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Erschienen in: European Archives of Oto-Rhino-Laryngology 8/2019

11.06.2019 | Review Article

Endoscopic approach for management of septal perforation

verfasst von: Isam Alobid

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 8/2019

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Abstract

Introduction

Septal perforation (SP) is a rather uncommondisorder and the most frequent aetiology of SP is nasal surgery, but they can also be secondary to drug abuse, inhaled substances, trauma, neoplasms, or inflammatory systemic diseases.

Discussion

Despite some asymptomatic presentations, the majority of SPs cause intermittent epistaxis, nasal obstruction, crusting, dryness, purulent discharge, and/or nasal whistling. Patients who have SP and mild symptoms usually require medical treatment such as nasal irrigations and ointments. Septal buttons may also be used in these patients. No gold standard technique has been recognized for the surgical management of SPs. The literature describes many methods of closure of SP. Many endoscopic techniques are available for septal repair, and the choice depends on the osteo-cartilaginous support, characteristics of the perforation (size, location) and the experience of the surgeon.

Conclusion

This article provides a meticulous review focusing on the endoscopic approaches to repair SP. Furthermore; educational drawings and tips and tricks are also discussed.
Literatur
1.
Zurück zum Zitat Alobid I, Castelnuovo P (2017) Nasoseptal perforations: endoscopic repair techniques. Thieme, pp 1–181. ISBN 978-3-13-205391-5 Alobid I, Castelnuovo P (2017) Nasoseptal perforations: endoscopic repair techniques. Thieme, pp 1–181. ISBN 978-3-13-205391-5
2.
Zurück zum Zitat Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 43:80–82CrossRefPubMed Gold M, Boyack I, Caputo N, Pearlman A (2017) Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging 43:80–82CrossRefPubMed
3.
Zurück zum Zitat Diamantopoulos II, Jones NS (2001) The investigation of nasal septal perforations and ulcers. J Laryngol Otol 115:541–544CrossRefPubMed Diamantopoulos II, Jones NS (2001) The investigation of nasal septal perforations and ulcers. J Laryngol Otol 115:541–544CrossRefPubMed
4.
Zurück zum Zitat Lanier B, Kai G, Marple B, Wall GM (2007) Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 99(6):473–479CrossRefPubMed Lanier B, Kai G, Marple B, Wall GM (2007) Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol 99(6):473–479CrossRefPubMed
5.
Zurück zum Zitat Chang DT, Irace AL, Kawai K, Rogers-Vizena CR, Nuss R, Adil EA (2017) Nasal septal perforation in children: presentation, etiology, and management. Int J Pediatr Otorhinolaryngol 92:176–180CrossRefPubMed Chang DT, Irace AL, Kawai K, Rogers-Vizena CR, Nuss R, Adil EA (2017) Nasal septal perforation in children: presentation, etiology, and management. Int J Pediatr Otorhinolaryngol 92:176–180CrossRefPubMed
6.
Zurück zum Zitat Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I (2018) Nasoseptal perforation: from etiology to treatment. Curr Allergy Asthma Rep 18(1):5CrossRefPubMed Pereira C, Santamaría A, Langdon C, López-Chacón M, Hernández-Rodríguez J, Alobid I (2018) Nasoseptal perforation: from etiology to treatment. Curr Allergy Asthma Rep 18(1):5CrossRefPubMed
7.
Zurück zum Zitat Ferguson BJ (1997) Nasal steroid sprays and septal perforations. ENT J 76(2):75–76 Ferguson BJ (1997) Nasal steroid sprays and septal perforations. ENT J 76(2):75–76
8.
Zurück zum Zitat Mullace M, Gorini E, Sbrocca M, Artesi L, Mevio N (2006) Management of nasal septal perforation using silicone nasal septal button. Acta Otorhinolaryngol Ital 26(4):216–218PubMedPubMedCentral Mullace M, Gorini E, Sbrocca M, Artesi L, Mevio N (2006) Management of nasal septal perforation using silicone nasal septal button. Acta Otorhinolaryngol Ital 26(4):216–218PubMedPubMedCentral
9.
Zurück zum Zitat Leong SC, Webb CJ (2018) Sino-Nasal Outcome Test-22 quality-of-life patterns in patients presenting with nasal septalperforation. Clin Otolaryngol 43(2):604–608CrossRefPubMed Leong SC, Webb CJ (2018) Sino-Nasal Outcome Test-22 quality-of-life patterns in patients presenting with nasal septalperforation. Clin Otolaryngol 43(2):604–608CrossRefPubMed
10.
Zurück zum Zitat Trimarchi M, Bertazzoni G, Bussi M (2014) Cocaine induced midline destructive lesions. Rhinology 52(2):104–111CrossRefPubMed Trimarchi M, Bertazzoni G, Bussi M (2014) Cocaine induced midline destructive lesions. Rhinology 52(2):104–111CrossRefPubMed
11.
Zurück zum Zitat Dosen LK, Haye R (2011) Surgical closure of nasal septal perforation. Early and long term observations. Rhinology 49(4):486–491PubMed Dosen LK, Haye R (2011) Surgical closure of nasal septal perforation. Early and long term observations. Rhinology 49(4):486–491PubMed
12.
Zurück zum Zitat Nomura T, Ushio M, Kondo K, Kikuchi S (2018) Effects of nasal septum repair on nasal airflow: an analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models. Auris Nasus Larynx 45(5):1020–1026CrossRefPubMed Nomura T, Ushio M, Kondo K, Kikuchi S (2018) Effects of nasal septum repair on nasal airflow: an analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models. Auris Nasus Larynx 45(5):1020–1026CrossRefPubMed
13.
Zurück zum Zitat Alobid I (2018) Endoscopic closure of septal perforation. Acta Otorrinolaringol Esp 69(3):165–174CrossRefPubMed Alobid I (2018) Endoscopic closure of septal perforation. Acta Otorrinolaringol Esp 69(3):165–174CrossRefPubMed
14.
Zurück zum Zitat Chen PG, Floreani S, Wormald PJ (2018) The utility of enlarging symptomatic nasal septal perforations. Ear Nose Throat J 97(3):E41–E43CrossRefPubMed Chen PG, Floreani S, Wormald PJ (2018) The utility of enlarging symptomatic nasal septal perforations. Ear Nose Throat J 97(3):E41–E43CrossRefPubMed
15.
Zurück zum Zitat Schultz-Coulon HJ (2005) Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 132(2):213–218CrossRefPubMed Schultz-Coulon HJ (2005) Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg 132(2):213–218CrossRefPubMed
16.
Zurück zum Zitat Neumann A, Morales-Minovi CA, Schultz-Coulon HJ (2011) Closure of nasal septum perforations by bridge flaps. Acta Otorrinolaringol Esp 62:31–39CrossRefPubMed Neumann A, Morales-Minovi CA, Schultz-Coulon HJ (2011) Closure of nasal septum perforations by bridge flaps. Acta Otorrinolaringol Esp 62:31–39CrossRefPubMed
17.
Zurück zum Zitat André RF, Lohuis PJ, Vuyk HD (2006) Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg 59(8):829–834CrossRefPubMed André RF, Lohuis PJ, Vuyk HD (2006) Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg 59(8):829–834CrossRefPubMed
18.
Zurück zum Zitat Lee HR, Ahn DB, Park JH, Kim YH, Sin CM, Youn SJ, Kim JS (2008) Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 1(3):154–157CrossRefPubMedPubMedCentral Lee HR, Ahn DB, Park JH, Kim YH, Sin CM, Youn SJ, Kim JS (2008) Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap. Clin Exp Otorhinolaryngol 1(3):154–157CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Stamm AC, Pignatari SS (2001) Nasal septal cross-over flap technique: a choanal atresia micro-endoscopic surgical repair. Am J Rhinol 15(2):143–148CrossRefPubMed Stamm AC, Pignatari SS (2001) Nasal septal cross-over flap technique: a choanal atresia micro-endoscopic surgical repair. Am J Rhinol 15(2):143–148CrossRefPubMed
20.
Zurück zum Zitat Castelnuovo P, Ferreli F, Khodaei I, Palma P (2011) Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 13(6):411–414CrossRefPubMed Castelnuovo P, Ferreli F, Khodaei I, Palma P (2011) Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg 13(6):411–414CrossRefPubMed
21.
Zurück zum Zitat Gras-Cabrerizo JR, Garcìa-Garrigòs E, Ademà-Alcover JM et al (2016) A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo’s flap): CT cadaver study. Surg Radiol Anat 38(6):723–728CrossRefPubMed Gras-Cabrerizo JR, Garcìa-Garrigòs E, Ademà-Alcover JM et al (2016) A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo’s flap): CT cadaver study. Surg Radiol Anat 38(6):723–728CrossRefPubMed
22.
Zurück zum Zitat Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121(8):1606–1610CrossRefPubMed Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121(8):1606–1610CrossRefPubMed
23.
Zurück zum Zitat Rivera-Serrano CM, Bassagaisteguy LH, Hadad G, Carrau RL, Kelly D, Prevedello DM, Fernandez-Miranda J, Kassam AB (2011) Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 25(6):e212–e216CrossRefPubMed Rivera-Serrano CM, Bassagaisteguy LH, Hadad G, Carrau RL, Kelly D, Prevedello DM, Fernandez-Miranda J, Kassam AB (2011) Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 25(6):e212–e216CrossRefPubMed
24.
Zurück zum Zitat Alobid I, Mason E, Solares CA, Prevedello D, Enseñat J, De Notaris M, Prats-Galino A, Bernal-Sprekelsen M, Carrau R (2015) Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology 53(3):235–241PubMed Alobid I, Mason E, Solares CA, Prevedello D, Enseñat J, De Notaris M, Prats-Galino A, Bernal-Sprekelsen M, Carrau R (2015) Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology 53(3):235–241PubMed
25.
Zurück zum Zitat Santamaria-Gadea A, Lopez-Chacon M, Langdon C, Van Gerven L, Valls-Mateus M, Bernal-Sprekelsen M, Alobid I (2018) Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits. Rhinology 56(4):386–392PubMed Santamaria-Gadea A, Lopez-Chacon M, Langdon C, Van Gerven L, Valls-Mateus M, Bernal-Sprekelsen M, Alobid I (2018) Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits. Rhinology 56(4):386–392PubMed
26.
Zurück zum Zitat Santamaría A, Langdon C, López-Chacon M, Cordero A, Enseñat J, Carrau R, Bernal-Sprekelsen M, Alobid I (2017) Radio-anatomical analysis of the pericranial flap “Money Box Approach” for ventral skull base reconstruction. Laryngoscope 127(11):2482–2489CrossRefPubMed Santamaría A, Langdon C, López-Chacon M, Cordero A, Enseñat J, Carrau R, Bernal-Sprekelsen M, Alobid I (2017) Radio-anatomical analysis of the pericranial flap “Money Box Approach” for ventral skull base reconstruction. Laryngoscope 127(11):2482–2489CrossRefPubMed
27.
Zurück zum Zitat Alobid I, Langdon C, López-Chacon M, Enseñat J, Carrau R, Bernal-Sprekelsen M, Santamaría A (2018) Total septal perforation repair with a pericranial flap: radio-anatomical and clinical findings. Laryngoscope 128(6):1320–1327CrossRefPubMed Alobid I, Langdon C, López-Chacon M, Enseñat J, Carrau R, Bernal-Sprekelsen M, Santamaría A (2018) Total septal perforation repair with a pericranial flap: radio-anatomical and clinical findings. Laryngoscope 128(6):1320–1327CrossRefPubMed
28.
Zurück zum Zitat Alobid I, Langdon C, Santamaría A (2018) Technique to repair total septal perforation with a pericranial flap: the money box approach. JAMA Facial Plast Surg 20(4):324–325CrossRefPubMed Alobid I, Langdon C, Santamaría A (2018) Technique to repair total septal perforation with a pericranial flap: the money box approach. JAMA Facial Plast Surg 20(4):324–325CrossRefPubMed
Metadaten
Titel
Endoscopic approach for management of septal perforation
verfasst von
Isam Alobid
Publikationsdatum
11.06.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 8/2019
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-019-05490-w

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