The nasal septum is made up of several bones and cartilage in the front that divides the right and left sides of the nose. This “wall” of tissue is covered with soft tissue that grows and shrinks in order to heat, humidity and purify the air we breathe. Every 2 to 6 hours one side of the nose swells while the other side contracts. This “nasal cycle” allows the open side of the nose to filter air while the other side heals and recovers. The septum can become punctured leading to a septal perforation which ultimately often needs to be repaired. Below we go further into septal perforations and their repair.
Any time there is a hole in the nasal septum there is a “septal perforation”. This is usually caused by loss of blood supply to both sides of the septum. Without this blood supply, the cartilage will not survive. Causes include medications that prevent adequate blood flow to the delicate sides of the septum. In addition, surgery can damage both sides of the septum as can trauma or placing instruments or fingers in the nose. Exposure to chemicals or cocaine may also cause perforations. Systemic diseases like tuberculosis syphilis or fungal disease as well as nasal malignancies can cause septal perforations.
A perforated septum can be caused by:
A hole in the septum prevents the proper airflow into the nose as the air will go from one side to the other. This can cause drying of the insides of the nose and further increase the size of the perforation. Symptoms include:
If the perforation becomes large enough or there is trauma to the outside of the nose then the nose may collapse. This results in a saddle-nose deformity causing worsening of breathing and the cartilage under the nasal bones to fall inward.
The risk factors of a septal perforation include:
Yes. A perforation may have no symptoms and you may have a hole in the septum without even being aware that it’s there. Saline rinses can soften crusting and help moisturize the inside of the nose. Emollients, ointments, and moisturizers can be useful to keep the nasal septum from drying out but should be cleared with your doctor before using in your nose. A septal “button” is a plastic plug that can be placed in the septum but tend to be uncomfortable. Sometimes the crusting needs to be removed by an otolaryngologist as it becomes too large to come out on its own.
Dr. Bennett individualizes every patient’s care. A minimum of half an hour is needed to fully understand your expectations and to get a complete history and evaluation of the inside and outside of your nose. Knowing what to expect will make the entire experience more pleasant and increase your satisfaction with the surgical results. Dr. Bennett will discuss the cosmetic and functional expectations of your perforated septum in detail to make sure all of your questions are answered. Depending on whether you have functional/breathing issues insurance may cover part of your surgery
Fixing a septal perforation is necessary when the symptoms become great enough to sufficiently decrease your quality of life. A whistling nose may bother one person and another may not care. The purpose of correcting a hole in the septum is to improve breathing, correct prevent or decrease crusting, decrease expansion of the perforation, decrease whistling or lessen bleeding. Many of the procedures are performed through the nostrils if the septal perforation is small enough with no external incisions needed. The operating time is usually a couple of hours and can be performed in the office, hospital, or ambulatory surgery center. You may not want to be awake and if so then general anesthesia will be used. After the procedure, you generally go home within an hour or two. Many times splints are placed inside the nose on both sides to protect the area of repair. With a successful surgery, your symptoms can be expected to improve or even resolve completely. Larger perforations may require an open approach with tissue flaps. Very large perforations may be too large to be closed.
Depending on the type of surgery you have, you will likely have nasal packing/splints in your nose. These are placed by Dr. Bennett to allow for proper healing of the internal nasal structures, like an “internal cast” for the nose. These typically are removed at your first postoperative visit, one week later. You will also likely have a nasal cast on the outside of the nose. This also helps reduce swelling and keep everything in place. This remains on the nose also for 1 week following surgery. Depending on your work, Dr. Bennett typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting as this can alter the structure of the nose through straining. If you wear glasses, you may require some alterations as to not provide pressure on the nasal bones. Dr. Bennett will provide you with pain medications, ointments, nasal sprays, all to help maximize your results.
You will see Dr. Bennett one week after surgery where he will remove all casting materials and splints. Your nose may be swollen for a temporary period of time, so don’t stress! The nose is a small area, and all that surgery causes swelling that eventually is reduced with time. Depending on the patient this swelling typically lasts for 2-3 weeks but can last up to two months in rare circumstances. To help reduce the swelling Dr. Bennett will re-apply tape to the nose that will be there until your second post-operative visit. This pressure dressing reduces the amount of swelling. The second postoperative visit will involve removing all the tape. Dr. Bennett will then see you in visitations two weeks later, and then one month after that. Dr. Bennett enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.