How To Treat Hole In Nose From Cocaine Use?

Unfortunately septal perforation is one of the most dreaded nasal complications of cocaine abuse. Even tough, most cases of septal perforation are due to other causes, such as recurrent nosebleeds, poor nasal habits, and some systemic diseases, cocaine remains one of the well know causes. Cocaine use is usually associated with also some other nasal damages related to chemical irritation and vascular comprise too. Regardless of the underlying cause, repair of septal perforation remains one of the most challenging and meticulous nasal surgeries. It often involves open approach for optimal exposure of nasal septum and meticulous dissection of the nasal lining to achieve a low tension closure with local tissue rearrangement. In cases of some larger perforations a 2 step surgery sometimes is needed to maximize the chances of a successful closure. The surgery should be done by someone who has extensive experience with this particular procedure with high success rate.

A septal perforation can occur from a number of reasons including trauma, surgery, auto-immune disease, or intranasal drug use, among many others. It is important to understand the cause of the septal perforation and correct that before fixing the perforation itself. For example, if someone continues to use cocaine or continues to have issues with an auto-immune process, fixing the perforation will likely fail even if things look good initially. It is also important to determine the primary symptoms associated with the perforation, as some patients with perforations actually have no symptoms at all and the holes are discovered incidentally. Some of the common complaints include frequent crusting, nose bleeds, nasal pain, and nasal obstruction. Before addressing anything surgically I also like to make sure we do everything we can to optimize the nasal cavity in the hopes of 1) potentially avoiding surgery and 2) make it more likely that surgery will succeed if we ultimately pursue that route. For me, I have my patients start a regimen of nasal saline rinses 2-3 times daily, vaseline ointment 3-4 times daily, and avoidance of any manipulation of any of the crusts within the nose as this will often lead to more inflammation of the tissues. After we've done this for at least 4-6 weeks, I will see them back and re-assess their symptoms and also the health of their nasal tissue. There are certainly times where this alone improves the symptoms and we can avoid surgery. If we determine that the nasal issues continue to be problematic and it looks like the tissue is healthy enough, we can then discuss surgery which will be largely dictated by the size of the perforation. If this is small, ie less than 1.5cm, we can sometimes just rotate tissue from within the nasal cavity primarily using endoscopes with no incisions on the outside of the nose. If larger, ie greater than 1.5cm, then I frequently recommend harvesting a temporalis fascia graft (small incision in the temple area) folded over a PDS plate via an open rhinoplasty (incision underneath the tip of the nose) type approach. In both these scenarios, I will have patients keep splints in place for at least 3-4 weeks after surgery to keep the graft healthy during the acute healing period. While historically, many providers have recommended against perforation repair due to low repair rates, the newer techniques such as the fascia graft method, have had repair rates in the 90% range in multiple research studies. Because of this, I would typically employ surgical repair over some of the other methods that some suggest such as the septal button which can be cumbersome and painful for patients. If you have a perforation, I would make sure to see a surgeon you feel comfortable with who sees these frequently and can have upfront discussions about the options available.
Hope this helps and best of luck!Kyle Kimura, MD

A perforation in the septum due to cocaine use is a very difficult problem that has to be assessed by an expert.  Most likely an ear, nose and throat surgeon is the one with this kind of expertise

A hole in the nose is also known as a septal perforation. 
You have already taken the first step in the recovery process for fixing this hole - stopping the cocaine use. This will not only help prevent your current perforation from getting bigger, but also stop more perforations from forming. The next step in repairing the perforation depends on the actual size of the perforation. Small to medium perforations can be fixed with surgery. Larger holes may require use of a silastic button. A silastic button is a device made of silicone that helps facilitate closure of the perforation. There are also more advanced surgical reconstructive options for larger septal perforations. 


Gary Linkov, MD
Facial Plastic & Reconstructive Surgeon
Manhattan

Good news is this can be repaired.  First of all congratulations on getting clean.  A hole in the septum can be repaired surgically or filled with a silicone septal button.  How yours should be addressed depends on the location and size of the septal perforation and how much it bothers you and how much you are willing to go through.  A septal perforation at the very front of the septum can result in loss of support of the tip of your nose and in those cases I recommend surgical repair with an open septorhinoplasty to reestablish structural support for the nose and repair the hole.  Further back in the septum, it may not affect the external structure of the nose, so there you would have two options: non surgically to place a silicone septal button to block the hole, or surgically a septoplasty to repair the hole, during the septoplasy your surgeon may need to use synthetic or animal derived products to help patch the hole.  Make sure you consult with a reputable facial plastic surgeon and discuss your options and concerns after they are able to examine you. 

Septal perforation can be very difficult to treat.  You may want to consultation a board certified plastic surgeon or and ENT surgeon who has an interest in septal perforation repair.