Nasal Septum Perforation - Definition, Causes, Symptoms, Diagnosis and Treatment
Treatment of Nasal Septal Perforation in Istanbul
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
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
Central holes - diameter of 0.5-2 cm
Large holes - diameter > 2 cm
Causes of Perforated Nasal Septum
Nasal septal perforation causes can be classified into the
following main categories :
Causes of Nasal Perforation :
Traumatic causes:
- Finger injury
- Septal hematoma
- Mucosal damage
- Aggressive nose picking
Iatrogenic causes:
- A nasogastric tube placement
- Septoplasty (SMR ) procedure
- Rhinoplasty ( nose job ) surgery
Inflammatory / Malignant Diseases
- Churg - Strauss Syndrome
- Sarcoidosis
- Leprosy
- Leishmaniasis
- My Rhinosclero
- Squamous cell cancer
Infectious Diseases
- Syphilis
- Septal abscess
Applied Medicines in The Nose
- Vasoconstrictor drugs
- Cocaine use
- Decongestants
Occupational reasons
- Mercury
- Ceramic chrome products
- Phosphorus
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
- 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.
Severe Necrosis of The Nasal Septum ame Turbinates Resulting From Vasculitis
The video above shows intranasal examination images of a patient with Crohn's Disease and different vasculitic diseases. After the patient's nasal septum perforation, which started fine for 15 years, dark colored necrotic tissue pieces started to come out from the nose. As seen in the video, unfortunately, it is seen that the inside of the nose has turned into a single cavity, and there is widespread inflammatory secretion, drying and crusting.
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.
The nasal septum, which is normally located in the midline of our nose, separates the nasal cavity into two separate air sections in a vertical oblique plane. Depending on the holes in the nasal septum, ie, due to nasal septum perforations, the air entering into the nose enters both air cavities at the same time rapidly passing through the hole in the nasal septum instead of entering two separate cavities. Due to the acceleration of the air entering the nose, it dries the mucosa, which is hit by the rapid air flow in the nose, and changes occur in the tissue over time. As seen in the photo above, it can be seen how the mucosa is dry and white in color, as the perforation of the patient with septum perforation appears to have changes in the outer nasal wall immediately adjacent to the perforation in adjacent mucosal areas.
Long-term mucosal damage due to nasal septum perforation and nasal hyperventilation
The nasal septum, which is normally located in the midline of our nose, separates the nasal cavity into two separate air sections in a vertical oblique plane. Depending on the holes in the nasal septum, ie, due to nasal septum perforations, the air entering into the nose enters both air cavities at the same time rapidly passing through the hole in the nasal septum instead of entering two separate cavities. Due to the acceleration of the air entering the nose, it dries the mucosa, which is hit by the rapid air flow in the nose, and changes occur in the tissue over time. As seen in the photo above, it can be seen how the mucosa is dry and white in color, as the perforation of the patient with septum perforation appears to have changes in the outer nasal wall immediately adjacent to the perforation in adjacent mucosal areas.
Chronic perforation of the nasal septum is associated with atrophy epithelial changes in the mucosal surface as a result of prolonged accelerated air contact. In this way, the ventilation purification and heating capacity of the nose gradually decreases over time. So, both nasal hyperventilation and mucosal changes may result in decreased nasal functions.
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
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
Surgical Repair of Nasal Septal Perforation
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| 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.
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| In the photo above, a button-shaped cartilage graft covered by normal intranasal mucosa is seen in the perforation area of the patient who had a nasal septum perforation repair a few months ago. |
Septum Perforation Repair With Underskin Tissue and Septal Cartilage Videos and Photos:
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:
Before and 3 Months After Nasal Septum Perforation (4x3cm) Surgery
Nasal Septum Perforation (4x3 cm) - Before and 3 Months After Repairing Surgery Video
Open technique nasal septum perforation closure operation (using rib cartilage) was performed on the patient who applied to our clinic for the surgical treatment of a 4x3 cm septal perforation that occurred after a septorhinoplasty operation performed in another clinic. After 3 months, the patient's internal nasal silicone splints were removed and it was observed that the perforation was completely closed. This was a result that made me happy, as we knew that the perforation edges were quite dry and thin prior to the operation.
Very Large Nasal Septal Perforations - Surgical Difficulty
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| 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.
You can see image on the above, there is a tomography scan showed that nasal septum perforation (red arrow), right inferior turbinate (yellow arrow), left inferior turbinate (green arrow).
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
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 >>
- Repair of Large Septum Perforation With Rib Cartilage Video
- Large Septum Perforation Repair With Rib Cartilage - Examination 4 Month After Surgery
- Nazal septum perforasyonu, tanımı, nedenleri, belirtileri ve tedavisi
- Nazal Septum Perforasyonu - Tanımı, Belirtileri ve Tedavisi
- Septum Perforasyonu Nedir ve Nasıl Tedavi Edilir?
Source Links >>
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
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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