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Blog de Otorrinolaringología

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4 January, 2019

Treatment for perforated nasal septum

Perforación del tabique nasal - Perforació del septe nasal

POST DEL DR. CRITOBAL LANGDON

The perforation of the nasal septum is a medical condition in which, the cartilaginous membrane dividing the nostrils develops a hole or fissure. A perforated nasal septum may cause annoying symptoms such as nasal obstruction, mucus discharge, nasal crusts and frequent nosebleeds. It is usually a consequence of previous nasal surgeries. Not as a consequence of bad practice, but because it is one of the risks when manipulating the nasal septum. Other common causes are repeated traumatisms and cauterizations on the nasal septum and / or nasal packings in people with repeated nosebleeds (epistaxis).

OTHER CAUSES OF PERFORATED NASAL SEPTUM

Some less frequent causes of perforation of the nasal septum are the systemic diseases that cause inflammation of the nose and sinuses, which end up affecting the blood circulation of the nasal septum and finally cause a loss of the tissue. It is also very related to the abuse of toxic substances such as cocaine, which generates direct damage to the nasal mucosa and, in addition, contains substances that generate antibodies that attack the blood vessels that irrigate the nose.

SYMPTOMS OF PERFORATION OF THE NASAL TABIQUE

The perforations of the nasal septum are usually asymptomatic, but sometimes they can cause a significant deterioration of the quality of life.

Typical symptoms include:

  • Nasal obstruction

  • Mucus formation and crusts

  • Recurrent nosebleeds

  • Whistles (in case of small perforations)

In addition to the symptoms related to nasal perforation, some patients are affected aesthetically, because they do not have enough support, a nose deformity called a saddle nose is caused. In cases in which the perforation is too anterior and / or superior, a fall of the nasal tip or alterations of the dorsum of the nose can be observed, affecting its external appearance.


Septal perforation after surgery of the nasal septum in a patient with nasal polyposis. A flap from the floor of the nostril was used to reconstruct the septal defect.
A, intraoperative image of right nostril showing a perforation of 2.2 cm maximum diameter; B final image of the reconstruction in the right nasal fossa; C, final image of the reconstruction in the left nostril.


HOW DO WE DIAGNOSE A PERFORATED NASAL SEPTUM?

To diagnose a perforated nasal septum, it is necessary to perform a nasal endoscopy. It is a simple procedure, performed in the office, in which we: localize the site of the perforation, evaluate the state of the edges and the osteocartilaginous support, remove crusts and make measurements for planning the surgery. In addition, a computerized tomography is performed that allows: assessment of the cartilage and remaining bone of the nasal septum, serves to measure the dimensions of the perforation by means of images and assess the relationship with the other nasal structures.

In cases where the cause of perforation of the septum is not clear in the clinical history, a biopsy is usually performed to rule out autoimmune inflammatory processes or even tumors that may be causing the perforation.

SURGERY FOR PERFORATED NASAL SEPTUM

The treatment is based on the symptomatology of the patient and the quality of life. There are perforations that produce no symptoms, which do not require any treatment. However, for a perforated nasal septum that produces symptoms, the best alternative is the reconstruction of the nasal septum by endoscopic endonasal surgery.

Related post:

· El equipo del Dr. Isam Alobid desarrolla una cirugía que permite la reconstrucción total del tabique nasal

The management of septal perforations is a challenge for the surgeon especially in large perforations (more than 2 cm) associated with aesthetic defects of the nose. Doctors Cristobal Langdon and Isam Alobid have extensive experience in the closure and reconstruction of nasal septum defects, in addition to developing new less invasive techniques with excellent results.



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