Septal perforation glossary
Ninety-odd words you will hear from your ENT or read in a report, defined in two lines, each pointing to the page of the guide that explains it.
Acellular dermis
Human dermis stripped of its cells, used as an interposition layer. Avoids a harvest, but remains tissue of foreign origin.
Advancement flap
Mucosa lifted around the hole then slid across to cover it, like drawing two curtains. The basic move, usually done on both sides.
Anterior ethmoidal artery
The vessel supplying the upper septum. It is the pedicle of the AEA flap, which brings in living mucosa without touching the turbinates.
Bacitracin
An antibiotic ointment sometimes prescribed as a short course on infected edges. Not a long-term treatment.
Bipedicled
Said of a flap left attached at both ends, so fed from both sides. More robust than a single-pedicle flap.
Bridge flap
Mucosa mobilised as a bridge across the perforation, fed from both ends. The reference technique in Germany, designed for large perforations.
Cartilage, costal
Cartilage harvested from a rib: rigid, flat, available in quantity. The harvest carries a risk of pneumothorax.
Cartilage, quadrangular
The cartilage forming the front of the septum. It is what is missing in the middle of an anterior perforation.
Closed approach
Operating through the nostrils, with no external incision. No visible scar, but a narrower view. Meta-analyses find no difference in outcome against the open approach.
Conchal cartilage
Cartilage from the bowl of the ear. The usual source of interposition cartilage, with low morbidity and a hidden scar.
Cotton test
A moist cotton plug is placed where a turbinate is missing to see if breathing improves. It can read falsely negative while a perforation stays open.
Cross-stealing
A technique that “steals” mucosa from one side to cover the other through the hole, offset, instead of bringing the edges face to face.
Crusting
Dry deposits on the edges, bleeding when pulled off and driving further enlargement. Rinses and gels exist mainly to prevent them.
Delphi method
A multi-round voting procedure that produces expert consensus without a meeting. This is how the 2026 international consensus was built.
Dexpanthenol
Provitamin B5, as an ointment or spray. A moisturising, healing local treatment recommended first-line.
Draf III
A wide frontal sinus opening, needed to bring a pericranial flap down into the nose. A heavy step, kept for salvage.
Edges
The rim of the perforation. Often dry and crusted: enlargement starts there.
Empty nose
A paradoxical feeling of blockage, with dryness and crusting, after excessive turbinate reduction. Closing the perforation does not fix it.
Epistaxis
A nosebleed. Common with a perforation, usually triggered by picking or a torn crust.
Ethmoidectomy
Surgical opening of the ethmoid cells. Worth flagging as history: it can involve the pedicle of the AEA flap.
Evidence level
The scale rating how solid a study is. Almost all the literature on perforations is level 4: retrospective series with no comparison group.
Fascia
The fibrous sheet wrapping muscle. Placed between the two mucosal layers, it acts as the scaffold of the repair.
Fascia lata
Fascia harvested from the outer thigh. Strong and available in quantity; leaves a scar on the leg.
Flap
Tissue moved without being disconnected from its blood supply: it arrives alive on the perforation. The principle behind most closures.
Floor and inferior meatus flap
Mucosa from the floor of the nose, pivoted towards the septum. Abbreviated NFIM; the extended version takes in the inferior turbinate.
Follow-up
How long patients were tracked. It is the most commonly missing figure: 91% closure at a few months and 72% at five years can describe the same surgery.
Free mucosal graft
A small piece of mucosa laid without a pedicle to speed regrowth over a raw area. A recently described adjunct, not a technique on its own.
Graft
Tissue cut from its blood supply and transplanted: it must re-establish a supply in place. Distinct from a flap.
Granulomatosis with polyangiitis
A vasculitis that can perforate the septum. Looked for with blood tests when the cause is not obvious.
Greater palatine artery flap
A flap brought up from the palate to the nose. It spares the nasal cavities entirely, at the cost of oral morbidity. A niche option.
Hemitransfixion
An incision at the nostril entrance along the front edge of the septum, giving access without a visible scar.
Humidifier
A device keeping room air at 40% humidity or more. Dry air is a perforation's main enemy.
Hyaluronic acid
A moisturising gel applied inside the nostril to limit crusting and dryness. Comfort care: it does not close the perforation.
2026 international consensus
The reference document in Rhinology: three voting rounds among 25 experts from 15 countries, 56 agreements on measurement, classification and treatment. Most figures on this site come from it.
Iatrogenic
Caused by medical care. It is the leading cause of septal perforation: 0.5 to 3% of septoplasties.
Idiopathic
No cause found despite a full work-up. That is the case in roughly a third of large perforations.
Inferior meatus
The space under the inferior turbinate. Several techniques harvest mucosa there or place their release incisions in it.
Interposition graft
The layer slid between the two mucosal faces, replacing the missing cartilage and separating the suture lines. It multiplies the odds of closure by almost seven.
Lateral nasal wall flap
A large flap taken from the outer wall of the nose, at the cost of the tear duct. Kept for extreme cases.
Lipoid pneumonia
A lung infection caused by repeatedly inhaling oily substances. This is why petroleum jelly and mineral oils are avoided in the nose, in favour of water-based gels.
Meta-analysis
A study pooling published series to derive an overall figure. The 2022 one gathers 64 studies and 1,591 patients.
Middle turbinate
The turbinate above the inferior one. Older techniques harvested a flap from it, with its bone; to be ruled out if your turbinates have already been reduced.
Money box
The vivid name for the pericranial flap's access route: a bone window at the root of the nose, like the slot of a piggy bank.
Mucociliary clearance
The nose's ability to move mucus and dust back towards the throat. A perforation disrupts it; closing it improves it.
Mucoperichondrium
Mucosa and perichondrium lifted together, as one layer. Surgeons follow this plane to avoid tearing the mucosa.
Mucosa
The moist, well-vascularised lining of the nose. A successful closure needs living mucosa on both sides. It is the scarce resource of this whole field of surgery.
Mupirocin
An antibiotic ointment that reduces crusting and infection of the edges. On prescription, in short courses.
N-TEC
Nasal cartilage engineered in the laboratory from your own cells. A phase I trial in Basel on five patients: feasibility shown, efficacy not established.
Nasal endoscopy
An examination with a scope, ideally recorded, that shows and measures the perforation. Insist on dimensions in the report.
Nasal floor
The floor of the nasal cavity. A donor site of mucosa for several flaps, and the usual place for release incisions.
Nasal septum
The wall separating the two nasal cavities: cartilage in front, bone behind, covered on both sides by mucosa.
NOSE-Perf
A 12-question scale scored 0 to 48, built to measure perforation symptoms. Validated in English and Spanish; no validated French version so far.
Open approach
Operating through an incision under the columella, which opens the nose like a bonnet. Better view, discreet scar under the nose.
Optimism bias
The documented tendency of surgeons to rate their results higher than non-operating colleagues: 90/75/50% against 80/50/25% in the 2024 German survey.
PDS
Polydioxanone: a resorbable plate acting as a temporary scaffold while the mucosa regrows.
Perfoplasty
Smoothing the edges to remove crusting, whistling and turbulence, without closing the hole. Symptom control was achieved in about 9 of 10 patients in the published series.
Perichondrium
The thin membrane stuck to the cartilage that feeds it. Lose it on both sides and the cartilage dies, widening the hole.
Pericranial flap
A flap raised from the periosteum of the skull and brought down into the nose. It does not bring true mucosa: kept for destroyed septa.
Periosteum
The bone's equivalent of perichondrium. The pericranial flap is made of the skull's periosteum.
Pistoning
The micro-movements of a septal button inside the hole. It is this rubbing that makes a poorly fitted button enlarge the perforation.
Polycaprolactone
A resorbable, 3D-printable polymer being tested as a closure scaffold. A clinical trial is running; it is not an available option.
Posterior septectomy
Deliberately removing the back of the septum to create a single cavity, when a large posterior perforation cannot be closed. Symptoms improved in nearly 8 of 10 patients.
Prevalence
The share of people affected in the population. For septal perforation: 0.9% in the only general-population study, up to about 2.6% in more recent estimates.
PRF
Platelet-rich fibrin, a cousin of PRP. Same logic: boosting healing alongside a technique, not closing the hole by itself.
PRP
Platelet-rich plasma: a concentrate from your own blood used to stimulate healing. Still under study for perforations.
Re-epithelialisation
The spontaneous regrowth of mucosa over a raw area or a scaffold. It is the bet made by techniques that do not suture.
Re-perforation
A hole that reopens after closure was achieved, often smaller. It is the failure mode specific to advancement flaps.
Rhinoplasty
Surgery on the shape of the nose. Combined with a perforation repair it was linked to more failures in one single-surgeon series, a risk not found everywhere.
S2 route
Authorisation requested before travelling, allowing surgery in a public hospital in another EU or EEA country, or Switzerland, at that country's tariff.
Saline rinse
Isotonic salt water, used morning and evening. The simplest and most useful care there is.
SEPEQOL
A quality-of-life questionnaire specific to septal perforation, developed and validated in Spanish.
Septal button
A silicone prosthesis plugging the hole without closing it. A permanent foreign body: the 2026 consensus keeps it for patients who cannot or will not have surgery.
Septal perforation
An opening straight through the septum, connecting the two nasal cavities. Repair means closing it on both sides.
Septoplasty
Surgery to straighten the septum. It is the leading cause of septal perforation, in 0.5 to 3% of cases.
Shear stress
The friction of air against the mucosa. It peaks at the upper front edge of the hole, exactly where endoscopy sees the lining erode.
Sinus CT scan
Cross-sectional imaging giving the perforation's dimensions and the state of the sinuses. With endoscopy, this is the minimum work-up.
Splints
Silicone plates placed either side of the septum after surgery to protect the repair. They stay in from a few weeks to three months depending on the team.
Stem cells
Cells able to turn into several tissue types. Tested to regenerate mucosa: systematic reviews conclude the evidence is very weak.
Stenosis
Scar narrowing, notably of the nostril entrance. A possible complication of nasal surgery.
Subtotal
Said of a perforation larger than 3 cm. Below that: small under 1 cm, medium 1 to 2 cm, large 2 to 3 cm.
Surgical volume
The number of perforations a surgeon closes each year. It is the modifiable factor that weighs most on the result.
Synechia
A scar band sticking two walls of the nasal cavity together. A frequent and usually benign complication after repair.
Temporoparietal fascia
Fascia harvested above the ear, often combined with a PDS plate. Abbreviated TPF; the scar hides in the hair.
Tricellufuse
A construct combining fascia lata, fat and diced septal cartilage. 86% closure at one year in medium perforations; every failure was a smoker.
Turbinate flap
A flap harvested from a turbinate, sometimes with its bone. To be ruled out if your turbinates have already been reduced: it would worsen one condition to repair the other.
Turbinates
Mucosa-covered ridges that warm and humidify air. Reducing them too far causes an empty nose; some techniques harvest tissue from them.
Upper lateral cartilage
The cartilage just above the quadrangular one. Its underside carries mucosa a flap can recruit, sparing the floor of the nose.
Vasculitis
Inflammation of blood vessels. One of the eight recognised families of causes, ruled out with blood tests when nothing else explains the perforation.
Vasoconstrictor
A spray that unblocks the nose by narrowing vessels. A recognised cause of perforation and a maintaining factor: not for prolonged use.
Whistling
The sound of air passing through a small perforation. It disappears as the hole grows, which is not good news.
Xenograft
A graft of animal origin, for example the acellular porcine collagen used for interposition.
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