1. Septal perforation surgical managment
Mohammed A. Alkarzae R5
SFH

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

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

4. Silastic sheet suture fixation site ?

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

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

7. etiology
IRRITATIVE
COCAINE ABUSE
CAUSTIC FUMES

8. 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

9. symptoms

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

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

12. Management

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

14. Surgical management

15. Middle turbinate Flap

17. 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.

18. middle turbinate flap (monopedicled superior flap )

20. Inferior turbinate flap

22. Rotation and advancement flap

26. 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

27. Regeneration technique

28. mucosal regeneration technique

30. 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.

31. Temporalis fascia graft

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

33. Stem cells ??

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