Nazal Septum Perforasyonu
Özet
Nazal septum perforasyonu (NSP), nazal septumun kıkırdak ya da kemik yapısında meydana gelen ve iki burun kavitesini kalıcı olarak birbirine bağlayan tam kat defektlerdir. Toplumda prevalansı yaklaşık %1 olarak tahmin edilen bu durum, tedavi süreçlerindeki zorluklar nedeniyle Kulak Burun Boğaz pratiğinde önemli bir yere sahiptir. NSP gelişimindeki en sık etiyolojik faktör iatrojenik nedenler, özellikle septoplasti gibi nazal cerrahiler iken, çocuklarda en sık neden travmadır. Dijital travmalar, kimyasal irritanlar, ilaç kullanımları ve bazı sistemik hastalıklar da perforasyona yol açabilir. Hastaların yaklaşık %40'ı asemptomatik olsa da, en sık karşılaşılan semptomlar kabuklanma, epistaksis, burun tıkanıklığı ve nefes alırken ıslık sesidir. Teşhis sürecinde endoskopik muayene ve detaylı anamnez kritik rol oynar. Tedavi yönetimi medikal ve cerrahi yaklaşımları içerir. Medikal tedavide burun nemlendiricileri, izotonik salin lavajları ve semptomatik rahatlama sağlayan silikon septal butonlar kullanılır. Şikayetleri devam eden uygun hastalarda ise mukozal ilerletme, cross-over, etmoid arter ve lateral nazal duvar flebi gibi çeşitli cerrahi tekniklerle onarım gerçekleştirilir. Cerrahi başarının temel amacı normal nazal fizyolojiyi geri kazandırmaktır.
Nasal septal perforation (NSP) refers to full-thickness defects occurring in the cartilage or bone of the nasal septum that permanently connect the two nasal cavities. Estimated to have a prevalence of approximately 1% in the population, this condition holds an important place in Otorhinolaryngology practice due to challenges in the treatment process. While the most common etiological factors in NSP development are iatrogenic reasons, particularly nasal surgeries like septoplasty, the most frequent cause in children is trauma. Digital trauma, chemical irritants, drug abuse, and certain systemic diseases can also lead to perforation. Although approximately 40% of patients are asymptomatic, the most frequently reported symptoms include crusting, epistaxis, nasal obstruction, and a whistling sound during breathing. Endoscopic examination and a detailed medical history play a critical role in the diagnosis process. Treatment management involves medical and surgical approaches. Medical treatment utilizes nasal moisturizers, isotonic saline lavages, and silicone nasal septal buttons that provide symptomatic relief. In suitable patients whose symptoms persist, reconstruction is performed using various surgical techniques such as mucosal advancement, cross-over, ethmoid artery, and pedicled lateral nasal wall flaps. The primary goal of surgical success is to restore normal nasal physiology.
Referanslar
Gold M, Boyack I, Caputo N, et al. Imaging prevalence of nasal septal perforation in an urban population. Clin Imaging. 2017;43:80-82. Doi: 10.1016/j.clinimag.2017.02.002.
Oberg D, Akerlund A, Johansson L, et al. Prevalence of nasal septal perforation: the Skövde population-based study. Rhinology. 2003;41(2):72-75.
Chang DT, Irace AL, Kawai K, et al. Nasal septal perforation in children: Presentation, etiology, and management. Int J Pediatr Otorhinolaryngol. 2017;92:176-180. Doi: 10.1016/j.ijporl.2016.12.003.
Jennings JJ, Shaffer AD, Stapleton AL. Pediatric nasal septal perforation. Int J Pediatr Otorhinolaryngol. 2019;118:15-20. Doi: 10.1016/j.ijporl.2018.12.001.
Kridel RWH, Delaney SW. Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience. Facial Plast Surg. 2018;34(3):298-311. Doi: 10.1055/s-0038-1654675.
Sharif-Askary B, Carlson AR, Van Noord MG, et al. Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic Review. Plast Reconstr Surg. 2020;145(3):669-684. Doi: 10.1097/PRS.0000000000006561.
Lanier B, Kai G, Marple B, et al. Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol. 2007;99(6):473-479. Doi: 10.1016/S1081-1206(10)60373-0.
Pereira C, Santamaría A, Langdon C, et al. Nasoseptal Perforation: from Etiology to Treatment. Curr Allergy Asthma Rep. 2018;18(1):5. Doi: 10.1007/s11882-018-0754-1.
Kridel RW. Considerations in the etiology, treatment, and repair of septal perforations. Facial Plast Surg Clin North Am. 2004;12(4):435-450. Doi: 10.1016/j.fsc.2004.04.014.
Dedhia RD, Davis SJ, Stephan SJ. Optimizing septal perforation repair techniques. Curr Opin Otolaryngol Head Neck Surg. 2020;28(4):212-217. Doi: 10.1097/MOO.0000000000000631.
Sonneveld KA, Sinha PK. Correction of Septal Perforation/Nasal Airway Repair. Oral Maxillofac Surg Clin North Am. 2021;33(1):119-124. Doi: 10.1016/j.coms.2020.09.006.
Murray A, McGarry GW. The clinical value of septal perforation biopsy. Clin Otolaryngol Allied Sci. 2000;25(2):107-109. Doi: 10.1046/j.1365-2273.2000.00332.x.
Diamantopoulos II, Jones NS. The investigation of nasal septal perforations and ulcers. J Laryngol Otol. 2001;115(7):541-544. Doi: 10.1258/0022215011908441.
Khong GC, Leong SC. Correlation of sinonasal symptoms with the size and position of nasal septal perforations. Laryngoscope. 2020;130(12):715-720. Doi: 10.1002/lary.28415.
Watson D, Barkdull G. Surgical management of the septal perforation. Otolaryngol Clin North Am. 2009;42(3):483-493. Doi: 10.1016/j.otc.2009.03.011.
Alobid I. Endoscopic approach for management of septal perforation. Eur Arch Otorhinolaryngol. 2019;276(8):2115-2123. Doi: 10.1007/s00405-019-05490-w.
Taylor RJ, Sherris DA. Prosthetics for nasal perforations: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(5):803-810. Doi: 10.1177/0194599815577084.
Price DL, Sherris DA, Kern EB. Computed tomography for constructing custom nasal septal buttons. Arch Otolaryngol Head Neck Surg. 2003;129(11):1236-1239. Doi: 10.1001/archotol.129.11.1236.
Schultz-Coulon HJ. Three-layer repair of nasoseptal defects. Otolaryngol Head Neck Surg. 2005;132(2):213-218. Doi: 10.1016/j.otohns.2004.09.066.
André RF, Lohuis PJ, Vuyk HD. Nasal septum perforation repair using differently designed, bilateral intranasal flaps, with nonopposing suture lines. J Plast Reconstr Aesthet Surg. 2006;59(8):829-834. Doi: 10.1016/j.bjps.2005.11.010.
Castelnuovo P, Ferreli F, Khodaei I, et al. Anterior ethmoidal artery septal flap for the management of septal perforation. Arch Facial Plast Surg. 2011;13(6):411-414. Doi: 10.1001/archfacial.2011.44.
Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, et al. Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope. 2011;121(8):1606-1610. Doi: 10.1002/lary.21889.
Rivera-Serrano CM, Bassagaisteguy LH, Hadad G, et al. Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy. 2011;25(6):212-216. Doi: 10.2500/ajra.2011.25.3693.
Alobid I, Mason E, Solares CA, et al. Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study. Rhinology. 2015;53(3):235-241. Doi: 10.4193/Rhino14.042.
Santamaria-Gadea A, Lopez-Chacon M, Langdon C, et al. Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits. Rhinology. 2018;56(4):386-392. Doi: 10.4193/Rhin18.036.
Santamaría A, Langdon C, López-Chacon M, et al. Radio-anatomical analysis of the pericranial flap "money box approach" for ventral skull base reconstruction. Laryngoscope. 2017;127(11):2482-2489. Doi: 10.1002/lary.26574.
Alobid I, Langdon C, Santamaría A. Technique to Repair Total Septal Perforation With a Pericranial Flap: The Money Box Approach. JAMA Facial Plast Surg. 2018;20(4):324-325. Doi: 10.1001/jamafacial.2017.2413.
