The nasal septum is the wall that separates the two nasal passages, and typically, this wall does not have any type of opening of any kind between the two passages. When a hole is present in the septum, the opening is known as a “septum perforation”. Holes in the septum can lead to problems like breathing issues, chronic nosebleeds, congestion, and nasal discharge, all of which can be very uncomfortable. Fortunately, septum perforations almost never occur naturally, but they can be very serious if they develop. So what are the most common causes of septum perforation, and how can these holes be fixed should they occur?
Causes of Septum Perforation
There are a few ways in which perforations can occur in the nasal septum. One of the most common and well-known causes of this problem is through drug use, specifically cocaine, but there are other possible causes. These include:
- Nasal trauma
- Excessive nose picking
- Overuse of decongestant sprays
- Nasal piercings
- Previous nasal surgery
Holes develop when damage to the tissue in the septum cuts off blood supply to the cartilage, which begins to die and open a perforation in the septum.
Can it Be Fixed?
In the case of smaller perforations, it’s not always necessary to treat the problem, however preventing further damage is essential for anyone with a hole in the nasal septum. Small perforations are often asymptomatic, or produce a slight whistling noise when breathing, which can be annoying but is not harmful. Often, these perforations can be managed with simple solutions such as saline solutions and lubrication. For larger perforations that do produce symptoms, surgery is a possibility. The success of the surgery will depend on a number of factors, only some of which the patient is in control of. These include:
- The size of the perforation
- The overall health of the patient
- The surgeon’s skill
- The quality of pre and post-operative care
- The structure of the nose
Rhinoplasty for Septum Perforation
Rhinoplasty is a general term for nasal surgery, and there are several sub-procedures of the surgery, including cosmetic rhinoplasty, septoplasty, and revision rhinoplasty. Rhinoplasty for septum perforation is a type of functional rhinoplasty, and while the techniques used will vary by surgeon, the procedure typically involves grafting tissue from another area of the body to cover the perforation in the nasal septum. This procedure is usually performed either under general anesthesia or local anesthesia with sedation.
Precautions and Aftercare
A successful procedure depends on more than just the surgeon’s skill. It is also up to the patient to ensure they are taking steps to promote a safe and successful surgery and to encourage optimal healing. This means following all directions and restrictions from the surgeon before and after surgery.
The initial recovery period typically lasts one to two weeks, but swelling may take up to 18 months to subside, and patients should be cautious for the first few months after surgery, as the nose will be fragile. Because septum perforations are often caused by drug use or other preventable problems, it is essential that patients do not pick up old habits following the procedure, as additional perforations are a very real risk.
Talk to an Expert
Fixing a hole in the nasal septum is no easy matter, which is why it is important for patients to seek the absolute best care they can. If you are seeking functional rhinoplasty for a nasal perforation, you should only consult with rhinoplasty specialists with board certification in facial plastic surgery, and, ideally otolaryngology (ear, nose, and throat) to help set you up for success.
Dr. Stuart Bentkover is an experienced and talented facial plastic surgeon with a passion for rhinoplasty, having dedicated much of his practice to advancing his skills in nasal surgery over the last few decades. If you would like to discuss your goals for rhinoplasty with Dr. Bentkover, call Bentkover Facial Plastic Surgery in Worcester (508-363-6500) or Stoneham (617-247-0033), MA to schedule your consultation.