Subscribe to RSS
DOI: 10.1055/s-0040-1714667
Perioperative Management of Nasal Septal Perforation: A Case Series and Review
![](https://www.thieme-connect.de/media/fps/202103/lookinside/thumbnails/10-1055-s-0040-1714667_200100or-1.jpg)
Abstract
Nasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6–32 mm), and that for perforations with a diameter below 22 mm was 97.9%.
Keywords
postoperative management - preoperative management - nasal septum - surgical repair - closurePublication History
Article published online:
14 January 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Oberg D, Akerlund A, Johansson L, Bende M. Prevalence of nasal septal perforation: the Skövde population-based study. Rhinology 2003; 41 (02) 72-75
- 2 Kridel RW. Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am 2004; 12 (04) 435-450 , vi
- 3 Lee HR, Ahn DB, Park JH. et al. Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 2008; 1 (03) 154-157
- 4 Tasca I, Compadretti GC. Closure of nasal septal perforation via endonasal approach. Otolaryngol Head Neck Surg 2006; 135 (06) 922-927
- 5 Bohluli B, Motamedi MH, Varedi P, Malekzadeh M, Ghassemi A, Bagheri SC. Management of perforations of the nasal septum: can extracorporeal septoplasty be an effective option?. J Oral Maxillofac Surg 2014; 72 (02) 391-395
- 6 Watson D, Barkdull G. Surgical management of the septal perforation. Otolaryngol Clin North Am 2009; 42 (03) 483-493
- 7 Walker A, Joshi A, D'Souza A. Care of the cocaine user with nasal deformity. Facial Plast Surg 2017; 33 (04) 411-418
- 8 Pedroza F, Patrocinio LG, Arevalo O. A review of 25-year experience of nasal septal perforation repair. Arch Facial Plast Surg 2007; 9 (01) 12-18
-
9
Romo T,
Yalamanchili H,
Moutran HA,
Paul BC,
Presti P,
Pearson J.
Septal perforation: surgical aspects. eMedicine 2018. Accessed July 20, 2019 at: https://emedicine.medscape.com/article/878817-overview.
- 10 Kim SW, Rhee CS. Nasal septal perforation repair: predictive factors and systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (01) 58-65
- 11 Jung YG, Hong JW, Eun YG, Kim MG. Objective usefulness of thin silastic septal splints after septal surgery. Am J Rhinol Allergy 2011; 25 (03) 182-185
- 12 Foda HM, Magdy EA. Combining rhinoplasty with septal perforation repair. Facial Plast Surg 2006; 22 (04) 281-288
- 13 Castelnuovo P, Ferreli F, Khodaei I, Palma P. Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 2011; 13 (06) 411-414
- 14 Teymoortash A, Werner JA. Repair of nasal septal perforation using a simple unilateral inferior meatal mucosal flap. J Plast Reconstr Aesthet Surg 2009; 62 (10) 1261-1264
- 15 von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery--is it justified?. J Laryngol Otol 1993; 107 (10) 902-905
- 16 Virkkula P, Mäkitie AA, Vento SI. Surgical outcome and complications of nasal septal perforation repair with temporal fascia and periosteal grafts. Clin Med Insights Ear Nose Throat 2015; 8: 7-11
- 17 Georgiou I, Farber N, Mendes D, Winkler E. The role of antibiotics in rhinoplasty and septoplasty: a literature review. Rhinology 2008; 46 (04) 267-270