European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 8, pp 2115–2123 | Cite as

Endoscopic approach for management of septal perforation

  • Isam AlobidEmail author
Review Article



Septal perforation (SP) is a rather uncommondisorder and the most frequent aetiology of SP is nasal surgery, but they can also be secondary to drug abuse, inhaled substances, trauma, neoplasms, or inflammatory systemic diseases.


Despite some asymptomatic presentations, the majority of SPs cause intermittent epistaxis, nasal obstruction, crusting, dryness, purulent discharge, and/or nasal whistling. Patients who have SP and mild symptoms usually require medical treatment such as nasal irrigations and ointments. Septal buttons may also be used in these patients. No gold standard technique has been recognized for the surgical management of SPs. The literature describes many methods of closure of SP. Many endoscopic techniques are available for septal repair, and the choice depends on the osteo-cartilaginous support, characteristics of the perforation (size, location) and the experience of the surgeon.


This article provides a meticulous review focusing on the endoscopic approaches to repair SP. Furthermore; educational drawings and tips and tricks are also discussed.


Endoscopic techniques Nasal septum Septal perforation Surgery 



This paper was supported by a research project from Storz Company that offered instruments and equipment to perform the dissection approaches.

Compliance with ethical standards

Conflict of interest

Consultant for Roche lab.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.


  1. 1.
    Alobid I, Castelnuovo P (2017) Nasoseptal perforations: endoscopic repair techniques. Thieme, pp 1–181. ISBN 978-3-13-205391-5Google Scholar
  2. 2.
    Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 43:80–82CrossRefGoogle Scholar
  3. 3.
    Diamantopoulos II, Jones NS (2001) The investigation of nasal septal perforations and ulcers. J Laryngol Otol 115:541–544CrossRefGoogle Scholar
  4. 4.
    Lanier B, Kai G, Marple B, Wall GM (2007) Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 99(6):473–479CrossRefGoogle Scholar
  5. 5.
    Chang DT, Irace AL, Kawai K, Rogers-Vizena CR, Nuss R, Adil EA (2017) Nasal septal perforation in children: presentation, etiology, and management. Int J Pediatr Otorhinolaryngol 92:176–180CrossRefGoogle Scholar
  6. 6.
    Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I (2018) Nasoseptal perforation: from etiology to treatment. Curr Allergy Asthma Rep 18(1):5CrossRefGoogle Scholar
  7. 7.
    Ferguson BJ (1997) Nasal steroid sprays and septal perforations. ENT J 76(2):75–76Google Scholar
  8. 8.
    Mullace M, Gorini E, Sbrocca M, Artesi L, Mevio N (2006) Management of nasal septal perforation using silicone nasal septal button. Acta Otorhinolaryngol Ital 26(4):216–218Google Scholar
  9. 9.
    Leong SC, Webb CJ (2018) Sino-Nasal Outcome Test-22 quality-of-life patterns in patients presenting with nasal septalperforation. Clin Otolaryngol 43(2):604–608CrossRefGoogle Scholar
  10. 10.
    Trimarchi M, Bertazzoni G, Bussi M (2014) Cocaine induced midline destructive lesions. Rhinology 52(2):104–111CrossRefGoogle Scholar
  11. 11.
    Dosen LK, Haye R (2011) Surgical closure of nasal septal perforation. Early and long term observations. Rhinology 49(4):486–491Google Scholar
  12. 12.
    Nomura T, Ushio M, Kondo K, Kikuchi S (2018) Effects of nasal septum repair on nasal airflow: an analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models. Auris Nasus Larynx 45(5):1020–1026CrossRefGoogle Scholar
  13. 13.
    Alobid I (2018) Endoscopic closure of septal perforation. Acta Otorrinolaringol Esp 69(3):165–174CrossRefGoogle Scholar
  14. 14.
    Chen PG, Floreani S, Wormald PJ (2018) The utility of enlarging symptomatic nasal septal perforations. Ear Nose Throat J 97(3):E41–E43CrossRefGoogle Scholar
  15. 15.
    Schultz-Coulon HJ (2005) Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 132(2):213–218CrossRefGoogle Scholar
  16. 16.
    Neumann A, Morales-Minovi CA, Schultz-Coulon HJ (2011) Closure of nasal septum perforations by bridge flaps. Acta Otorrinolaringol Esp 62:31–39CrossRefGoogle Scholar
  17. 17.
    André RF, Lohuis PJ, Vuyk HD (2006) Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg 59(8):829–834CrossRefGoogle Scholar
  18. 18.
    Lee HR, Ahn DB, Park JH, Kim YH, Sin CM, Youn SJ, Kim JS (2008) Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 1(3):154–157CrossRefGoogle Scholar
  19. 19.
    Stamm AC, Pignatari SS (2001) Nasal septal cross-over flap technique: a choanal atresia micro-endoscopic surgical repair. Am J Rhinol 15(2):143–148CrossRefGoogle Scholar
  20. 20.
    Castelnuovo P, Ferreli F, Khodaei I, Palma P (2011) Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 13(6):411–414CrossRefGoogle Scholar
  21. 21.
    Gras-Cabrerizo JR, Garcìa-Garrigòs E, Ademà-Alcover JM et al (2016) A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo’s flap): CT cadaver study. Surg Radiol Anat 38(6):723–728CrossRefGoogle Scholar
  22. 22.
    Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121(8):1606–1610CrossRefGoogle Scholar
  23. 23.
    Rivera-Serrano CM, Bassagaisteguy LH, Hadad G, Carrau RL, Kelly D, Prevedello DM, Fernandez-Miranda J, Kassam AB (2011) Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 25(6):e212–e216CrossRefGoogle Scholar
  24. 24.
    Alobid I, Mason E, Solares CA, Prevedello D, Enseñat J, De Notaris M, Prats-Galino A, Bernal-Sprekelsen M, Carrau R (2015) Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology 53(3):235–241Google Scholar
  25. 25.
    Santamaria-Gadea A, Lopez-Chacon M, Langdon C, Van Gerven L, Valls-Mateus M, Bernal-Sprekelsen M, Alobid I (2018) Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits. Rhinology 56(4):386–392Google Scholar
  26. 26.
    Santamaría A, Langdon C, López-Chacon M, Cordero A, Enseñat J, Carrau R, Bernal-Sprekelsen M, Alobid I (2017) Radio-anatomical analysis of the pericranial flap “Money Box Approach” for ventral skull base reconstruction. Laryngoscope 127(11):2482–2489CrossRefGoogle Scholar
  27. 27.
    Alobid I, Langdon C, López-Chacon M, Enseñat J, Carrau R, Bernal-Sprekelsen M, Santamaría A (2018) Total septal perforation repair with a pericranial flap: radio-anatomical and clinical findings. Laryngoscope 128(6):1320–1327CrossRefGoogle Scholar
  28. 28.
    Alobid I, Langdon C, Santamaría A (2018) Technique to repair total septal perforation with a pericranial flap: the money box approach. JAMA Facial Plast Surg 20(4):324–325CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unidad Alergo Rino, Centro Médico Teknon. C/Vilana 12, Clinic 194.BarcelonaSpain
  2. 2.Rhinology and Skull Base Unit, Department of OtorhinolaryngologyHospital ClínicBarcelonaSpain

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