Nasal septal perforations and nasal obstruction

Nasal septal perforations cause a wide range of symptoms that vary from mild discomfort and nasal obstruction to life-threatening epistaxis. The differential diagnosis, pathophysiology, and treatment of this disorder are reviewed.     

Treatment of nasal septal perforations with a custom-made prosthesis

We present the fabrication and clinical use of a custom-made nasal septal silicone button that can be inserted transnasally into a perforation of the nasal septum by the physician as an office procedure, or by the patients themselves in their home. Questionnaire and retrospective chart review were used to evaluate the efficacy of this prosthesis as treatment of disturbing symptoms from nasal septal perforation. The study included 41 patients (27 women) with a nasal septal perforation. The follow-up time ranged from 1 to 9 years. Symptoms investigated were nasal obstruction, crusting, feeling of dryness, pain, epistaxis, and whistling from the nose. The degree of experienced symptoms was estimated on a VAS-scale. The questionnaire was answered by 37 of the 41 patients. Fourteen patients were still using their button at the follow-up. Treatment with the prosthesis greatly diminished all the investigated symptoms. Also, use of the silicone button resulted in an improved quality of life. No case of infection was noted in connection with use of the silicone prosthesis.     

鼻腔复合瓣膜夹层法修补鼻中隔穿孔

我科于2006年1月至2007年8月以来,采用鼻腔底瓣膜推移对合缝合并夹层鼻堤部瓣膜、甚至加用鼻中隔软骨进行修补的方法,治疗鼻中隔穿孔11例,效果满意,报告如下.     

Intranasal aerodynamic aspects in patients with nasal septal perforations

Summary In an attempt to determine the influence of septal perforations on nasal airflow, nasal resistances were measured with active posterior rhinomanometry and compared before and after closure of asymptomatic septal perforations in five patients. No significant differences were found in the nasal resistances before and after closure of perforations either on inspiration or expiration. All patients were also unaware of any perceptive changes in nasal patencies after closure of the perforations.     

Bioactive glass and turbinate flaps in the repair of nasal septal perforations

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft and the use of turbinate flaps in 23 patients with septal perforations. Another 16 patients were treated with mucoperiosteal flaps only. The perforations were successfully closed in 38 of the 39 patients. One patient had a near-total septal perforation due to hypophysial surgery; it could not be closed. No extrusions of the BAG and no BAG-associated infections were seen; the average follow-up period was 28 months. BAG S53P4 seems to be a good interpositional graft in the repair of medium and large nasal septal perforations, and turbinate flaps are also reliable.     

Sandwich graft technique outcomes in medium and large size nasal septal perforations

IntroductionSurgical treatment of medium and large sized nasal septal perforation is challenging. Techniques with and without interposition grafts are used.ObjectiveThe aim of this study is to explain how we apply the sandwich graft technique that we use in medium and large nasal septal perforations as well as to present the results.MethodsWe retrospectively reviewed the patients who were operated with the sandwich graft technique between January 2014 to December 2018 and followed up for at least 6 months. The demographic data, symptom scores, examination, and surgical findings of the patients were taken from the hospital records. Surgical outcomes were presented according to both perforation etiologies (idiopathic or iatrogenic) and sizes (Group A: < 2 cm, Group B: ≥ 2 cm).ResultsWe reviewed 52 cases and 56 surgeries. The average diameter of the perforations was 19.2 mm. The success rate after initial surgeries was 84.6% (44/52). After 4 revision surgeries, the perforation was closed in 88.5% of the cases (46/52). Success rates for Group A and Group B were 90.0% and 86.4%, respectively (p = 0.689). The success rates in idiopathic and iatrogenic cases were 93.3% and 86.5%, respectively (p = 0.659).ConclusionThis study showed that the success rate of sandwich graft technique was higher in medium-sized perforations than large-sized ones and in idiopathic perforations compared to iatrogenic ones, but the latter rate was not statistically significant. This demonstrated that perforation size was not as important in the sandwich graft technique as in flap techniques.     

Measuring the size of nasal septal perforations. A simple radiological method

A simple method of preoperative documentation of nasal septal defects is described. The borders of the defect and the surrounding regions of the nasal septum are marked with an X-ray contrast medium and a lateral radiogram is performed. The perforation is outlined and the image allows evaluation of the size, shape and location of the septal defect. Some clinical examples are presented.     

Repair of nasal septal perforations using local mucosal flaps and a composite cartilage graft

The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.     

A new method of construction of obturators for nasal septal perforations and evidence of outcomes

• Septal obturators and buttons for nasal septal perforations are often poorly tolerated. • We describe a new method of obturator construction using three‐dimensional imaging which more closely replicates the true anatomy of the defect. • Patients were assessed using a questionnaire relating to how symptoms had changed between having no obturator, a conventional obturator and the new CT obturator. • Eight of nine patients had an improvement in total symptom scores comparing old obturators to new CT obturators and this was significant with a P‐value of 0.018 using Student's paired t‐test. • The majority of patients were satisfied with the new obturators and reported an overall improvement of symptoms.     

Surgical closure of septal perforations

Septal perforations only require treatment when symptoms develop. Two surgical procedures are described for the repair of septal perforations. For defects up to 2 cm, a posterior inverting septal flap composed of mucoperiosteum taken from the bony septum has been successful in seven of eight patients. In two patients with large defects, a two-staged nasolabial skin flap was rotated into the defect and was successful in each case.