Abstract
Nasal septal perforation is a prevalent pathology, and its successful treatment remains
a significant challenge. Surgical closure is complex, and there are a plethora of
accounts of various surgical techniques within the existing literature. Much less
has been written about perioperative considerations, which are arguably just as important.
This article therefore focuses predominantly on the pre and postoperative management
of patients with septal perforation. By drawing both on the existing literature and
a series of 64 cases managed over several years by our department, this review aims
to consolidate guidance on patient selection, timing of surgical intervention, postoperative
splinting, use of antibiotics, and patient advice. It is clear that the size of the
perforation (relative to the size of the septum), health of surrounding mucosa, and
the systemic health and age of the patient remain essential considerations in patient
selection and operative timing. Internal and external splints are widely used to good
effect, but the role of nasal packing is less clear-cut. This article suggests packing,
but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin
paste). Use of prophylactic antibiotics remains controversial. The complete closure
rate for the series presented here was 81.3%, with an average perforation diameter
of 15.1 mm (range: of 6–32 mm), and that for perforations with a diameter below 22 mm
was 97.9%.
Keywords
postoperative management - preoperative management - nasal septum - surgical repair
- closure
