Showing posts with label Symptoms of nasal septum perforation. Show all posts
Showing posts with label Symptoms of nasal septum perforation. Show all posts

Saturday, February 3, 2018

Symptoms, Causes and Diagnosis of Nasal Septum Perforation

Symptoms, causes and diagnosis of nasal septum perforation - Diagnosis of nasal septum perforation - Causes of nasal septum perforation - Symptoms of nasal septum perforation - Nasal septal perforation symptoms - Nasal septal perforation repair in Istnbul, Turkey
Symptoms, causes and diagnosis of nasal septum perforation - Diagnosis of nasal septum perforation - Causes of nasal septum perforation - Symptoms of nasal septum perforation - Nasal septal perforation symptoms - Nasal septal perforation repair in Istanbul, Turkey

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


Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delik
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.


Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delik
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


Nasal septum perforation may cause linear jet air currents in the nose, causing scabs in the nose, sounding in the form of whistling, bleeding, and dryness in the nose.


Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delik
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


Most of septal perforation is detected incidentally during a routine physical examination. Since the posterior perforations are generally asymptomatic when compared with the anterior holes, the importance of septal perforation is important. Nasal endoscopy may be helpful in evaluating all septum. the position and diameter of the hole should be noted. In the adjacent photo, septum perforation is observed, which is small and located locally. It is seen that there are few crusts on perforation edges. Such septum holes may be recognized by chance during endoscopic nasal examination.

Nasal endoscopic examination is usually sufficient for diagnosis. Paranasal sinus tomography is useful in measuring available perforation dimensions.


Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delik
Symptoms, causes, diagnosis and treatment  of nasal septum perforation

In the above photograph, a paranasal sinus tomography section of a patient with nasal septum perforation of approximately 3.5 x 1.5 cm is seen. Towards the end of the sections, it appears that the inferior turbinates are approaching to the perforation region. In patients with nasal septum perforation, there is a rapid air leak from one nasal cavity to the other nasal cavity in varying amounts of perforation. In these regions where the dry, fast, particulate air is the most sharply pointed to the nasal turbinates, the reflexes of the nasal turbinates are stimulated by the reflex reflex mechanisms. For this reason, in patients with nasal septum perforation, nasal turbinates are prone to regrowth and nasal obstruction is more likely to occur. Without perforating; the operation of nose surgery alone will not be enough for a permanent comfortable nose breathing. When you click on the photo, you can see the perforation areas, which can be viewed in large size and marked with arrow marks.

Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delik
Symptoms, causes, diagnosis and treatment  of nasal septum perforation

Links to more detailed information about causes, classification, indications, treatment of nasal septum perforations:

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.

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Nasal Septum Perforation Due To Cocaine Abuse

Symptoms, Causes and Diagnosis of Nasal Septum Perforation

Symptoms, Causes and Diagnosis of Nasal Septum Perforation

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

Nasal Septum Perforation

Nasal Septum Perforation

Nasal Septum Perforation

Nasal Septum Perforation

Nasal Septum Perforation

Nasal Septum Perforation

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.




Nasal Septum Perforation Closure - Treatment in Turkey Istanbul

Nasal Septum Perforation Closure - Treatment in Turkey Istanbul

Nasal Septum Perforation Closure - Treatment in Turkey Istanbul


Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey
Bosphorus - Istanbul - Turkey - ENT Doctor Istanbul - ENT Specialist Istanbul - Nose Job Istanbul - Rhinoplasty Istanbul - ENT Office Istanbul - Dr.Murat Enoz - ENT Clinic Istanbul - ENT Doctor in Istanbul - Nose Job in Turkey

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47



Friday, June 30, 2017

Large Septum Perforation Repair And Rhinoplasty Operation With Rib Cartilage

About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey
About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

About nasal septum perforation


Septum perforasyonu tanımı - Septum perforasyonu  nedenleri - Septum perforasyonu belirtileri - Septum perforasyonu tedavisi - Açık teknik septum perforasyonu ameliyatı - Açık teknik septum perforasyonu onarımı - Burun duvarında delikSeptal holes (hole formation in the nose, hole in the nasal wall, perforation of the nasal septum), there is a hole in the septum separating the nasal cavity in two. Especially those larger than 2 cm in diameter are called "large septum perforations" or "large septum perforations" and are a challenge that the ear, nose and throat specialists face with difficulties. In fact, for septum perforation therapy (nasal cartilage puncture treatment), the cause of this condition (often iatrogenic, that is, it may be due to nasal surgery or it may be idiopathic) should be determined and the most appropriate surgical treatment should be selected. All surgical procedures aimed at repairing nasal septal perforations are based on two main principles: using the mucosal, mucopericondrial and / or mucoperiosteal flaps in the nasal cavity or using autografts containing connective tissue. Doctors who perform septum perforation surgery can perform surgical repair of septal perforation using "closed technique" or "open technique". The advantage of the first is that it does not leave any external scars. However, disadvantages associated with difficulty associated with a narrow surgical field may be encountered. Most surgeons prefer the "open" technique because they offer a larger operating area, superior perforation (especially in large and / or posterior perforations), and better access to posterior margins and binocular vision.

Symptoms of nasal septum perforation


Septum perforation usually results in air escape between the nasal cavities in the nose and hyperventilation resulting in accelerated airflow. Patients usually go to see a specialist when signs such as crusting, nosebleeds, odor disorders occur or when symptoms develop that may disrupt nasal breathing. However, septal perforations can also be detected during routine examination. Frontal and wide septal perforations are more symptomatic, but posterior perforations tend to be less symptomatic due to the moisturizing effect of the nasal turbinates.


Diagnosis of nasal septum perforation


Anterior endoscopic rhinoscopy during the nasal septum hole can be easily seen and diagnosed. In the endoscopic nasal examination, the perforation configuration, the presence of crusting, and the irregularities of the mucosa structure can be assessed. Occasionally, septum perforation can be detected incidentally on the nasotomography taken. Nasal endoscopy provides more information about the assessment of the entire septum. Palpation with a septum cotton tip applicator or a blunt thin metal tool can give valuable information about the quadrangular cartilage integrity in the rest of the septum. Dr. From Rami K. Batniji tarfi, the diagnostic algorithm of perforation of nasal septum is defined. A modified algorithm for a systematic evaluation of septal perforation.

Preoperative and postoperative radiologic specific study and imaging techniques may be required for septal perforation to obtain as much information as possible about the paranasal sinus tomography or Magnetic Resonance Imaging, nasal structure, and the frame, especially as imaging modalities.

Classification of septum perforations according to their size


Roughly the septum perforations are divided into 3 according to their size:

  • Small holes indicate those with diameters ≤ 0,5 cm
  • Middle perforations ranging in diameter from 0.5 to 2 cm
  • Large perforations (large septal perforations) are > 2 cm septal holes

Causes of nasal septum perforation


The causes of the nasal puncture may be local or systemic diseases. Nasal septum perforation may occur due to multiple causes, such as traumatic causes, iatrogenic causes, infectious causes, degenerative diseases, overuse of vasoconstrictors, cocaine abuse, and more recently the use of chemotherapy agents.

Nasal septum perforation treatment




Surgical repair is generally not recommended for perforations that do not cause subjective and functional problems. Surgical complete repair of large septum perforations is more difficult than other lesions. It determines the need for surgical care and considers what is still best available. Apart from surgical treatment, septal button application is also available. If the price of the septal button is low compared to the surgical treatment, it causes disadvantages such as causing the hole to grow, causing foreign body reaction and infection. In patients with complaints of nose instability, intranasal moisturizing medical treatment can also be given. Many surgical techniques have been proposed for repair of perforation, but the results are often insufficient for large perforations (for complete closure). Permanent millimetric repair of the defect in large perforations is not always possible. It may be necessary to use cartilage tissue as grafts from other areas such as the ear or rib.
Septal perforation is affected both by the repair procedure and the method used during the intervention, as well as by the care of the patient before and after the operation. The open approach is thought to be more likely to provide perforation repair in cases of large septal perforations, dominating the perforation margin and providing routine surgical dissection.

You can find more detailed information about nasal septum perforation and links to the pre- and post-treatment images in the "Resources" section below.

Large septum perforation repair with rib cartilage



Patient with extensive septum perforation (approximately 3.5 cm x 2 cm in size, ovoid shaped, septum hole) was operated with septum perforation surgery and nasal aesthetic surgery with the help of grafts prepared from rib cartilagin. In the procedure, cadaver-derived and irradiated rib tissue was used.

Fine cartilaginous grafts prepared from rib cartilage were inverted and stained with soluble 4/0 PDS material. During the open technique of nasal aesthetic surgery, the graft prepared from the rib cartilage was placed vertically in the middle of septation and perforation. The local mucosal advancement fingers were shifted and sewn on the base of the nose. After the nasal aesthetic operation was completed, a nasal silicone splint was placed in each nostril and the nose bandaged after the procedure.

Here are the photos taken during the process:

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About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey

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You can find details about "About nasal septum perforation - Symptoms of nasal septum perforation - Diagnosis of nasal septum perforation - Classification of septum perforations - Causes of nasal septum perforation - Nasal septum perforation treatment - Large septum perforation repair with rib cartilage - Large septum perforation repair with rib cartilage - Nasal septal perforation repair with irradiated cadaver rib cartilage - Repair of nasal septal perforation with rib cartilage - Nasal septum perforation repair with irradiated costal cartilage - Septal perforation - Surgical treatment of nasal septal perforation - Septal perforation repair surgery in Istanbul - Perforated septum treatment in Turkey" and before and after photos at >>
  1. Nazal septum perforasyonu, tanımı, nedenleri, belirtileri ve tedavisi
  2. Symptoms, Causes and Diagnosis of Nasal Septum Perforation
  3. Surgical treatment of nasal septal perforations. Our experience
  4. Innovative technique for large septal perforation repair and radiological evaluation
  5. Septal Perforation - Medical Aspects Treatment & Management


Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47