Specialist ENT SEPTAL PERFORATION

SEPTAL PERFORATION

Perforation of the nasal septum may occur due to various reasons.

Specialist ENT Screenshot 2020 11 27 Ganpati nose

Causes:

  1. Trauma:

    ➣ Surgical post SMR.

    ➣ Nose picking.

    ➣ Repeated cautery.
  2. Malignant diseases:

    ➣ Malignant tumors.

    ➣ Granulomas (Wegner’s).
  3. Chronic infections:

    ➣ Syphilis.

    ➣ Tuberculosis.
  4. Poisons:

    ➣ Industrial poisons like mercury and chromium.

    ➣ Cocaine addicts.
  5. Idiopathic:

    ➣ Most common site: Chondro Vomerine junction.
Pathological stages:
  1. Stage I:    Redness.
  2. Stage II:    Congestion of the mucosa.
  3. Stage III:    Irritation.
  4. Stage IV:    Rhinorrhea.
Sign and Symptoms: 60 % of the septal perforations are asymptomatic. The symptoms depend on the area of   perforation.
a) More anterior the perforation, more the symptoms.
b) Larger the perforation more the symptoms. Symptoms:
  1. Whistling noise during inspiration.
  2. Atrophic changes.
  3. Bleeding.
Treatment:
Medical treatment:
  1. Treat the root cause if any.
  2. Apply cicatric cream to lesion.
  3. Avoid trauma.
  4. Improve general health.
  5. Alkaline nasal douches.
Surgical treatment: Septal perforation repair surgery can be performed using either the “closed technique” or “open technique”. The advantages of the former consist in the fact that it does not leave any external scar. Many Surgeons prefer the “open” technique, as it offers a wider operating field, thus allowing better access to the superior and posterior margins of the perforation (especially in large and/or posterior perforations) and affording binocular vision.

1.Flaps- Surgery aimed at correcting nasal septal perforations is based on two main principles: repairing the perforation using mucosal mucoperichondrial and/or mucoperiosteal flaps from the internal nasal cavity, and connective tissue autografts interposed between the mucosal flap. Buccal flap can also be used. 

Specialist ENT Screenshot 2020 11 27 Ganpati nose

2. Silastic buttons– silicone prosthetic devices can be used in those patients presenting contra-indications for surgery.

Specialist ENT Screenshot 2020 11 27 Ganpati nose
3. Grafts:

    a) Temporalis fascia.

    b) Composite pinna graft.

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