title: Nasal septal perforation in children: Presentation, etiology, and management.
abstract: OBJECTIVE
  The presentation, etiology, and treatment of nasal septal perforation have been described in the adult literature; however, reports in the pediatric population are limited. In this study, we review our experience with pediatric nasal septal perforations with a focus on presentation, pathogenesis, management, and outcomes of surgical repair.
  
  
  METHODS
  A retrospective chart review was performed on pediatric patients diagnosed with nasal septal perforations from 1998 to 2015. Data regarding patient demographics, perforation characteristics, and treatment were extracted and analyzed.
  
  
  RESULTS
  Twenty-seven patients met inclusion criteria. Mean age was 10.8 years (range 2 months-17 years). Nasal crusting (n = 19, 73%) and epistaxis (n = 15, 58%) were the most common complaints at presentation. The most common etiologies were trauma (n = 9, 33%), iatrogenic sources (n = 5, 19%), and neoplasm (n = 3, 11%). Septal perforations were primarily located in the anterior septum (n = 17, 81%) and the average size was 0.9 cm (±0.37) in diameter. Four patients were managed with a nasal septal button. Successful closure was achieved in four out of six patients (66.7%) who underwent surgical repair.
  
  
  CONCLUSIONS
  In our series, septal perforations in children occurred most frequently due to digital nasal trauma, and crusting was the most common symptom. Factors to consider prior to repair include symptomatology, the etiology of the perforation, co-morbidities, ability to comply with post-operative care/restrictions, availability of adjacent tissue/grafts, and potential effects on nasal growth. Even with careful consideration of these factors, successful closure was limited to two-thirds of patients who were offered repair.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Alexandria L
authors.initials: AL
authors.lastname: Irace
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: Carolyn R
authors.initials: CR
authors.lastname: Rogers-Vizena
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Nuss
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: eelam.adil@childrens.harvard.edu.
authors.forename: Eelam A
authors.initials: EA
authors.lastname: Adil
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D061270:Nasal Septal Perforation / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies
keywords: Cautery; Epistaxis; Nasal trauma; Pediatric nasal septal perforation