A hole of the nasal septum (perforated septum)
Nasal septum perforation usually occurs due to surgical trauma and other traumatic causes (such as finger nose mixing and cocaine use). Apart from these, it can also occur due to systemic diseases that can hold the nose. Because septal perforation can be associated with many systemic diseases, it is essential to have a detailed medical history assessment. The causes of septal perforation are numerous and varied. Inflammatory diseases such as collagen vascular diseases, sarcoidosis and Wegener granulomatosis can cause septal perforation. In addition, it can cause septum holes in infected processes such as, for example, tuberculosis, syphilis and fungal diseases. Rarely, septal perforation is the first finding of sinonasal malignancies (nose and sinus cancers). Drug use should be monitored. Chronic use of vasoconstrictive nasal sprays and steroid nasal sprays may cause septal perforation. In addition, the use of cocaine may cause septal holes. Work with industrial gases, such as contact with wood dust, nickel treatment processes, and skin layering, may result in the development of sinonasal malignancy and septal perforation (more information can be found on the Septal Perforation - Medical Aspects Clinical Presentation link).
Similar link >> Intranasal Closure of Small Septum Perforations With Double-sided Cartilage Button Graft
The paranasal sinus tomography of the patient with nasal septum perforation seen during the endoscopic nasal examination above is shown below.
Traumatic causes
◙ Previous surgery
◙ Intra-nasal cauterization for nosebleed
◙ Nasal mixing
◙ Nasogastric tube insertionSeptal hematoma arising from any blunt trauma
◙ Battery or other foreign object escaping into the nose
◙ Chronic nasal cannulae use
◙ Turbulence airflow
Inflammatory or infectious causes
◙ Sarcoidosis
◙ Wegener granulomatosis
◙ Systemic lupus erythematosus
◙ Tuberculosis
◙ Syphilis
◙ AIDS
◙ Diphtheria
◙ Crohn's disease
◙ Dermatomyositis
◙ Rheumatoid arthritis
◙ Neoplastic causes
◙ Cancer
◙ T-cell lymphomas
◙ Cryoglobulinemia
Other reasons
◙ Ingestion substances (eg cocaine, topical corticosteroids, long-term oxymetazoline or the use of phenylephrine)
◙ Chromic acid smoke
◙ Renal failure
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Symptoms, causes, diagnosis and treatment of nasal septum perforation |
The paranasal sinus tomography of the patient with nasal septum perforation seen during the endoscopic nasal examination above is shown below.
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Symptoms, causes, diagnosis and treatment of nasal septum perforation |
Causes of Nasal Septum Perforation
The causes of septum perforation can be summarized as follows:Traumatic causes
◙ Previous surgery
◙ Intra-nasal cauterization for nosebleed
◙ Nasal mixing
◙ Nasogastric tube insertionSeptal hematoma arising from any blunt trauma
◙ Battery or other foreign object escaping into the nose
◙ Chronic nasal cannulae use
◙ Turbulence airflow
Inflammatory or infectious causes
◙ Sarcoidosis
◙ Wegener granulomatosis
◙ Systemic lupus erythematosus
◙ Tuberculosis
◙ Syphilis
◙ AIDS
◙ Diphtheria
◙ Crohn's disease
◙ Dermatomyositis
◙ Rheumatoid arthritis
◙ Neoplastic causes
◙ Cancer
◙ T-cell lymphomas
◙ Cryoglobulinemia
Other reasons
◙ Ingestion substances (eg cocaine, topical corticosteroids, long-term oxymetazoline or the use of phenylephrine)
◙ Chromic acid smoke
◙ Renal failure
Symptoms of Nasal Septum Perforation
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Symptoms, causes, diagnosis and treatment of nasal septum perforation |
In patients with nasal septum perforation, drying occurs in the nasal secretions due to impaired nose physiology and abnormal acceleration of the nasal airflows. If the perforation diameter is small and set in the front, it may cause a whistle or whistling sound. Due to chronic dryness and thickening of the secretions, a nasty smelling nasal discharge may develop over time. The high-velocity airflow impinging on the perforation edges can cause excessive drying, scaling and bleeding in the mucous membranes in this region. Over time, all mucosal areas within the nose can be affected and beside the complaint of nasal instability; dry, cold and unfiltered air will pass through the lower respiratory tracts, so the airways in this area can be affected in the same way.
Diagnosis of Nasal Septum Perforation
Nasal endoscopic examination is usually sufficient for diagnosis. Paranasal sinus tomography is useful in measuring available perforation dimensions.
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Symptoms, causes, diagnosis and treatment of nasal septum perforation |
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Symptoms, causes, diagnosis and treatment of nasal septum perforation |
- https://www.youtube.com/watch?v=_OBeLAPq850
- https://www.burun-estetigi-rinoplasti.com/2019/01/nazal-septum-perforasyonu-ameliyati.html
- http://www.muratenoz.com/2017/08/nazal-septum-perforasyonu-onlemler.html
Nasal Septum Perforation Due To Cocaine Abuse
In the photos below, the patient with a history of nasal cocaine use for approximately 8 months shows endoscopic examination photos and paranasal sinus computed tomographs. Dense crusting and bleeding areas on the perforation edges attract attention.
Before and After Photos of Patient Who Has Nasal Septum Perforation
In the photos below, the patient, who had a nasal operation 4 times before, and nasal septum perforation was revealed, there are photos taken during the endoscopic examination and images of sinus tomography before the surgery
We performed open technique septum perforation repairing surgery to the patient who has a hole in the nasal septum approximately 2 cm in diameter (nose surgeries and septum perforation surgery has been performed 5 times before) (You can look the video and photos on the below). We placed cartilage on both the subcutaneous tissue and the outer part in the middle of the hole in the septum. Nasal septum is a structure that divides the nasal cavity vertically, and punctures in this structure may cause rapid air passage through the hole and associated symptoms (rash in the nose, dryness, crusting, nasal discharge, and darkening of the discharge ...). When the hole remains for a long time and the diameter of the hole can gradually grow. Especially in 4 cm and larger septum perforations, the possibility of complete closure with a single operation decreases.
Before and 3 Months After Nasal Septum Perforation (4x3cm) Surgery Video
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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