Repair of Nasal Septal Perforation

Surgery Overview

The nasal septum is the structure between the nostrils that separates the nasal passages. It's made of cartilage and thin bone. A hole (perforation) can form in the cartilage as a complication of previous nasal surgery, from cocaine use, excessive nose picking, trauma, cancer, or diseases such as tuberculosis, sarcoidosis, or syphilis. As damage reduces blood supply in the septum, the cartilage begins to die, and a hole forms.

Some perforations can cause bleeding, pain, and a whistling sound when you inhale. If dried blood or scabs build up, you could also have trouble breathing through your nose.

Many perforations don't need to be closed. Small holes may need only frequent rinsing with saltwater (saline) solutions and applying lubricating gels. You can buy these without a prescription.

Several surgical techniques may be used to close a larger perforation. A surgeon may use tissue from inside your nose or from another part of your body (autograft) to stitch into the hole. Other doctors may use tissue to create a flap to cover the hole.

Surgery for large perforations usually requires general anesthesia.

A doctor may want to try a nonsurgical technique to close the hole before suggesting surgery. In some cases, a doctor may insert septal "buttons" made of silicone or other materials that are cut to fit the hole.

What To Expect After Surgery

After surgery, you will start to rinse your nose several times a day with saline. Your doctor will teach you how to use the saline. You can expect drainage after surgery.

You may need to have your nose cleaned in the doctor's office a few times. Your nose should be healed 2 to 3 weeks after the nasal pack is removed.

Avoid blowing your nose, strenuous exercise, and bending forward for a few days. And take care not to injure your nose during exercise or other activities.

Why It Is Done

Some nasal septum perforations can cause symptoms such as bleeding and pain. Small perforations can create a whistling sound when you inhale. In cases of long-term, severe perforation, the bridge of the nose can develop a saddle-shaped deformity. Surgery can resolve these problems.

How Well It Works

Surgery to repair a nasal septum perforation is usually successful.

Success of surgery depends to some extent on the size of the perforation and also on proper postsurgery care at home. Large perforations are more difficult to close.

The repair may not be as successful in people who smoke or have diabetes as in other people, because these conditions can reduce blood supply to the septum.

Risks

Bleeding and infection can occur after any surgery. Sometimes the perforation may reopen and need another surgery.