Repair of Nasal Septal Perforation

The nasal septum is the structure between the nostrils that separates the nasal passages. The septum, composed of cartilage and thin bone, can develop a hole (perforation) 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 develops.

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

Many perforations do not need to be closed. Small perforations may need only frequent rinsing with saltwater (saline) solutions and applying lubricating gels. Both can be bought 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 perforation.

Surgery for large perforations usually requires general anesthesia.

Some doctors place a foam pack or splint in the nose, to be left in place for 5 to 7 days. After the pack or splint is removed, you will begin rinsing the nose several times a day with saline. Your doctor will instruct you on 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. Also take care not to injure your nose during exercise or other activities.

Some nasal septal 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 saddlelike deformity. Surgery can resolve these problems.

Surgery to repair a nasal septal perforation is usually successful. However, some large perforations may be difficult to close.

Bleeding and infection can occur after any surgery. You should contact your doctor if you have:

• Heavy bleeding. Mild bleeding is normal.
• A fever of 101°F (38.3°C) or higher.
• Severe pain. Mild pain is expected.
• Pus.
• A foul smell coming from the nose.
• A persistent headache.

Sometimes the perforation may reopen, requiring another surgery.

Success of surgery depends to some extent on the size of the perforation—large perforations being more difficult to close—and on proper postsurgery care at home.

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.

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

Other Works Consulted

• Lund VJ (2003). Acute and chronic nasal disorders. In JB Snow Jr, JJ Ballenger, eds., Ballenger's Otorhinolaryngology: Head and Neck Surgery, 16th ed., pp. 741–759. Hamilton, ON: BC Decker.