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What is Septal Perforation Repair?

Septal perforation repair is a surgical procedure performed to treat a perforated nasal septum.

Nasal septal perforation is a condition where there is a perforation or a hole in the nasal septum. The septum is the bone and cartilage in the middle of your nose, separating the right and left nostrils. A perforation can develop in the cartilage as a complication of previous nasal surgery, nasal trauma or fracture, excessive nose picking, infections, abuse of medicated nasal sprays, illicit drug abuse, or certain diseases such as sarcoidosis, tuberculosis, or syphilis. As damage decreases blood supply in the septum, the cartilage begins to die and a hole is formed. The hole may vary in size depending upon the cause of the perforation. A hole in the septum can also alter the external shape of the nose, leading to a collapsed nasal bridge (saddle nose deformity) and loss of nasal height. This is more common when there is a larger perforation.

Sometimes, depending upon the size of the septal perforation, the hole may heal on its own. However, as the size increases, the possibility of spontaneous resolution diminishes. A proper nasal septal perforation repair is crucial because of the delicate nature of the tissue.

Indications for Septal Perforation Repair

Your surgeon may recommend septal perforation repair when symptoms of septal perforation is affecting your quality of life. Symptoms of a perforated septum include:

  • Difficulty breathing
  • Nasal crusting
  • Nasal congestion
  • Altered sense of smell
  • Whistling sounds when breathing
  • Recurrent nosebleeds

Symptoms of a perforated septum will vary from patient to patient. Often, the symptoms will depend upon the size of the hole in your septum. These can be categorized as:

  • Small (smaller than 1 centimeter)
  • Medium (between 1 and 2 centimeters)
  • Large (bigger than 2 centimeters)

Surgical septal perforation repair becomes necessary in patients with serious complications.

Preparation for Septal Perforation Repair

Preparation for septal perforation repair may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Diagnostic tests and imaging to help detect any abnormalities that could compromise the safety of the procedure. This includes a routine nasal exam, blood work, nasal endoscopy, or CT scan.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
  • You are advised to abstain from smoking for a defined period before and after surgery as smoking may cause breathing issues during the surgery, as well as slow down the healing process.
  • You should not consume any solids or liquids at least 8 hours before surgery.
  • A written consent will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Septal Perforation Repair

Septal perforation repair is a reconstructive surgical procedure. The objective of this nasal surgery is to close the perforation and restore the normal structure and function of the nasal septum. Septal perforation repair surgery is usually performed as a day procedure under a general anesthetic. The procedure takes 1 to 3 hours, and you typically go home the same day. There are two ways to repair a nasal septal perforation - the closed approach or the open approach. Some surgeons utilize a closed approach technique, which means they go in through the opening in your nostrils to access the treatment area. While others utilize an open approach which requires a small, well-hidden incision underneath your nose. Your surgeon will choose the one based on where the hole is and how big it is, as well as their skills and experience. Typically, your surgeon will take a local flap of tissue from your nose, or even your mouth, to cover the perforation. The flap is then secured in place with sutures, and sometimes supported with additional tissue or materials, such as bone or cartilage grafts or tissue from other parts of your body. You will likely have nasal packs/splints in your nose for a specific period to protect the repair and promote healing.

A septal button is a less often used technique where a prosthetic is used to fill the hole in the septum.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after septal perforation repair will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
  • You may experience pain, inflammation, and discomfort in the operated area. Medications are prescribed as needed to manage these, along with antibiotics to address the risk of surgery-related infection.
  • Sinus irrigations are usually recommended several times a day during your recovery. Your doctor will give you instructions on how to perform them.
  • Avoid blowing or picking your nose, strenuous exercise, lifting anything heavy, and bending forward for a few days. If you do sneeze, make sure to sneeze with your mouth open.
  • Your nose should be healed in a couple of weeks after the nasal pack or splint has been removed.
  • Keep your follow-up visits as recommended to ensure a positive surgical outcome.

Risks and Complications

Septal perforation repair is a safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Infection
  • Bleeding
  • Poor wound healing and scarring
  • Airway obstruction
  • Nasal discharge/crusting
  • Pain and swelling
  • Redness on the outside of your nose
  • Allergic/anesthetic reactions
  • Recurrent or persistent nasal perforation
  • Need for secondary and revision surgeries

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