Septum perforation

Nasal septal perforation (nostril) is the perforation of the cartilage and/or bone nasal septum in the middle that divides the nostrils into two.  In many cases, it does not cause discomfort, but symptomatic patients complain of recurrent nosebleeds, nasal crusting, whistling, headache, dryness and nasal congestion. Anterior perforations usually cause complaints, while posterior ones are not symptomatic.

Causes of septum perforation:

Only symptomatic perforations require treatment to relieve symptoms. Medical treatment with nasal washes and ointments can reduce crusting, dryness and nasal congestion only in mild symptomatic perforations.

A useful alternative is mechanical closure with a prosthesis such as a septal button.  Silicone buttons can alleviate epistaxis, whistling and nasal congestion, but these prostheses cannot control the production of crusting around the margins of the button, causing discomfort for patients. 

If these treatments fail, surgical treatment is recommended. Many surgical techniques have been reported for septal perforation repair, but most are technically difficult, require experienced surgeons, and are associated with a relatively low success rate, as evidenced by the high number of reperforation.

Reported surgical approaches include external rhinoplasty, middle facial degloving, unilateral hemitransfixation, and closed endonasal techniques.

In the last decade, many studies have achieved good optimal results with closed endoscopic techniques.  Using the endoscope, excellent images can be obtained without excessive dissection and with good control of the septal perforation margins.  The disadvantage of these techniques is that they require good endoscopic skills (and therefore may be more difficult to obtain for less experienced surgeons) and a longer operative time.