Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic approach for management of septal perforation

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Introduction

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.

Discussion

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.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Alobid I, Castelnuovo P (2017) Nasoseptal perforations: endoscopic repair techniques. Thieme, pp 1–181. ISBN 978-3-13-205391-5

  2. Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 43:80–82

    Article  PubMed  Google Scholar 

  3. Diamantopoulos II, Jones NS (2001) The investigation of nasal septal perforations and ulcers. J Laryngol Otol 115:541–544

    Article  CAS  PubMed  Google Scholar 

  4. Lanier B, Kai G, Marple B, Wall GM (2007) Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 99(6):473–479

    Article  PubMed  Google Scholar 

  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 92:176–180

    Article  PubMed  Google Scholar 

  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):5

    Article  CAS  PubMed  Google Scholar 

  7. Ferguson BJ (1997) Nasal steroid sprays and septal perforations. ENT J 76(2):75–76

    CAS  Google Scholar 

  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):216–218

    CAS  PubMed  PubMed Central  Google Scholar 

  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):604–608

    Article  CAS  PubMed  Google Scholar 

  10. Trimarchi M, Bertazzoni G, Bussi M (2014) Cocaine induced midline destructive lesions. Rhinology 52(2):104–111

    Article  PubMed  Google Scholar 

  11. Dosen LK, Haye R (2011) Surgical closure of nasal septal perforation. Early and long term observations. Rhinology 49(4):486–491

    CAS  PubMed  Google Scholar 

  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):1020–1026

    Article  PubMed  Google Scholar 

  13. Alobid I (2018) Endoscopic closure of septal perforation. Acta Otorrinolaringol Esp 69(3):165–174

    Article  PubMed  Google Scholar 

  14. Chen PG, Floreani S, Wormald PJ (2018) The utility of enlarging symptomatic nasal septal perforations. Ear Nose Throat J 97(3):E41–E43

    Article  PubMed  Google Scholar 

  15. Schultz-Coulon HJ (2005) Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 132(2):213–218

    Article  PubMed  Google Scholar 

  16. Neumann A, Morales-Minovi CA, Schultz-Coulon HJ (2011) Closure of nasal septum perforations by bridge flaps. Acta Otorrinolaringol Esp 62:31–39

    Article  PubMed  Google Scholar 

  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):829–834

    Article  PubMed  Google Scholar 

  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):154–157

    Article  PubMed  PubMed Central  Google Scholar 

  19. Stamm AC, Pignatari SS (2001) Nasal septal cross-over flap technique: a choanal atresia micro-endoscopic surgical repair. Am J Rhinol 15(2):143–148

    Article  CAS  PubMed  Google Scholar 

  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):411–414

    Article  PubMed  Google Scholar 

  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):723–728

    Article  PubMed  Google Scholar 

  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):1606–1610

    Article  PubMed  Google Scholar 

  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–e216

    Article  PubMed  Google Scholar 

  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):235–241

    PubMed  Google Scholar 

  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):386–392

    CAS  PubMed  Google Scholar 

  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):2482–2489

    Article  CAS  PubMed  Google Scholar 

  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):1320–1327

    Article  PubMed  Google Scholar 

  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):324–325

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Unidad Alergo Rino, Centro Médico Teknon. C/Vilana 12, Clinic 194., Barcelona, Spain

    Isam Alobid

  2. Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, Barcelona. c/ Villarroel 170, 08036, Barcelona, Spain

    Isam Alobid

Authors
  1. Isam Alobid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isam Alobid.

Ethics declarations

Conflict of interest

Consultant for Roche lab.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alobid, I. Endoscopic approach for management of septal perforation. Eur Arch Otorhinolaryngol 276, 2115–2123 (2019). https://doi.org/10.1007/s00405-019-05490-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05490-w

Keywords

Search

Navigation