Septal perforation can it be fixed?

Question

I want to start off saying that I had an deviated septum surgery about 4 years ago. I have a septal perforation on the right side of my nose. It has become big to the point that my right cheek looks a bit flat and the tip of my nose has changed shape. I am having difficulty breathing, dry nose, congestion, pain from time to time, and numbness mostly head area. I am not sure what to do at this point.

Anil R. Shah, MD · Answer

Septal perforation repair is one of the most difficult procedures to perform.  I developed a procedure to repair large septal perforations utilizing a pericranial flap.  The use of this flap can help close larger perforations.  Here are some methods of closure of septal perforation based on size:
-Small (pinpoint)- not advised to fix small perforations, especially asymptomatic perforations that are stable.  These should be observed.  The risk of the procedure of increasing size after repair
-Medium perforations- The use of a variety of techniques can be employed such as sliding flaps (can only repair perforations reliably at 1.5 cm), turbinate flaps (smaller perforations), and endoscopic rotational flaps (less than 1.5 cm) can be utilized.
-Large perforations- The use of pericranial flaps (see above) and free flaps (requires ICU stay) are the only 2 options.  I have had great success utilizing pericranial technique (see video below) to repair septal perforations.
Best Anil Shah

Matthew Bridges, MD, FACS · Answer

Some of the symptoms you list, such as flattening of the cheek and numbness, are not typical symptoms of a septal perforation.  Also, a perforation by nature goes all the way through the septum, so there would be no right and left.  You would need to be examined by a specialist in repairing septal perforations to see what is going on and what can be done.

Benjamin C. Paul, MD · Answer

Septal perforations can be repaired. I actually co-authored the e-medicine/medscape article on how to do this (see link below). You should be seen by an ENT/Facial plastic surgeon who has experience with this problem. Best of luck from Manhattan.

Septal perforation can it be fixed?

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Septal perforation can it be fixed?

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