OtoRhinoLaryngology Portal

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Septal Perforation: Clinical Assessment


As seen externally using 0 degree endoscope over left nasal introitus.

As seen internally using 0 degree endoscope passed through right nasal cavity. 


Watch video of large nasal septum perforation @ YouTube

Septal Perforation: The Impact of Size & Site of Involvement

                     Small                                                Large


Septal perforation may involve its cartilaginous or bony part.  These images showed the difference between a small and large septal perforation involving its cartilaginous segment.  Small hole may cause whistling sound while bigger size may not.  However, the latter can present with crustings or epistaxis.  Septal button can be used for small to medium size perforation.  Reconstructive septal surgery may have role in bigger perforation but the success of surgery is small.


Disturbance of laminar flow may results in drying effect and crusts formation.


Watch video of septal perforation in HD @ YouTube

Watch video of small versus large septal perforation @ YouTube

Nasal Septum Fractures

CT-scan images show displaced traumatic fractures of cartilaginous nasal septum which had caused right anterior nasal cavity obstruction following trauma.  Fracture line involving the upper 1/3rd of bony septum is seen as well.  Septal exploration, removal of blood clots, debridement of fractured cartilage pieces, and temporary splinting of the septum need to be undertaken.  As much of normal cartilage must needs to be preserved.

Severely narrowed right nasal cavity from fractured and de-railed cartilaginous nasal septum (S).  (+) - inferior turbinate.

Fractured nasal septum (FS). (+) - inferior turbinate, (*) - middle turbinate, interrupted line - lower septal/maxillary crest prominence with septum de-railed.

Synechiae- Left Inferior Turbinate to Nasal Septum

This image shows a synechiea or adhesion band involving left inferior turbinate and the nasal septum.  It complicates septoplasty and mucosal cautery of the inferior turbinate as part of management of deviated nasal septum and persistent hypertrophy.  It is important not to cause opposing raw surfaces

to come into contact during healing phase. 

In selected cases, silastic intranasal splint can be inserted temporarily.


Watch video of adhesion bands after sinus surgery @ YouTube