What Is a Nasal Septum Perforation?

Nasal septum perforation refers to the permanent perforation of the nasal septum through the nasal cavities for various reasons. The shape, location and size of the perforations vary. Nasal septum perforation is mostly the result of nasal septal surgery injury. Although it does not cause serious consequences, its symptoms often trouble patients.

Basic Information

English name: perforation of nasal septum
Visiting department: ENT

Common locations: nasal septum
Common causes: Trauma, nose specific infectious disease
Common symptoms: Nasal dryness and pus formation, often accompanied by headache and nosebleeds

Causes of Nasal Septum Perforation

Trauma

Frequent digging of the nose, nasal septum abscess caused by nasal trauma, nasal septum surgery damage mucosa on both sides of the nasal septum, corrosive and irritating substances such as chromic acid, silicon dust, arsenic, mercury, cement, lime and other long-term irritation caused by nasal septum mucosa, Caustic drugs are repeatedly used to cauterize the mucous membranes on both sides of the nasal septum.

2. Special infectious diseases of the nose

For example, perforations caused by tuberculosis, lupus, and leprosy are mostly in the cartilage of the nasal septum, and syphilitic perforations are mostly located in the bone of the nasal septum with saddle nose.

3. Acute infectious diseases

Such as diphtheria, smallpox, typhoid and scarlet fever.

4. Other

Wegener's granulomas, nasal cancer, foreign bodies and stones. Nasal trauma caused improper management of nasal septum injury. Improper management of nasal septum abscess. The course of the disease that causes nasal septum ulcers is prolonged.

Clinical manifestations of nasal septum perforation

The variety of causes of nasal septum perforation determines that it can be manifested either as an independent disease or as a local manifestation of a disease. As far as perforating the nasal septum is concerned, it is mainly manifested by dry nasal cavity and pus formation, often accompanied by headache and nosebleeds. If the small perforator is in the anterior segment of the nasal septum, whistling sounds often occur; if it is in the posterior segment of the nasal septum, there is no whistling sound. Tuberculosis and viruses cause pus odor.

Nasal Septum Perforation

Nasal examination revealed perforation of the nasal septum, crusting of the perforation, erosion of the edge of the perforation, and easy bleeding. Sometimes small perforations are often covered by scabs and ignored. The scabs should be removed and the size, location, and shape of the perforations should be carefully examined.

Diagnosis of nasal septum perforation

Nasal cavity dry, often with pus formation, causing nasal congestion and headache, often with blood in the nose or nosebleeds, if the perforation is in the front of the nasal septum, there can be whistle when breathing, the perforation in the back of the nasal septum can be asymptomatic Easy to diagnose.

Any swollen nasal septum with symmetrical swelling, obvious local pain, and redness and pain associated with nasal bridge and nasal tip should be carefully examined, and pus can be diagnosed by aspiration through the swelling site.

Nasal Septum Perforation Treatment

1. Nasal septum mucosal flap repair method

(1) Reduced suture method is suitable for small perforations located before and below the nasal septum. After local surface and infiltration anesthesia, remove the edge of the perforation a little to form a fresh wound. Make an arc-shaped incision at 1 ~ 2cm above the edge of the perforation, and its length should exceed the diameter of the perforation. Separate the mucosal periosteum on both sides of the nasal septum from the perforation wound margin to an arcuate incision to loosen the mucoperiosteal membrane, then pull it back and cover the perforation. Place the septum soft tissue valve 1 to 2 cm below the soft tissue valve and pull the tissue valve Pull forward to cover the perforation and stitch at the front upper edge of the perforation.

(2) Nasal septum mucosal flap index repair method is to make a curved incision on the left mucosa of the nasal septum, bypassing the perforation trailing edge from below the perforation to below the perforation. From the beginning of the incision, another arc-shaped incision is made around the leading edge of the perforation. The two merge into a fusiform shape, with a perforation in the middle and a triangular mucosal flap on the upper and lower sides. Peel off to form a mucosal flap with the perforated edge as the pedicle. Turn the mucosal flap above the perforation downwards and the lower mucosal flap upwards. This forms the mucosa on the right side of the perforation. The coverage of the left perforation is the same as that of the unilateral reduction suture, but the width of the mucosal flap must be guaranteed.

2. Turbinate mucosal flap repair method

(1) The inferior turbinate mucosa transposition method is used to remove the perforated margin a little to form a new wound. Make an inverted "U" incision on the ipsilateral middle turbinate, peel the mucosal flap from the top to the pedicle, flip this mucosal flap over the perforation, and sew it around the wound edge around the perforation. The contralateral nasal cavity was stuffed, and the pedicle was cut off after 2 to 3 weeks.

(2) The inferior turbinate mucosal transposition method is the same as above, except that a positive "U" incision is made on the surface of the inferior turbinate, and the mucosal flap is flipped over the nasal perforation higher than the level of the inferior turbinate.

3. Nasal floor and nasal septum mucosal repair method

Make a front-to-back incision on the outer side wall of the lower nasal passage of one side of the nasal cavity. From this incision down to the bottom of the nose, and then separate the mucoperiosteal and mucochondral membranes as far as possible. The opposite side is treated in the same way. Then cut a narrow mucosal flap forward and backward at the upper edge of the perforation, transposition the bilateral mucosal flap upwards, cover the position on the perforation, and suturing the two sides.

4. Free nasal tissue transplantation

Extranasal tissues used to repair perforation of the nasal septum are temporal fascia broad fascia, tibial periosteal, and so on. The free graft should be slightly larger than the perforation. Make a longitudinal incision in front of the left nasal septum perforation, and peel off the mucosa around the perforation with a stripper from the incision. The removed fascia was placed in the incision and embedded between the two layers of mucous membranes that had been peeled off around the perforation, and then fixed with sutures. The nasal cavity was packed and compressed.

5. Non-surgical closure

According to the size of the perforation, "H" shaped silicone buttons of different specifications are selected and embedded in the perforation site. The two leaves of the button are located on both sides of the nasal septum, and the central axis of the two leaves is located in the middle of the perforation.