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CREATION OF PERFORATIONS

Septal perforations can be caused by:

  • Incorrectly performed operations on the nose
  • Vascular diseases
  • Excessive nose picking/rhinotillexomania
  • Cocaine use
  • An unknown cause (50% are idiopathic)
  • Perforations can cause minimal but also significant functional symptoms for the patient

Small perforations can cause a whistling sound when a patient breathes through the nose. Large perforations usually do not cause whistling, but they do cause a feeling of congestion and contribute to nasal crusting. This can be very annoying for the patient. Correction of a septal perforation depends on the size of the perforation.

Small perforations can be corrected with a one-stage (2-hour) operation with a high success rate > 90%.

The diagram opposite shows the inner lining of the nose on both sides of the septum to close the hole and a cartilage graft to repair the hole in the frame.

Call +31 (0) 85 029 0829 for an appointment

TYPES OF PERFORATIONS

Smaller to moderate perforations up to 3 cm can be repaired with flaps on the inside of the nose and cartilage graft from your ear cartilage (see our group publications on septal perforation). Very large perforations larger than 3-4 cm can still be closed/repaired surgically, but this is much more complicated.

There are different ways of tackling saddle nose deformity. However, the majority can be corrected in a one-stage operation. Some more severe forms require more than one stage to reconstruct the part of the nose. We have additional techniques to repair large septal perforations that are not amenable to closure/repair using standard techniques.

Septal Perforation FAQs

What is a septal perforation?

A septal perforation is a hole or tear in the nasal septum, the cartilage and bone that divides the two nostrils. This condition can vary in size and may be located in different areas of the septum, potentially affecting breathing and nasal structure. Septal perforations can be classified as small < 1 cm medium 1-3 cm and large > 3 cm.

What are the common causes of septal perforations?

The common causes of septal perforations include trauma to the nose, such as from an injury, surgery, or even prolonged use of nasal decongestant sprays. Chronic conditions like cocaine use can also lead to the development of septal perforations due to the drug’s harmful effects on the nasal lining.

What are the symptoms of a septal perforation?

Symptoms of a septal perforation can include nasal obstruction, frequent nosebleeds, whistling sounds when breathing, and dryness or crusting in the nose. Some individuals may also experience facial pain or a reduced sense of smell.

How is a septal perforation diagnosed?

Your doctor will examine the inside of the nose using a nasal speculum or endoscope to get a clear view of the septum.

Can a septal perforation heal on its own?

No septal perforations do not heal naturally and require surgical intervention to close the hole.

What are the treatment options for a septal perforation?

Several treatment options for septal perforation include conservative measures like saline nasal sprays, humidification, and avoiding irritants to surgical repair. Medications, such as nasal ointments, may be prescribed to help with dryness and discomfort. Sometimes, a septal button (a small device placed in the perforation) may provide temporary relief. Our experience is that septal buttons can cause discomfort and can in some instances enlarge the perforation.

Is surgery always necessary to correct a septal perforation?

Surgery is not always necessary to correct a septal perforation. We advise closure for enlarging perforations and symptomatic perforations.

What is involved in septal perforation surgery?

Septal perforation surgery, is performed through open septorhinoplasty and moving the lining of the nose on each side to close the hole.

What is the recovery like after septal perforation surgery?

The recovery after septal perforation surgery can vary depending on the complexity of the surgery and the individual’s healing process. Most patients can expect swelling and discomfort for several days to weeks. Pain can usually be managed with medications, and the patient may need to avoid strenuous activities or blowing their nose for a 4 weeks. Often there is nasal obstruction for 6 weeks following surgery. This almost always settles as the lining of the nose heals into its new position.

How successful is septal perforation repair surgery?

Our success rate is over 95% for perforations smaller than 3 cm. This is one of the higher successful closure rates in the world. Many other series/clinics have closures rates of 40-60%

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EXECUTIVE DOCTOR

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CALLUM FARIS

ENT specialist and specialist in facial plastic surgery

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