Septal Perforation Research Paper

DISCUSSION

The exact incidence of nasal septal perforation is unknown as most of the patients are asymptomatic and others may not seek medical attention2. Iatrogenic cause still continues to be a main reason for nasal septal perforation. Excessive nasal packing, post-operative septal haematomas and infections may result in septal perforations following surgery2. However, with refinements in rhinologic surgeries, the incidence of nasal septal perforation secondary to septal surgery has declined to 1% 2,3. Other causes include trauma, digital manipulation, drugs and neoplasms 2,3. Nasal septal perforations may be the first sign of drug abuse or serious systemic disease 2. In our series, iatrogenic cause was the most common cause accounting

Several detailed laboratory investigations are performed to exclude systemic causes, malignancy, or any other ongoing process that must be excluded prior to repair. In our study most of the septal perforations were caused following septal surgery as mentioned above. Tomography of the paranasal sinuses is indicated to evaluate the nasal septum and the presence of concomitant paranasal sinus disease9. We assessed the size of perforations and the size of the flap available preoperatively using Plain CT-scan of Nose and Paranasal sinuses with a combination of axial and coronal sections. This gave us a clear picture of the defect in the nasal septum along with accurate information of the availability of nasoseptal flap.

Various surgical procedures include septal rotation flaps 10, inferior turbinate flap 11,12, oral vestibular flap 13, sublabial mucosal flaps 14, nasolabial flaps 14, radial forearm free flaps15, pericranial flaps 16 and tissue expansion 17. Several interposition grafts include temporal muscle fascia 18, septal cartilage 19, nasal turbinate 20, conchal cartilage 21, mastoid bone with periosteum 22 ear tragus cartilage with perichondrium 23 and ethmoid bone and iliac crest and acellular human dermal allograft. 24, 10,