In this case a long time causes nasal septum perforation can occur.
 
 
 

Symptoms of Nasal Septal Perforation

 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Symptoms of Nasal Septal Perforation
 
Nasal septum perforation can cause loss of laminar airflow and recirculation of air in the nasal cavity. This is associated with a symptom of nasal congestion. Large and anterior lesions are more likely to affect nasal laminar air flow and be symptomatic. A perforated septum can vary in size and location and it may be asymptomatic or cause a variety of symptoms. Small anterior septal perforations can cause a whistling noise when breathing. Larger perforations usually have more severe symptoms. These can be a combination of nasal crustation, epistaxis, difficulty breathing, nasal pressure and discomfort. The closer the perforation is to the nostrils, the more likely it is to cause symptoms.
 

Diagnosis of Nasal Septal Perforation

 
 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Diagnosis of Nasal Septal Perforation
 
Nasal endoscopic examination is usually sufficient for diagnosis of septal perforation. Paranasal sinus CT scan may be required for further evaluation and differantial diagnosis.

In the photo above, nasal endoscopic appearance and sinus computed tomography of patient with septum perforation that occurring after rhinoplasty operation are showing.

Medical Treatment - Nasal Septal Perforation

 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Medical Treatment - Nasal Septal Perforation
 
Medical treatment of nasal septal perforation generally involve the topical application of agents that clean and humidify the nasal mucosa. Conjugated estrogen (Premarin), saline sprays, petroleum jelly, mixtures of various oil and petrolatum can be used.
 

Septal Button - Nasal Septal Perforation

 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Septal Button - Nasal Septal Perforation
 
 
Prefabricated septal buttons are other therapeutic options for septal perforations. Placement of nasal septal buttons can provide improvement or resolution of epistaxis, difficulty breathing, pain, and whistling after in many of patients. There are some disadvantages of septal buttons such as, patient intolerance, local irritation, nasal obstruction and accumulation of inspissated secretions. Generally it will be removed within 6 months.
 

Surgical Repair of Nasal Septal Perforation


Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Surgical Repair of Nasal Septal Perforation
 
There are different technique are defined to closure of nasal septum perforation. Mucosal rejuvenation techniques, crossover flap techniques, and other different flap techniques which include cartilages, mucosa with bone parts of nasal septum and adjacent tissues currently use to reparing the septal perforations. Perforation repairing surgery especially suitable for symptomatic patients.
 

Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Small anterior septal perforations can be repaired with local flaps.
Sometimes, inferior turbinate flaps can be use to perforation closure. Many of closure techniques limited to repair of nasal septum perforations which smaller than 3 cm in diameter. Location of perforation is not a contraindication for repairing surgery. Generally general anesthesia can be preferred but local anestehsia with minimal invasive techniques can be also used especially small and anterior perforations.
Different types of connective tissue grafts can be use in the repair of septal perforations; these included mastoid periostium, temporalis fascia or pericranium, septal bone or cartilage, fascia lata and acellular dermal allografts (Source: Combining Rhinoplasty with Septal Perforation Repair).

Septal Perforation Definition, Symptoms, Treatment Video


Repair of Large Septum Perforation With Rib Cartilage Video:




Large Septum Perforation Repair With Rib Cartilage - Examination 4 Month After Surgery Video:



Very Large Nasal Septal Perforations - Surgical Difficulty

Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Very Large Nasal Septal Perforations - Surgical Difficulty

It is difficult surgical closure of large perforations. In large perforations, some authors have suggested the use of labial and oral flaps (source: Innovative technique for large septal perforation repair and radiological evaluation). The open approach can be use to easily assesment of perforation edges and to ensure routine surgical dissection and reconstruction of the defect. Nasal hump, rib cartilages also use for repair of large septal perforation.

Dr. Heller et al. used the "Facial Artery Musculomucosal (FAMM) Flap" to repair of large nasal septal perforations. You can find detailed information at >> Repair of Large Nasal Septal Perforations Using Facial Artery Musculomucosal (FAMM) Flap

Bipedicled mucoperichondrial flaps can be used with endoscopically assisted approach in large septal pefortaions. You can find detailed information at >> Large nasal septal perforation repair by closed endoscopically assisted approach.

While different techniques exist other than thereof; surgical success is  reduced while perforation diameter is increased due to decreased tissue perfusion dryer effect of the nasal airflow.

Postoperative Patient Care After Nasal Septal Perforation Repair

 
Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair
Postoperative Patient Care After Nasal Septal Perforation Repair
 
Postoperatively, nasal silicone splints may stay longer than 1 week especially in patients with large perforation. Saline nasal irrigations or regular humidification is alwas useful before and after the septal perforation repairing surgery. Nasal irrigation and lubrication may provide increasing the success of the operation may improve tissue regeneration.

Antibiotics and pain medication are usually given for a period of first one week.

Dietary and lifestyle changes are not necessary.
 
You can see detailed information about "Definition of Nasal Septal Perforation - Causes of Perforated Nasal Septum - Symptoms of Nasal Septal Perforation - Diagnosis of Nasal Septal Perforation - Medical Treatment For Nasal Septal Perforation - Septal Button - Nasal Septal Perforation - Surgical Repair of Nasal Septal Perforation - Very Large Nasal Septal Perforations - Surgical Difficulty - Postoperative Patient Care After Nasal Septal Perforation Repair"at >>


Source Links >>

  • Nasal Septum Perforasyonu

  • Açık Teknik Septal Perforasyon Ameliyatı

  • Nazal septum perforasyonu, tanımı, nedenleri, belirtileri ...

  • Nasal septum perforation

  • Septal Perforation - Medical Aspects - eMedicine - Medscape

  • Nasal septal perforation - Radiopaedia.org

  • Repair of Nasal Septal Perforation-Surgery Overview

  • Surgical treatment of nasal septal perforations ...

  • A Review of 25-Year Experience of Nasal Septal Perforation ...


  • Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
    Appointment Phone: +90 212 561 00 52
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