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Septal Perforation Repair ... - Florida

Had a septorhinoplasty in the early summer of 2010...

Had a septorhinoplasty in the early summer of 2010 followed by a revision septoplasty in the late summer. Then discovered a perforation about a quarter inch in diameter. Whistling, crusting, and bleeding were daily problems. Due to my public speaking responsibilities, I had the perforation repaired in January 2011 (4 months after the revision septoplasty).

+ Seems like the repair has worked, no more whistling (4 weeks post-op).
+ Insurance covered about 98% of the medical bills (approaching $40,000 with follow-up debridements, Rx, etc.)

- Extremely difficult to find a surgeon who could repair the hole.
- Short amount of time between the prior nose surgery and the perforation repair led to substantial swelling (septum was about a half-inch wide at 1 day post-op). This swelling prevented proper drainage, which led to a sinus infection, headaches, etc.
- External shape of the nose was altered even though all incisions were performed internally. The movement of mucosal flaps created thin areas inside the nostrils. This has left my nose very flimsy and the nostrils get drawn inward when breathing in.
- Surgery was out-patient but under general anesthesia (4 hrs) since it was endoscopic.
- The surgeon is employed by a major hospital so he always rushed between patients and did not respond to email, etc.

+ The repair has closed the perforation (14 weeks...

+ The repair has closed the perforation (14 weeks post-op). The surgeon has given me a nearly 100% likelihood that the septum will heal fully (in 6 months) without any additional complication.

- Still very dry and tender; tissues still somewhat flimsy.

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Fingers and toes crossed that you don't get sinus infections! They are ghastly. Please keep us posted. Here's to good health!

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It isn't winter yet but if I do not get sinus infections like before it will definately have been worth it. While it is frustrating and stressful having the whistling sound it is not nearly as bad as always being sick.

There was no other option when I had the surgery.
I knew there were possible complications but it was worth taking the risk because I was so miserable. Being sick for 8 months straight and getting to the point where antibiotics didn't break the cycle was my breaking point. I can still get sinus infections depending on how bad my other sinus cavities are but I won't know the full effect of the surgery for a few months. Most surgeons just do the maxillaries since they aren't too close to your brain like the other cavities are... in hopes that it does the trick.

As far as the septal perforation goes I guess I have to wait and see a few more months since I am still healing. If it doesn't close on its own I can see if another surgery to cover the hole with grafts will be covered by my insurance. If not I can always get a septal button put in the hole though I am not a fan of having a silicone button in my nose. I would rather have the problem properly fixed.

I guess it is a waiting game to see how much the surgery worked but if it helps with the sinus infections it will definately have been worth it.
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Hi there,

I'm wondering, at this point, if you feel this was worth it or not. And if you'd mind changing your rating to reflect that. Thanks! :0)

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Yes, I have sent you a private message with the details.
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Can you let us know what Dr. you went to?
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It doesn't seem even remotely possible that your 4x8 mm perforation will heal on its own, nor can your surgeon close it with a simple "stitch". I have a few other posts, which may help you to find a good surgeon. Remember to contact your insurance company first and tell them that you need to find an ENT surgeon that specializes in tissue rearrangement / nasal reconstruction / closure of septal perforations.

To control the whistling (especially at night), there are a few options. First, clean the area well and apply saline nasal gels (such as Ayr). A second option is to buy ear plugs (insert into the ears, not the nostrils); the yellow foam ones are ideal since they can fit in your ear without being uncomfortable like big ear muffs or headphones. The third option that worked for me was to place sterile gauze or cotton into one nostril so that it prevents air flow through that nostril. Then spray it with saline before bed. The whistling would subside and the saline can be absorbed by the nasal tissues to keep them moist. There is a big risk of this approach though, and many doctors would advise against it. If you inadvertently introduce more bacteria into your nostril, it will have the entire night to colonize and spread. Even after the gauze is removed, the bacteria will already have established itself inside the nostril. This approach did work for me because I used disposable sterile gloves, sterilized my tweezers after each use, etc. Talk to your doctor for his/her opinion before you try this.
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Thank you for your reply.

The hole is about 4mm wide and about 8mm tall and it is located right before my bridge (I believe this is where the "saddle" in my nose is) about 3-4mm from the top of the septum. The bottom of the hole has exposed cartilage and I do not know how much cartilage is missing beyond the hole.

It is symptomatic... it whistles and it is driving me up a wall! It is currently covered up by crusts. I am on antibiotics now and I am worried about when I am finished with this second dose of antibiotics. Once the crusts are gone the cartilage will be exposed. I live in a cold weather region so I know that once October hits I am in trouble due to the dry air!
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In my opinion, the most important consideration is whether you are symptomatic. If it isn't causing any problems (whistling, bridge deformity, bleeding, etc.), then perhaps the best treatment approach is to do nothing. Can you provide more details of the perforation? Specifically, how large is it? Where is it located? What are your symptoms?

Typically, the hole will remain the same size unless you manipulate/irritate it and an infection grows. Keep it clean and well moisturized; your doctor should provide you with specific instructions on how to do so.

Post back with more info if possible ...
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Hi, I just had septoplasty and I ended up with a septal perforation right after. What a nightmare!!! I haven't gotten the response I want from my surgeon and he told me in a rushed two minute visit that I was fine and that if it didn't close up on itself within a month after surgery he would stitch it closed. After doing some basic research online I have several concerns about his reaction. I am trying to get a second oppinion but no office will see me since it is a complication of another surgeon's work. Any advise? Thank you so much!
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You might want to post this as a question in our Doctor Q&A community. If you'd include a photo that would be very helpful!

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hi, thanks for sharing. do you know the technique your surgeon used to fix your septal perforation? did he take cartilage from your ear? rib?

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Yes, the procedure was an endoscopic repair using bilateral nasal mucosal flaps with Alloderm placed between the flaps (no cartilage or other tissue was harvested elsewhere)...
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I'm glad you were able to get that repaired and that you have good insurance. What an  expense! And time suck, too, I'm sure.

Thanks for sharing your story on RealSelf. I hope your nose just continues to get better.

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