Septal Perforation - Medical Aspects 

  • Author: Rami K Batniji, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 28, 2012
 

Background

Septal perforations are a diagnostic challenge because various potential causes are possible. Therefore, elucidating the cause of the septal perforation requires obtaining a thorough history. Although several surgical options are available for the treatment of symptomatic septal perforations (see Septal Perforation: Surgical Aspects), this article focuses on the medical management of septal perforations.

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Pathophysiology

The nasal septal mucoperichondrium provides the blood supply to the septal quadrangular cartilage. Any insult (eg, chemical, physical, iatrogenic) to this normal anatomy can lead to the development of a perforation.

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Epidemiology

Mortality/Morbidity

Septal perforations can cause significant morbidity. The symptoms associated with septal perforations include nasal congestion or obstruction, nasal crusting and drainage, recurrent epistaxis, and a whistling sound from the nose. In addition to the symptoms related to nasal septal perforations, manifestations of the disease process that caused the perforation (eg, lupus, Wegener granulomatosis) may also carry significant morbidity.

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Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Rami K Batniji, MD  Private Practice, Batniji Facial Plastic Surgery

Rami K Batniji, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, California Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

James F Chmiel, MD  Clinical Assistant Professor, Department of Otolaryngology, State University of New York at Buffalo

James F Chmiel, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

J David Kriet, MD, FACS  Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine

J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: AO North America Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

  1. Adler D, Ritz E. Perforation of the nasal septum in patients with renal failure. Laryngoscope. Feb 1980;90(2):317-21. [Medline].

  2. Avcin T, Silverman ED, Forte V. Nasal septal perforation: a novel clinical manifestation of systemic juvenile idiopathic arthritis/adult onset Still's disease. J Rheumatol. 2006;33(1):199-200.

  3. Baum ED, Boudousquie AC, Li S, et al. Sarcoidosis with nasal obstruction and septal perforation. Ear Nose Throat J. Nov 1998;77(11):896-8, 900-2. [Medline].

  4. Echeverria-Zumarraga M, Kaiser C, Gavilan C. Nasal septal carcinoma: initial symptom of nasal septal perforation. J Laryngol Otol. Sep 1988;102(9):834-5. [Medline].

  5. Fairbanks DNF, Fairbanks GR. Nasal Septal Perforations: Management and Prevention. Aesthetic Plastic Surgery Rhinoplasty. 631-642.

  6. Greene D. Total necrosis of the intranasal structures and soft palate as a result of nasal inhalation of crushed OxyContin. Ear Nose Throat J. Aug 2005;84(8):512, 514, 516. [Medline].

  7. Ibanez-Bermudez F, Castillo Ceballos A, Gallardo Avila A, et al. [Wegener's granulomatosis of the nasal fossa]. Acta Otorrinolaringol Esp. Sep-Oct 1995;46(5):361-4. [Medline].

  8. Kim DW, Egan KK, O'Grady K, et al. Biomechanical strength of human nasal septal lining: comparison of the constituent layers. Laryngoscope. Aug 2005;115(8):1451-3. [Medline].

  9. Kridel RW. Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am. Nov 2004;12(4):435-50, vi. [Medline].

  10. Kriskovich MD, Kelly SM, Jackson WD. Nasal septal perforation: a rare extraintestinal manifestation of Crohn's disease. Ear Nose Throat J. Jul 2000;79(7):520-3. [Medline].

  11. Mathews JL, Ward JR, Samuelson CO, et al. Spontaneous nasal septal perforation in patients with rheumatoid arthritis. Clin Rheumatol. Mar 1983;2(1):13-8. [Medline].

  12. Neville E, Mills RG, Jash DK, et al. Sarcoidosis of the upper respiratory tract and its association with lupus pernio. Thorax. Dec 1976;31(6):660-4. [Medline].

  13. Rejali SD, Simo R, Saeed AM, et al. Acquired immune deficiency syndrome (AIDS) presenting as a nasal septal perforation. Rhinology. Jun 1999;37(2):93-5. [Medline].

  14. Rettinger G, Hosemann W. Measuring the size of nasal septal perforations. A simple radiological method. Rhinology. Sep 1988;26(3):157-9. [Medline].

  15. Robson AK, Burge SM, Millard PR. Nasal mucosal involvement in lupus erythematosus. Clin Otolaryngol Allied Sci. Aug 1992;17(4):341-3. [Medline].

  16. Smith I, Smith M, Mathias D, et al. Cryoglobulinaemia and septal perforation: a rare but logical cause. J Laryngol Otol. Jul 1996;110(7):668-9. [Medline].

  17. Teichgraeber JF, Riley WB, Parks DH. Nasal surgery complications. Plast Reconstr Surg. Apr 1990;85(4):527-31. [Medline].

  18. Vargas-Aguayo AM, Lopez-Perez VM. [Centrofacial lymphoma, cause of middle line granuloma syndrome. Report of a case]. Gac Med Mex. Nov-Dec 1998;134(6):743-6. [Medline].

  19. Williams N. A survey of respiratory and dermatological disease in the chrome plating industry in the West Midlands, UK. Occup Med (Lond). Dec 1996;46(6):432-4. [Medline].

 
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Proposed algorithm for a systematic evaluation of newly diagnosed septal perforations.
A simple technique to modify an oxygen nasal cannula that helps to prevent the cannula tip from rubbing against the nasal septum. Two wooden sticks are taped to the hub of the nasal cannula. This technique can also be used in patients with preexisting septal perforations to decrease crusting and epistaxis.
To assess the size of a perforation, barium paste is applied to the edges of the perforation and a lateral 6-foot plain film is obtained of the head. Technique described by Rettinger and Rosemann.
 
 
 
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