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Erschienen in: Current Allergy and Asthma Reports 1/2018

01.01.2018 | Rhinosinusitis (J Mullol, Section Editor)

Nasoseptal Perforation: from Etiology to Treatment

verfasst von: Carla Pereira, Alfonso Santamaría, Cristobal Langdon, Mauricio López-Chacón, José Hernández-Rodríguez, Isam Alobid

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 1/2018

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Abstract

Purpose of Review

Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment.

Recent Findings

NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience.

Summary

When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.
Literatur
2.
Zurück zum Zitat • Chang DT, Irace AL, Kawai K, Rogers-Vizena CR, Nuss R, Adil EA. Nasal septal perforation in children: presentation, etiology, and management. Int J Pediatr Otorhinolaryngol. 2017;92:176–80. Reports about NSPs in the pediatric population are limited; this is a retrospective chart review performed on 27 pediatric patients diagnosed with nasal septal perforations from 1998 to 2015. https://​doi.​org/​10.​1016/​j.​ijporl.​2016.​12.​003. CrossRefPubMed • Chang DT, Irace AL, Kawai K, Rogers-Vizena CR, Nuss R, Adil EA. Nasal septal perforation in children: presentation, etiology, and management. Int J Pediatr Otorhinolaryngol. 2017;92:176–80. Reports about NSPs in the pediatric population are limited; this is a retrospective chart review performed on 27 pediatric patients diagnosed with nasal septal perforations from 1998 to 2015. https://​doi.​org/​10.​1016/​j.​ijporl.​2016.​12.​003. CrossRefPubMed
3.
Zurück zum Zitat • Gold M, Boyack I, Caputo N, Pearlman A. Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging. 2017;43:80–2. The prevalence of NSP on facial bone CT scan in an urban hospital setting in New York, USA. They reviewed 3708 CT scans and found a prevalence of NSP of 2.05% (more than double of that previously reported). The most common risk factor was cocaine abuse. https://​doi.​org/​10.​1016/​j.​clinimag.​2017.​02.​002. CrossRefPubMed • Gold M, Boyack I, Caputo N, Pearlman A. Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging. 2017;43:80–2. The prevalence of NSP on facial bone CT scan in an urban hospital setting in New York, USA. They reviewed 3708 CT scans and found a prevalence of NSP of 2.05% (more than double of that previously reported). The most common risk factor was cocaine abuse. https://​doi.​org/​10.​1016/​j.​clinimag.​2017.​02.​002. CrossRefPubMed
4.
Zurück zum Zitat Oberg D, Akerlund A, Johansson L, Bende M. Prevalence of nasal septal perforation: the Skovde population-based study. Rhinology. 2003;41(2):72–5. PubMed Oberg D, Akerlund A, Johansson L, Bende M. Prevalence of nasal septal perforation: the Skovde population-based study. Rhinology. 2003;41(2):72–5. PubMed
9.
Zurück zum Zitat Diamantopoulos II, Jones NS. The investigation of nasal septal perforations and ulcers. J Laryngol Otol. 2001;115(7):541–4. CrossRefPubMed Diamantopoulos II, Jones NS. The investigation of nasal septal perforations and ulcers. J Laryngol Otol. 2001;115(7):541–4. CrossRefPubMed
13.
Zurück zum Zitat John WS, Wu L-T. Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015. Drug Alcohol Depend. 2017;(180):376–84. John WS, Wu L-T. Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015. Drug Alcohol Depend. 2017;(180):376–84.
15.
Zurück zum Zitat Smith JC, Kacker A, Anand VK. Midline nasal and hard palate destruction in cocaine abusers and cocaine’s role in rhinologic practice. Ear Nose Throat J. 2002;81(3):172–7. PubMed Smith JC, Kacker A, Anand VK. Midline nasal and hard palate destruction in cocaine abusers and cocaine’s role in rhinologic practice. Ear Nose Throat J. 2002;81(3):172–7. PubMed
16.
Zurück zum Zitat •• Trimarchi M, Bertazzoni G, Bussi M. Cocaine induced midline destructive lesions. Rhinology. 2014;52(2):104–11. The author found that 4.8 of cocaine users had pathologies that mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies. They concluded that the presence of ANCA directed against human neutrophil elastase is the most distinguishing feature of cocaine-induced midline destructive lesions. https://​doi.​org/​10.​4193/​Rhin. PubMed •• Trimarchi M, Bertazzoni G, Bussi M. Cocaine induced midline destructive lesions. Rhinology. 2014;52(2):104–11. The author found that 4.8 of cocaine users had pathologies that mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies. They concluded that the presence of ANCA directed against human neutrophil elastase is the most distinguishing feature of cocaine-induced midline destructive lesions. https://​doi.​org/​10.​4193/​Rhin. PubMed
18.
Zurück zum Zitat Dokuyucu R, Gokce H, Sahan M, Sefil F, Tas ZA, Tutuk O. Systemic side effects of locally used oxymetazoline. Int J Clin Exp Med. 2015;8(2):2674–8. PubMedPubMedCentral Dokuyucu R, Gokce H, Sahan M, Sefil F, Tas ZA, Tutuk O. Systemic side effects of locally used oxymetazoline. Int J Clin Exp Med. 2015;8(2):2674–8. PubMedPubMedCentral
19.
Zurück zum Zitat Cervin A, Andersson M. Intranasal steroids and septum perforation—an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology. 1998;36(3):128–32. PubMed Cervin A, Andersson M. Intranasal steroids and septum perforation—an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology. 1998;36(3):128–32. PubMed
21.
Zurück zum Zitat Cervin A, Akerlund A, Greiff L, Andersson M. The effect of intranasal budesonide spray on mucosal blood flow measured with laser Doppler flowmetry. Rhinology. 2001;39(1):13–6. PubMed Cervin A, Akerlund A, Greiff L, Andersson M. The effect of intranasal budesonide spray on mucosal blood flow measured with laser Doppler flowmetry. Rhinology. 2001;39(1):13–6. PubMed
30.
Zurück zum Zitat Khan S, Pujani M, Jetley S. Primary nasal tuberculosis: resurgence or coincidence—a report of four cases with review of literature. Lab Physicians. 2017;9(1):26–30. CrossRef Khan S, Pujani M, Jetley S. Primary nasal tuberculosis: resurgence or coincidence—a report of four cases with review of literature. Lab Physicians. 2017;9(1):26–30. CrossRef
31.
Zurück zum Zitat Hup AK, Haitjema T, de Kuijper G. Primary nasal tuberculosis. Rhinology. 2001;39(1):47–8. PubMed Hup AK, Haitjema T, de Kuijper G. Primary nasal tuberculosis. Rhinology. 2001;39(1):47–8. PubMed
32.
Zurück zum Zitat Butt AA. Nasal tuberculosis in the 20th century. Am J Med Sci. 1997;313(6):332–5. PubMed Butt AA. Nasal tuberculosis in the 20th century. Am J Med Sci. 1997;313(6):332–5. PubMed
35.
Zurück zum Zitat Chaptini C, Marshman G. Leprosy: a review on elimination, reducing the disease burden, and future research. Lepr Rev. 2015;86(4):307–15. PubMed Chaptini C, Marshman G. Leprosy: a review on elimination, reducing the disease burden, and future research. Lepr Rev. 2015;86(4):307–15. PubMed
38.
Zurück zum Zitat Primary and secondary syphilis—United States, 2000-2001. MMWR Morb Mortal. Wkly Rep. 2002;51(43):971–3. Primary and secondary syphilis—United States, 2000-2001. MMWR Morb Mortal. Wkly Rep. 2002;51(43):971–3.
41.
Zurück zum Zitat Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1–298. Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1–298.
42.
Zurück zum Zitat Nsagha DS, Bamgboye EA, Assob JCN, Njunda AL, Kamga HLF, Zoung-Kanyi Bissek A-C, et al. Elimination of leprosy as a public health problem by 2000 AD: an epidemiological perspective. Pan Afr Med J. 2011;9:4. PubMedPubMedCentral Nsagha DS, Bamgboye EA, Assob JCN, Njunda AL, Kamga HLF, Zoung-Kanyi Bissek A-C, et al. Elimination of leprosy as a public health problem by 2000 AD: an epidemiological perspective. Pan Afr Med J. 2011;9:4. PubMedPubMedCentral
43.
Zurück zum Zitat Rejali SD, Simo R, Saeed AM, de Carpentier J. Acquired immune deficiency syndrome (AIDS) presenting as a nasal septal perforation. Rhinology. 1999;37(2):93–5. PubMed Rejali SD, Simo R, Saeed AM, de Carpentier J. Acquired immune deficiency syndrome (AIDS) presenting as a nasal septal perforation. Rhinology. 1999;37(2):93–5. PubMed
48.
Zurück zum Zitat Romero-Gómez C, Aguilar-García JA, García-de-Lucas MD, Cotos-Canca R, Olalla-Sierra J, García-Alegría JJ, et al. Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies. Clin Exp Rheumatol. 2015;33(2 Suppl 89):S-11-8. PubMed Romero-Gómez C, Aguilar-García JA, García-de-Lucas MD, Cotos-Canca R, Olalla-Sierra J, García-Alegría JJ, et al. Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies. Clin Exp Rheumatol. 2015;33(2 Suppl 89):S-11-8. PubMed
54.
Zurück zum Zitat Devaney KO, Travis WD, Hoffman G, Leavitt R, Lebovics R, Fauci AS. Interpretation of head and neck biopsies in Wegener's granulomatosis. A pathologic study of 126 biopsies in 70 patients. Am J Surg Pathol. 1990;14(6):555–64. Devaney KO, Travis WD, Hoffman G, Leavitt R, Lebovics R, Fauci AS. Interpretation of head and neck biopsies in Wegener's granulomatosis. A pathologic study of 126 biopsies in 70 patients. Am J Surg Pathol. 1990;14(6):555–64.
64.
Zurück zum Zitat Reategui Schwarz E, Oikonomou KG, Reynolds M, Kim J, Balmiki RL, Sterling SA. Extranodal NK/T-cell lymphoma, nasal type, presenting as refractory pseudomonas aeruginosa facial cellulitis. J Investig Med High Impact Case Rep. 2017;5(3):2324709617716471. PubMedPubMedCentral Reategui Schwarz E, Oikonomou KG, Reynolds M, Kim J, Balmiki RL, Sterling SA. Extranodal NK/T-cell lymphoma, nasal type, presenting as refractory pseudomonas aeruginosa facial cellulitis. J Investig Med High Impact Case Rep. 2017;5(3):2324709617716471. PubMedPubMedCentral
67.
Zurück zum Zitat Alobid I. Endoscopic closure of septal perforation. Acta Otorrinolaringológica Española. 2017. (In Press). Alobid I. Endoscopic closure of septal perforation. Acta Otorrinolaringológica Española. 2017. (In Press).
68.
Zurück zum Zitat Mullace M, Gorini E, Sbrocca M, Artesi L, Mevio N. Management of nasal septal perforation using silicone nasal septal button. Acta Otorhinolaryngol Ital. 2006;26(4):216–8. PubMedPubMedCentral Mullace M, Gorini E, Sbrocca M, Artesi L, Mevio N. Management of nasal septal perforation using silicone nasal septal button. Acta Otorhinolaryngol Ital. 2006;26(4):216–8. PubMedPubMedCentral
73.
Zurück zum Zitat •• Alobid I, Castelnuovo P. Nasoseptal perforations: endoscopic repair techniques. Thieme 2017. ISBN 978–3- 13-205391- 5. eISBN: 9783132054011. Atlas of dissection with a complete review of nasal anatomy, evaluation of NSP, etiologies, and finally, all endoscopic approaches available for the repair of nasoseptal perforations. Approaches are explained step by step using photographs from fresh cadaver dissections made by the authors. •• Alobid I, Castelnuovo P. Nasoseptal perforations: endoscopic repair techniques. Thieme 2017. ISBN 978–3- 13-205391- 5. eISBN: 9783132054011. Atlas of dissection with a complete review of nasal anatomy, evaluation of NSP, etiologies, and finally, all endoscopic approaches available for the repair of nasoseptal perforations. Approaches are explained step by step using photographs from fresh cadaver dissections made by the authors.
76.
Zurück zum Zitat •• Alobid I, Mason E, Solares CA, Prevedello D, Enseñat J, De Notaris M, et al. Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology. 2015;53(3):235–41. Radio-anatomical study in 40 de-identified CT angiographies. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. A clinical study with endoscopic closure of a large NSP in three patients. The study demonstrates that anterior and posterior lateral wall flaps are viable alternatives to repair symptomatic large defects, and each one may cover approximately up to three quarters of the nasal septum. https://​doi.​org/​10.​4193/​Rhin14.​042. PubMed •• Alobid I, Mason E, Solares CA, Prevedello D, Enseñat J, De Notaris M, et al. Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology. 2015;53(3):235–41. Radio-anatomical study in 40 de-identified CT angiographies. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. A clinical study with endoscopic closure of a large NSP in three patients. The study demonstrates that anterior and posterior lateral wall flaps are viable alternatives to repair symptomatic large defects, and each one may cover approximately up to three quarters of the nasal septum. https://​doi.​org/​10.​4193/​Rhin14.​042. PubMed
78.
Zurück zum Zitat Carrau RL. Pericranial flap. In: Alobid I, Bernal-Sprekelsen M E (eds) Anatomical landmarks for endoscopic approaches to the paranasal sinuses and the skull base: instructional step-by-step dissection guide. Thieme (2017). ISBN 978–3- 13-201881-5. eISBN: 978–3- 13-201891- 4. Carrau RL. Pericranial flap. In: Alobid I, Bernal-Sprekelsen M E (eds) Anatomical landmarks for endoscopic approaches to the paranasal sinuses and the skull base: instructional step-by-step dissection guide. Thieme (2017). ISBN 978–3- 13-201881-5. eISBN: 978–3- 13-201891- 4.
Metadaten
Titel
Nasoseptal Perforation: from Etiology to Treatment
verfasst von
Carla Pereira
Alfonso Santamaría
Cristobal Langdon
Mauricio López-Chacón
José Hernández-Rodríguez
Isam Alobid
Publikationsdatum
01.01.2018
Verlag
Springer US
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 1/2018
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-018-0754-1

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