Septal Perforation

 

Septal Perforation

A Septal Perforation can be a very troublesome problem to have, and usually results in significant distress to patients. It is a full thickness hole in the nasal septum, affecting most functions of the nose. Typically, patients will have difficulty breathing through their nose, pain, excessive crusting, noisy breathing (whistling) and bleeding. In more severe septal perforations, the septal hole can cause a saddle nose deformity, or sinking of the bridge of the nose, causing it to appear flat and smaller than normal.  Most septal perforations are caused by having previous nasal surgery. In other instances, they are caused by using topical medications and drugs. Lastly, and more rarely, connective tissue diseases such as Wegener’s Granulomatosis, and Lupus can cause them. Prior to any correction of your septal perforation, it is important that you discuss the cause of your septal perforation, as it has implications in your care.

Our center is one a few centers in the country that can surgically repair septal perforations.  We have coauthored scientific papers and book chapters which detail septal perforations and discuss techniques to close them.  After having closed greater than 2 cm perforations many patients have flown in for their surgery from places around the world.  Make sure to ask us for details regarding your reservation, hotels, local eatery’s, and surgical scheduling if you are traveling from afar. 

During your consultation, it is very important to discuss the cause of the septal perforation, as untreated causes can often result the recurrence of perforation following surgery. Other procedures may be combined during the closure of the septal perforation.

Surgery is performed under general anesthesia and is performed on an outpatient basis. A small hidden incision is made on the skin between the nostrils, while all the remaining incisions are done inside the nose. Intranasal flaps are raised above and below the septal perforation. The deviated portions of the septum are repaired.  Each layer is closed individually, and a graft is placed between the nasal lining to help strengthen the closure. Soft silastic splints are then used to protect the closure and left in place for a short period until the closure heals.

After surgery, pain typically is not a large concern for most patients.  Instead, most patients are tired from anesthesia, and there is some discomfort.  Often, patients feel as though they have a cold – their head feels heavy and they are stuffy. Patients are ready to return back to work (depending on what the activities of work are) or school after one week. Much of the swelling comes down within the first 6-8 weeks. The silastic splints are typically taken out at 2 weeks but can be left longer if needed.  The nose will continue to improve every day.  Light exercise can be initiated around 3 weeks (no heavy lifting or impact exercise). Full contact sports need to wait for 6 weeks to allow the nasal bones to heal fully. Contacts are fine, but glasses can exert asymmetric pressure on the nasal bones. Ask your surgeon for options if you wear glasses. If you would like, all your post op appointments can be scheduled ahead of time to help plan. After the first few, visits are regularly scheduled at 3-month intervals for one year to check on the healing process.  Because of the complexity of septal perforation repair, swelling can take longer to come down.