Septal Perforation – Medical Aspects

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Septal perforations are a diagnostic challenge because various potential are possible. Therefore, elucidating cause of 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.

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.

Using facial bone computed tomography (CT) scans from 3708 patients, a study by Gold et al found the prevalence of nasal septal perforation in an urban population to be 2.05%. history of drug abuse was the predominant risk factor, with cocaine being the most commonly used drug. [1]

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.

retrospective cohort study by Leong and Webb found that nasal septal perforation and chronic rhinosinusitis (CRS) have similar effects on of life, as measured using the Sino-Nasal Outcome Test-22 (SNOT-22). Patients in the CRS cohort had a higher mean total SNOT-22 score (57.2) than did those in the septal perforation cohort (50.2), but the difference was not statistically significant. Lack of statistical significance was also seen for differences in the mean scores for rhinologic and ear/facial symptoms and for the psychological and dysfunction domains. However, the mean score for extranasal rhinologic symptoms was significantly higher for the CRH patients than for those with perforation (11.2 vs 6.4, respectively). [2]

Gold M, Boyack I, Caputo N, Pearlman A. Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging. 2017 May – Jun. 43:80-2. [Medline].

Leong SC, Webb CJ. Sino-Nasal Outcome Test-22 -of-life patterns in patients presenting with nasal septal perforation. Clin Otolaryngol. 2018 Apr. 43 (2):604-8. [Medline].

Peyriere H, Leglise Y, Rousseau A, et al. Necrosis of the intranasal structures and soft palate as a result of heroin snorting: a case series. Subst Abus. 2013. 34(4):409-14. [Medline].

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

Hulterstrom AK, Sellin M, Monsen T, Widerstrom M, Gurram BK, Berggren D. Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations. Acta Otolaryngol. 2016 Feb 6. 1-6. [Medline].

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, Triological Society

Disclosure: Nothing to disclose.

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, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Disclosure: Nothing to disclose.

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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.

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: Society of University Otolaryngologists-Head and Neck Surgeons, AO Foundation, 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

Disclosure: Received honoraria from AO North America for speaking and teaching.

Septal Perforation – Medical Aspects

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