scholarly journals A paediatric patient with nasal septal perforation – symptoms, diagnosis and treatment options

New Medicine ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Maciej Pilch ◽  
Anna Tuszyńska ◽  
Karolina Raczkowska-Łabuda ◽  
Lidia Zawadzka-Głos
Keyword(s):  
Nasal Septum ◽  
Treatment Options ◽  
Diagnostic Methods ◽  
Septal Perforation ◽  
Nasal Cavities ◽  
Nasal Septal Perforation ◽  
Paediatric Patients ◽  
External Nose ◽  
Supporting Element ◽  
Medical University

Introduction. Nasal septum is an anatomical structure which not only separates both nasal cavities, but is also a supporting element for the external nose, and has an impact on its physiology. Structural abnormalities of the nasal septum, such as deviations and defects, affect the airflow in the nasal cavities. Nasal septal perforation is one of the factors that impair nasal patency due to secondary pathological changes. There are various treatment options, depending on the symptoms reported and the stage of septal lesions. Treatment strategy is selected individually for each patient. Aim. The aim of this paper was to discuss the symptoms, diagnostic methods and treatment options in children with nasal septal perforation. Patients of the Department of Paediatric Otolaryngology, Medical University of Warsaw, were included in the analysis. Material and methods. We present cases of 18 patients aged between 3 and 17 years, admitted to the Outpatient ENT Clinic at the Department of Paediatric Otolaryngology, Medical University of Warsaw. Results. A total of 18 patients aged between 3 and 17 years (mean age 12.83 years, SD = 4.34) reported to our clinic. In most cases, nasal septal perforation developed as a complication of septoplasty (4) or nasal trauma. Nasal bleeding and crusting were the most commonly reported symptoms. Perforation was accompanied by external nasal deformity in about 1/3 of patients. Conclusions. Only few reports on paediatric patients with nasal septal perforation may be found in literature. All data obtained was analysed based on reports describing adult and paediatric patients. The severity of symptoms varied depending on the aetiology.

Different surgical treatments for nasal septal perforation and their outcomes

2007 ◽  
Vol 121 (5) ◽  
pp. 419-426 ◽  
Author(s):  
A Y Goh ◽  
S S M Hussain
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Journal Club ◽  
Treatment Options ◽  
Surgical Approaches ◽  
Septal Perforation ◽  
Inclusion Criteria ◽  
Hand Search ◽  
Nasal Septal Perforation ◽  
The Subject

Objective: To critically evaluate the literature on surgical treatment options for nasal septal perforations and to analyse the outcomes of these treatment options.Design: A systematic review of studies of nasal septal perforation closure using surgical intervention, published from January 1975 to March 2006.Data sources: Forty-nine papers were identified from electronic databases (all Evidence Based Medicine reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effectiveness and Cochrane Controlled Trials Register), EMBASE, Ovid (Medline) and British Medical Journal publications) and from a hand search of the reference lists of retrieved papers. Textbooks pertinent to the subject were referred to for background reading. Twenty-three studies met the inclusion criteria.Main outcome measure: Effectiveness of the surgical intervention to completely close the perforation.Results: Five studies examined the sole use of intranasal mucosal flaps to close the perforation, i.e. inferior turbinate flaps, quadrangular cartilage flap and mucoperiosteal flap. Eighteen studies reported the use of a combination of intranasal mucosal flap and interposition graft. Graft materials included temporalis fascia, mastoid periosteum, nasal septal material, acellular human dermal graft, conchal cartilage and porcine small intestine mucosa. Studies utilising interposition grafts generally produced higher closure rates. The surgical approaches documented include closed endonasal, unilateral hemitransfixion, external rhinoplasty and midfacial degloving techniques. A range of surgical treatment methods was reported in the literature, but some papers were excluded from this review as they did not meet the inclusion criteria. It was difficult to infer the true effectiveness of each study as the subject numbers were small, patient selection criteria were often unspecified and the follow-up period was brief. However, factors leading to an increased chance of success were identified.Conclusion: The review found an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. It is difficult to be categorical about the effectiveness of a surgical treatment method; nonetheless, each technique has its own advantages and drawbacks.

scholarly journals Nasal Septal Perforation in Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Yusho Ishii ◽  
Tsuyoshi Shirai ◽  
Yousuke Hoshi ◽  
Yoko Fujita ◽  
Yuko Shirota ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Rare Case ◽  
Inflammatory Cells ◽  
Graves Disease ◽  
Septal Perforation ◽  
Drug Induced ◽  
Nasal Septal Perforation ◽  
Anca Associated Vasculitis

Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves’ disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.

scholarly journals Systemic Lupus Erythematosus with Unusual Manifestations

2020 ◽  
Vol 17 (6) ◽  
pp. 43-53
Author(s):  
Lorena Manea ◽  
Cătălin Mihai Popescu ◽  
Raluca Popescu ◽  
Daniela Adriana Ion ◽  
Andreea Alexandra Nicola ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Nasal Septum ◽  
Disease Patient ◽  
Clinical Manifestations ◽  
Unknown Etiology ◽  
Septal Perforation ◽  
Systemic Lupus ◽  
Extended Defect ◽  
Nasal Septal Perforation

Abstract Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology, presenting with variable clinical picture. Having a high heterogeneity and lacking pathognomonic features, very often the diagnosis poses a great challenge for the clinician. Several unusual clinical manifestations such as nasal septal perforation and digital gangrene can occur in LES patients. Case report. We report the case of a 42-year-old woman, known with SLE, hospitalized in our department for a clinical presentation consisting of a recent major epistaxis, physical asthenia and acral necrosis of the upper limbs. Physical examination revealed an afebrile patient, with a cushingoid facies, facial telangiectasias, and necrotic scars localized on the distal phalanges, bilaterally. A diagnostic nasal endoscopy showed a large septal perforation with the absence of the cartilaginous nasal septum. CT highlighted an extended defect at the level of the cartilaginous part of the nasal septum. Conclusion. Nasal septal perforation remains an underdiagnosed invalidating complication of lupus and treated and discovered early could have an important impact on the general health of an already burdened by disease patient.

Nasal septal carcinoma: initial symptom of nasal septal perforation

1988 ◽  
Vol 102 (9) ◽  
pp. 834-835 ◽  
Author(s):  
M. Echeverria-Zumarraga ◽  
C. Kaiser ◽  
C. Gavilan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Differential Diagnosis ◽  
Nasal Septum ◽  
Early Stage ◽  
Surgical Excision ◽  
Young Female ◽  
Initial Symptom ◽  
Primary Squamous Cell Carcinoma ◽  
Septal Perforation ◽  
Nasal Septal Perforation

AbstractA case of a primary squamous cell carcinoma of the nasal septum in a young female with initial symptom of septal perforation is reported. Carcinoma of the nasal septum is an uncommon entity and there are a few cases reported in the literature. The functional impact of their treatment and the high mortality makes it important to diagnose it at early stage. We discuss the differential diagnosis of septal perforation and recommend early wide surgical excision.

scholarly journals Nasal Septal Perforation: Experience of Management

2021 ◽  
Vol 28 (3) ◽  
pp. 255-259
Author(s):  
Selçuk Kuzu ◽  
Çağlar Günebakan
Keyword(s):  
Nasal Septum ◽  
Inflammatory Diseases ◽  
Nasotracheal Intubation ◽  
Septal Perforation ◽  
Closure Rate ◽  
Composite Tissue ◽  
Nasal Septal Perforation ◽  
Common Causes ◽  
Septum Perforation ◽  
Nasal Septum Perforation

Introduction Nasal septal perforation is the loss of composite tissue comprising the mucosa, bone or cartilage structures that form the nasal septum. Nasal septum perforation has many causes. Though it may be idiopathic, the most common causes are iatrogenic like nasal surgeries. Among other reasons are septal hematoma, nasal picking habit, nasal cauterization due to nosebleeds, nasotracheal intubation, cocaine use, vasculitis, inflammatory diseases such as sarcoidosis, This study aims to review the approach to management of patients with nasal septal perforation who underwent repair of the perforation in a tertiary clinic, in the light of current literature. Materials and Methods In this study, the records of 27 patients who were diagnosed with nasal septal perforation and treated surgically in a tertiary clinic, between January 2015 and June 2019 were reviewed retrospectively. Results The successful closure rate of perforations was 74%. In 4 of 7 patients whose perforations were not completely closed, the perforation size was larger than 2 cm in diameter. Conclusion Successful repair of nasal septal perforation depends largely on the cause, location, size of the perforation, cartilage bone tissue on the perforation edges, surgical technique and the surgeon's experience.

scholarly journals Nasal Septal Perforation Due to Desmopressin Nasal Spray Use

2021 ◽  
pp. 014556132110264
Author(s):  
Daniela A. Brake ◽  
Grant S. Hamilton ◽  
Stephen F. Bansberg
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Nasal Spray ◽  
Nasal Septum ◽  
Treatment Success ◽  
Septal Perforation ◽  
Spray Application ◽  
Nasal Septal Perforation ◽  
Clinical Considerations

Perforations of the nasal septum have many etiologies and occasionally result from intranasal medicated spray use. This case report describes a perforation related to the use of desmopressin nasal spray, which has not been previously reported in the literature. Clinical considerations presented in this article include appropriate technique of nasal spray application, appropriate monitoring of patients on intranasal sprays, and indications for evaluation by an otolaryngologist. Septal perforation treatment success is improved with an early diagnosis.

Party Lines and Other Mucosal Crimes: Nasal Septal Perforation: A Review of Common and Uncommon Causes

Neurographics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 182-195
Author(s):  
C.S. Taylor ◽  
T.A. Nichols ◽  
D.A. Joyner
Keyword(s):  
Differential Diagnosis ◽  
Nasal Septum ◽  
Clinical Symptoms ◽  
Septal Cartilage ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Septal Perforation ◽  
Ischemic Necrosis ◽  
Nasal Septal Perforation ◽  
Common Causes

Nasal septal perforation refers to the abnormal communication of the nasal cavities via a defect in the nasal septum. Clinical symptoms, if present, include bleeding, crusting, a sensation of nasal obstruction, and whistling noises during inhalation. The mucoperichondrium of the nasal cavity contains most of the nasal septal vasculature and sandwiches the relatively avascular septal cartilage. An insult to the mucoperichondrium on both sides of the septal cartilage in approximately the same area results in ischemic necrosis of the septal cartilage, which leads to nasal septal perforation. Nasal septal perforation is a common end to an expansive list of etiologies that occur due to ischemic necrosis or direct erosion of the osteocartilaginous nasal septum from a tumor or infection. Imaging alone is typically insufficient to establish the exact underlying etiology. However, there are imaging features that may narrow the differential diagnosis or suggest less common causes, particularly malignancy. Radiologists can also identify lesions that place the nasal septum at risk, such as for a nasal septal hematoma or an abscess. Preoperative imaging allows for the evaluation of the size of the defect, as well as other areas of osseous and cartilaginous destruction in the palate, sinus walls, or orbits, that may need surgical reconstruction.Learning Objective: Describe nasal septal anatomy, pathophysiology of nasal septal perforation, and the differential diagnosis for causes of nasal septal perforation.

Nasal Septal Perforation Closure by “Sandwich Grafts”: Technique, Initial Results

2021 ◽  
Author(s):  
Mattis Bertlich ◽  
Friedrich Ihler ◽  
Maya Bertlich ◽  
Mark Jakob ◽  
Martin Canis ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Case Series ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Reliable Technique ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Foreign Materials ◽  
Septal Perforations ◽  
Initial Results

AbstractNasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous “sandwich graft.” It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

Assessing Patient Symptoms Due to Nasal Septal Perforation: Development and Validation of the NOSE-Perf Scale

2021 ◽  
pp. 019459982199201
Author(s):  
Cullen M. Taylor ◽  
Stephen F. Bansberg ◽  
Michael J. Marino
Keyword(s):  
Nasal Obstruction ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Control Group ◽  
Septal Perforation ◽  
Specific Symptom ◽  
Nose Scale ◽  
Nasal Septal Perforation ◽  
Patient Reported

Objective Reporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease-specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient-reported symptoms related to NSP. Study Design Validation study. Setting A tertiary care center. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE-Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation. Results The study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905-0.954). Test-retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart ( r = 0.898, P < .001). Discriminant validity was confirmed via a receiver operating characteristic ( P < .001, area under the curve = 0.700). The NOSE-Perf scale was able to distinguish among all 3 study groups ( P < .001) and between NSP and nasal obstruction ( P = .024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction ( P = .545). Conclusions The NOSE-Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

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