I had a septoplasty last January 2011 which has left me with a 4mm perforation. The whistling/turbulence is preventing me from being able to relax and forget about my breathing as it constantly draws the attention back to my breathing. As a result I am very often anxious and stressed. My surgeon tells me that he cannot close up the hole and is suggesting freshening the does of the perforation and second septoplasty!! Is it possible to find a surgeon who is able to close up the 4mm perforation?
Nasal Perforation Post Septoplasty. Can A Surgeon Close this up?
Doctor Answers 7
Septal perforation following septoplasty.
The incidence of nasal septal perforation following rhinoseptoplasty ranges from 1% - 5%. Septal perforations can be challenging to successfully repair and the chances of success decrease proportionately with increasing size of the defect. The driving factor in arguing for an attempted repair is the degree of symptoms such as crusting, whistling and recurrent epistaxis. In your case it sounds as though repair is advisable. A 4mm defect can be successfully repaired in 80 to 90 % of cases in experienced hands. If your original surgeon is unwilling to undertake the repair, then I suggest you visit other qualified nasal surgeons.
Mario J. Imola, MD, DDS, FRCSC.
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Nasal septal perforations can be closed, espcially if they are small
Closing a nasal septal perforation is more technically difficult than a straight forward septoplasty but smaller perforations such as 4 mm have a very high sucess rate. This should eliminate the whistling and improve nasal airflow.
Nasal Septal Perforation after Rhinolasty
If you're accurate when you say the septal perforation is 4mm this can be successfully closed with a revision procedure. I would encourage you to have the perforation closed because it can enlarge over time, making the procedure much more challenging. If your surgeon does not want to close the opening, I encourage you to get a second opinion.
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Septal perforation after nasal surgery
Septal perforation is a well known complication of septal surgery. The reason you have whistling is because your perforation is small; large perforation usually don't whistle. Closure of a septal perforation under 1 cm has a great rate of success, but it will require an additional surgery. Most of the surgeons with good experience in rhinoplasty should be able to help you get rid of this problem.
Nasal septal perforation
small perforations like you describe can definitely be closed with a high rate of success. See a surgeon with experience in this type of surgery.
Septal Perforations are difficult. They are a known risk of any septal operation. Your surgeon is correct in telling you a second operation is needed to repair the defect. A 4mm defect should be able to be closed but will require post op splints and careful nasal toilet. I would encourage you to go back and visit with your original surgeon. If he is uncomfortable with a secondary procedure he will refer you to a colleague with more experience. I hope this helps you.
Stephen E. Metzinger MD MSPH FACS
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