Causes and Clinical Characteristics of the Nasal Septal Perforation

Yun, Du Hwan; Kim, Yong Jae; Kim, Jae Ho; Lee, Bong Jae

Abstract

BACKGROUND AND OBJECTIVES: As septoplasty has been performed more often in recent years, the incidence of septal perforation as one of its complications has also been increased. Authors aimed to elucidate the etiology and clinical characteristics of the septal perforation.
MATERIALS AND METHODS
Fifty-eight patients with septal perforation were diagnosed between 1991 and 1998 at the Department of Otolaryngology, Asan Medical Center. Of them, 46 were male and 12 were female, and their ages ranged from 14 to 76 years of age (mean : 47 years). Medical records were retrospectively reviewed to investigate the etiology, clinical symptoms, and treatment results.
RESULTS
The most common cause of septal perforation was associated with nasal surgery (41 patients ; 72%) such as submucous resection (22 patients), septoplasty (10 patients), and transseptal pituitary tumor surgery (7 patients). Malignancy involving the nasal septum was the second common cause (8 patients ; 14%). Nasal stuffiness was the most common complaint (36 patients ; 62%), followed by crust formation (24 patients ; 41%), and nasal bleeding (7 patients ; 12%). Around three quarters of patients had perforation smaller than 10 mm in diameter and the cartilaginous septum was the most common site of perforation (88%). Eleven patients not responding to medical treatment underwent surgical repair with a success rate of 91%.
CONCLUSIONS
This study shows that most of the septal perforations are caused by previous nasal surgery involving the nasal septum. Surgeons should be very careful not to make a bilateral corresponding mucosal tear during the septal surgery. If this occurs, meticulous suture-repair with interposition of graft should be applied. For the chronic symptomatic perforation that is refractory to medical treatment, surgical repair using flap and grafts could be performed with a success rate of 90%.