Septal perforation surgical managment Mohammed A. Alkarzae R5 SFH

Nasal septal perforations are relatively common affecting up to 1% of the general population

etiology TRAUMA NASAL TRAUMA WITH SEPTAL HEAMATOMA SEPTAL SURGERY NASAL PICKING BILATERAL CAUTERISATION NGT NASAL PACKING

Silastic sheet suture fixation site ?

Among 721 patients who had a silastic sheet insertion Nasal septal perforation at the suture fixation site occurred in 0.97%

etiology INFECTION/INFLAMMATORY SYPHILIS WEGENER’S GRANULOMATOSIS SLE SARCOIDOSIS TB

etiology IRRITATIVE COCAINE ABUSE CAUSTIC FUMES

etiology IDIOPATHIC NEOPLASM IRRITATIVE INFECTION TRAUMA CARCINOMA COCAINE ABUSE SEPTAL ABSCESS NASAL TRAUMA WITH SEPTAL HEAMATOMA LETHAL MIDLINE GRANULOMA CAUSTIC FUMES TB SEPTAL SURGERY SYPHILIS NASAL PICKING WEGENER’S GRANULOMATOSIS BILATERAL CAUTERISATION SLE NGT SARCOIDOSIS NASAL PACKING

symptoms

SYMPTOMS NASAL OBSTURCTION CRUSTATION EPISTAXIS WHISTLING FOREIGN BODY SENSATION FOUL SMELLING NASAL DISCHARGE

investigations CRP RF ESR ANA C-ANCA ACE Ca level CXR

Management

Nonsurgical management Nasal Hygiene : Nasal irrigation ( N.S ) petroleum-based ointment antibiotic-based ointment Nasal Septal Button

Surgical management

Middle turbinate Flap

Follow-up period for all patients was 20 months Complete closure of the perforation was achieved in 29 of the 31 patients. Complete failure of the repair was observed in 2 patients.

middle turbinate flap (monopedicled superior flap )

Inferior turbinate flap

Rotation and advancement flap

Small-to-moderate–sized septal perforations are usually repaired with local advancement flaps their success rate has been reported to range from 85 to 100% large perforations with a diameter of 20 mm are considered to have high failure rates in surgical repair

Regeneration technique

mucosal regeneration technique

Postoperative examinations at 3 and 6 months 14 out of 15 (93 Postoperative examinations at 3 and 6 months 14 out of 15 (93.3%) total repairs with complete closure.

Temporalis fascia graft

A sample of 81 patient with septal perforation Successful closure of perforations was obtained in 78%

Stem cells ??

Autologous adipose tissue was harvested from the anterior abdominal wall Adipose-derived stem cells were cultured, expanded, and then seeded onto resorbable scaffold materials.