A nasal septal perforation is a medical condition in which the nasal septum, the cartilaginous membrane that cleaves the nostrils, develops holes or fissures.
This may occur directly, as in nasal piercings, or indirectly, such as long-term topical drug use, including intranasal ethylphenidate, methamphetamine, cocaine, crushed pills, or decongestant nasal sprays, chronic epistaxis, excessive nose removal. and as a complication of nasal surgery such as septoplasty or rinoplasty. Less common causes for hollow nasal septum include rare granulomatous inflammatory conditions such as granulomatosis with polyangiitis. It has been reported as a side effect of anti-angiogenesis drugs such as bevacizumab.
Video Nasal septum perforation
Signs and symptoms
The perforated septum may vary in size and location, and is usually found deep within the nose. It may be asymptomatic, or cause various signs and symptoms. Small perforations can cause whistling sounds when breathing. Larger perforations usually have more severe symptoms. It can be a combination of hardening of the skin, emptying blood, difficulty breathing, nasal pressure and discomfort. The closer the perforation to the nostrils, the more likely it causes the symptoms.
Maps Nasal septum perforation
Treatment
Perforation of the septum is administered with many options. Treatment often depends on the severity of the symptoms and the size of the perforation. In general, anterior septal perforation is more disturbing and symptomatic. Posterior septal perforation, which occurs mainly iatrogenic, is often administered by simple observation and sometimes the intended part of the skull base operation. Unobtrusive perforation of the septum can be managed with simple observation. While no perforation of the septum will close spontaneously, since most of the septal perforations that are unlikely to gain greater observation are the proper form of management. For bleeding or painful perforations, initial management should include the humidification and application of the ointment to the perforation edge to speed healing. Peripheral peripheral mucosaisation will help prevent repeated epistaxis and pain and the majority of septal perforation can be managed without surgery.
For perforations where anosmia, or loss of odor, and persistent whistling are a problem, the use of septal sillicone keys is a treatment option. These can be placed when the patient is awake and usually in the clinic. While the complication of the insertion of the buttons is minimal, the presence of the keys can disrupt most patients.
For patients who want a definitive closure, surgery is the only option. Before determining candidacy for surgical closure, a perforation etiology should be determined. Often this requires a biopsy of perforation to rule out autoimmune causes. If a known cause such as cocaine is a disturbing agent, it should be ensured that the patient does not use irritation.
For those who are determined to be medically cleansed for surgery, the anatomical location and size of the perforation should be determined. This is often done with a combination of sinus CT scans without contrast and endoscopic evaluation by Nose and Throat Ear physicians. Once the dimensions are obtained, the surgeon will decide whether it is possible to close the perforation. Some approaches to accessing the septum have been described in the literature. While the sublabial and midfacial degloving approaches have been described, the most popular today is the rhinoplasty approach. This can include open and closed methods. The open method produces scars on the columella, however, allowing for more visibility to the surgeon. The closed method uses an incision on the inside of the nose. The concept behind the closure includes unifying the edges of the mucosa on each side of the perforation with minimal tension. An antposition graft is also frequently used. The anticipate graft provides extended stability as well as structure to the perforation area. Classically, the graft of the scalp using temporalis fascia is used. Kridel et al. First describe the use of the aseliular dermis so that no further incisions are necessary; they report an extraordinary closing rate of over 90%. Overall perforation closure rates vary and are often determined by the skill of the surgeon and the techniques used. Often surgeons who claim a high degree of closure opt for easier perforations to close. An open rhinoplasty approach also allows for better access to the nose to correct concurrent nasal deformities, such as saddle nose deformities, which occur with perforation of the septum.
See also
- Deviation of nasal septum
References
- Different surgical treatments for perforation of the nasal septum and results
- Closure of Septal Perforation Using External Septorhinoplasty Approach
- Experience Review of 25 Year Perforation of Nasal Sepht Perforation
External links
- The Encyclopedia of Drug articles on the perforated septum
- Nasal Septoplasty
- Information and Treatment of Septal Perforation
Source of the article : Wikipedia
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