Episode # 278 • 16 Jun 2026
Comprehensive Evaluation & Surgical Management of Nasal Septal Perforations
Septal perforations can be deceptively challenging, with a wide range of etiologies, symptoms, and treatment options to consider. In this episode of BackTable ENT & Allergy Podcast, hosts Dr. Ashley Agan and Dr. Gopi Shah interview Dr. Oswaldo Henriquez, a board-certified otolaryngologist and rhinologist at WellStar Health System in Atlanta, to explore the complexities of evaluating and managing nasal septal perforations. The conversation covers how perforation size and location shape symptoms, the most common causes including iatrogenic trauma and chronic nose picking, and a thorough, stepwise approach to diagnosis and treatment.
Timestamps
00:00 - Introduction
03:01 - Septal Perforations Overview
07:58 - Causes and Risk Factors
13:26 - History Red Flags and Differential Diagnosis
16:28 - Exam and Documentation Tips
21:22 - Labs Biopsy and Imaging Workup
31:19 - Conservative Care and Septal Buttons
34:20 - Surgery Candidacy and Counseling
41:35 - Surgical Techniques Landscape
47:38 - Scaffolds and Grafts
49:07 - Septal Blood Supply Map
53:00 - CAT Scan Planning Tips
55:15 - AEA Flap Technique
01:05:22 - Real Case Walkthrough
01:10:41 - Postop Care and Swelling
01:20:44 - Pitfalls and Success Rates
01:24:09 - Wrap Up
Resources
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More about this episode
Dr. Henriquez outlines the key components of a comprehensive workup, including endoscopic exam, measurement, biopsy, and CT imaging for surgical planning. He discusses management options from conservative care and septal buttons to advanced endoscopic pedicled flap repairs, sharing insight on surgical techniques, success rates, splinting, and post-op care. The episode provides practical tips for physicians at any career stage looking to refine their approach to septal perforations, from diagnosis through recovery.
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