Septal perforation – Causes, Clinical features, Management

The different causes of septal perforation are:

  • Traumatic perforation
    • Septal surgery
    • Cautery for epistaxis
    • Habitual nose picking
    • Deliberate perforation for putting ornaments
  • Pathological perforation
    • Septal abscess
    • Nasal myiasis
    • Rhinolith
    • Chronic granulomatous diseases
      • Leprosy, Lupus, Tuberculosis – perforation of cartilaginous septum
      • Syphilis – perforation of bony septum
    • Wegener’s granuloma
  • Drugs and Chemicals
    • Long term use of steroid nasal sprays
    • Exposure to certain chemicals in industry
      • eg: chromium
    • Cocaine addicts
  • Idiopathic

Clinical features:

  • Small perforations result in a whistling sound
  • Large perforations cause crusting which bleed upon removal

Management:

  • The identification of the cause is essential
  • Small perforations can be closed by using plastic flaps
  • In case of large perforations, removal of crusts can be done using alkaline nasal douche and application of bland ointment
  • Silastic buttons can be used to close large perforations
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