What Is a Perforated Septum? 

Nasal septum perforation (NSP)  is a condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole. 

Causes of Nasal Septum Perforation?

The most common cause of Nasal Septum Perforation is complication developed after the previous nose surgeries.

• Trauma (septal fracture, septal hematoma, nasal foreign bodies and nose piercing, continuous nose picking, septal cauterization, nasotracheal intubation),

• Long-term use of nasal spray,

• Cocaine use,

• Inflammation (vasculitides, collagen vascular diseases, sarcoidosis, Wegener's granulomatosis),

• Infection (tuberculosis, syphilis, lepromatous leprosy, mucor, diphtheria, AIDS, etc.),

• Chemical irritants (chromium industry workers)

• Tumors

What Kind of Complaints Does Nasal Septum Perforation Cause?

Symptoms such as crusting, bleeding, whistling breathing sound , nasal congestion, pain, nasal and postnasal drip may be observed in septum perforations. Some patients do not have any complaints. Symptoms vary depending on the location, size, and cause of the perforation. Small perforation at the back side of the nasal septum may be asymptomatic and cause a particularly whistling sound in the anterior part. As the perforation size increases, laminar air flow in the nose is disrupted and turbulent flow occurs. This situation causes drying, crusting and nasal congestion. In addition, a large anterior perforation may cause loss of nasal dorsal support and collapse, called a saddle nose deformity. Moderate to low-grade cartilage inflammation may cause pain in cocaine users and in infectious perforations.

How Is Nasal Septum Perforation Diagnosed?

The nose wings are opened with a little a tool called a nasal speculum and the inside of the nose is examined. An anterior perforation can be easily seen in this examination. Endoscopic examination is performed to see the perforations in the posterior part of the nasal septum. 

In the endoscopic examination, an intranasal examination is performed with a 2.7 or 4 mm thick instrument called a nasal endoscope, with a tiny camera and light at the tip.
Both methods of examination are painless and take a short time. If necessary, sinus tomography can be performed for the detailed evaluation.

Treatment of nasal septal perforation

In the treatment of Nasal Septum Perforation, conservative treatments such as nasal irrigation, softening and moisturizing ointments, septal sealers (septal button) can be applied initially.
However, these treatments are often not sufficient to relieve symptoms. The ideal treatment for permanent solution is surgery. In surgical method, the mucosa in the nose is lifted and turned or pushed towards the perforation. Then the perforation is closed by suturing. Doing this process bilaterally and putting a barrier (cartilage, bone, fascia, etc.) increases the success of the procedure. Successful of nasal septal perforation repair depends especially on the cause, location, size of the perforation, the presence of cartilage-bone tissue at the edges of the perforation, surgical technique, and the surgeon's experience. Since nasal septal perforation is mostly caused by mucosal tears in nasal surgeries such as septoplasty and SMR (submucous resection), reciprocal mucosal tears should be repaired as soon as they are detected. Surgical treatment success is lower in Nasal Septum Perforations that develop as a result of cocaine use, inflammatory diseases such as Wegener's granulomatosis, nose picking, and nasal cautery use. A perforation in the front area has a greater chance of being closed, than in the back one. A small perforation (less than 1 cm) has a closure probability of 90-100%, while a large perforation (greater than 2 cm) has a closure rate of 70-80%.

You can read my articles published in international and national journals about the different surgical techniques I have used in nasal septum perforation surgery and their results on the links below.

1 Islam A, Celik H, Felek SA, Demirci M. Repair of nasal septal perforation with "cross-stealing" technique. Am J Rhinol Allergy. 2009 Mar-Apr;23(2):225-8. doi:10.2500/ajra.2009.23.3299. PubMed PMID: 19401054.
 Islam A, Felek S, Celik H, Arslan N, Can IH, Oğuz H. [Repair of nasal septal perforation with different intranasal flap techniques and their outcomes]. Kulak Burun Bogaz Ihtis Derg. 2009 Sep-Oct;19(5):232-8. Turkish. PubMed PMID: 1996140

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