Repair of Nasal Septal Perforations

Sedaghat, Ahmad; Bleier, Benjamin

Repair of Nasal Septal Perforations

Open Education Resource

2025-03-11

Abstract

The most common causes of nasal septal perforations are trauma, iatrogenic e.g. septoplasty, and pharmacologic e.g. intranasal corticosteroids and cocaine abuse. Other aetiologies such as vasculitis, malignancy and infection should be considered when investigating a patient when a cause is not apparent. Most septal perforations go unnoticed. The most troublesome signs and symptoms include a whistling sound, crusting and epistaxis; these are consequences of disrupttion of laminar airflow and its desiccating effect on the nasal tissues. In some cases with e.g. vasculitis or chronic picking at nasal crusts, septal perforations may grow in size and cause collapse of the dorsal or caudal supports leading to nasal deformity. Despite its varied aetiology, the common mechanism for developing a septal perforation is disruption of blood flow and devitalisation of the septum. Despite its rich blood supply in the form of Kiesselbach’s plexus, perforations most commonly involve the anterior septum; this plexus is comprised of the terminal branches of the superior labial, greater palatine and anterior ethmoidal arteries and does not tolerate vascular insults well.