Closure of septal perforations

The septum is a rigid partition that divides the interior of the nose between left and right nasal cavities. It is composed of bone and cartilage covered by mucusa on both surfaces. Septal perforation occurs when a hole appears connecting one nasal cavity with the other.

Possible causes for septal perforation include previous surgery, traumatism, exposure to toxic substances (cocaine), or less common inflammatory diseases or tumors.

They are usually asymptomatic but can be accompanied by crusty and/or malodorous discharges, bleeding, wheezing, and nasal deformity or loss of support of the pyramid.

Possible techniques for repair include rotation of the septum and vascularised flaps of mucosa from the rest of the intact septum or turbinates. Intervention is usually performed endoscopically although sometimes an open access approach through the columella helps.

The surgical indication, the technique to use and expectations of success are conditioned by the size of the perforation. Nevertheless, the complete abandonment of cocaine is an essential condition to have any possible chance of repairing the lesion.