Perforated Septum; how worried should I be?

A small septal perforation should not lead to any functional or cosmetic problems.  However if it can be fixed with a chondromucosal flap, it may be something to consider.  

Septal perforations range in size and symptoms.  Typically, posterior septal perforations can be left alone that are asymptomatic while the more anterior the perforation the more likely it will become symptomatic.  If a perforation is stable in size (especially if the patients is using nasal saline, gel and other nasal emollient) then observation is fine.  If the perforation continues to grow in size or becomes symptomatic, repair can be considered.

Thank you for
your question. I am sorry to hear about the issues you are having. Many
patients will develop a septal perforation in their lifetime. Some are due to
trauma, some from disease and others occur from a nasal surgery. Fortunately
only some people will even notice the perforation. Symptoms can include
whistling, crusting or bleeding. If the patient has symptoms that bother them
there are treatments that can be tired including creams, saline irrigation or
septal button. Repair of the perforation is possible but not always easy.Please address
your concerns with your surgeon. Good luck and
hope this helps you.Dr. Wayne

Dear TiffanyIt depends on the size and location of the perforation. Generally small perforations are without symptoms and do not cause issues other than an occasional whistle sound on breathing. Larger perforations can lead to crusting and bleeding. Generally no need to do anything unless it keeps enlarging or you have any symptoms.

Small septal perforations can occur after septorhinoplasty.  They cause problems when they create turbulent airflow, which can make you feel "stuffy" even when you have wide open passages.  They can create a "whistling" sound when breathing, and can sometimes crust and bleed if they are not cared for.  Usually, small postoperative perforations do not cause these problems.  Generally, septal perforations are fixed to help correct the above problems, but they may be fixed as a preventative measure as well.  Do not worry excessively about the perforation, and make sure to visit with your surgeon for their advice.  

Thank you for you question.  A septal perforation is a rare post-operative issue that can happen after septorhinoplasty.  Usually these are small, and are of no consequence.  Be sure to follow up with your surgeon, though, so this can be followed.  Depending on the location of the perforation (if it is close to the front part of the septum), they could cause a breathing issue. Hopefully as your swelling goes down from surgery, you will be able to breathe better.  I hope that this helps, -David Gilpin

Septal perforations are an unfortunate complication of septorhinoplasty that is rare but well documented.  In general, a small perforation is not clinically significant. However, it is important to follow up with your surgeon to evaluate and discuss the clinical side based on your physical exam.

Typically, a perforation will not have an effect on the outside appearance of your nose. You could develop symptoms of whistling noises when you breath, more congestion, frequent bleeding, or dryness. However, most perforations do not result in any symptoms at all. In the meantime, I would recommend keeping the nose moist to prevent the mucosa (or lining of your nose) from drying out and causing the hole to get bigger. You could get saline sprays over the counter and Vaseline ointment to use in the nose to prevent it from drying. The perforation should be watched as it may require treatment in the future.

Hello Tiffanyjolene,The septum serves to separate the left and right sides of the nose.  When there is a perforation it affects the way that air flows by it.  This can create a whistling noise on occasion.  Because the mucosa of the septum can be irritated when the air is flowing by in a different pattern, it predisposes this area to bleed.  This is especially true if you are on blood thinners.  Depending on the size of the perforation, it may indicate you have lost support for the nose, although your surgeon should have left sufficient cartilage at the top of the nose and the front of the nose to minimize the risk of collapse.  If all you have is a very small perforation, then chances are you will never notice a problem.  If you have a larger perforation, then you may notice problems.  The other issue is that repair of a septal perforation can be difficult depending on the size and how much cartilage was removed initially from your septum.  I would follow up with your surgeon to evaluate your nose and determine the best course of action.  If repair is needed, make sure you go to someone with experience because if it doesn't work the first time, your chance of success with a second septal perforation repair will be much lower.  I hope this helps and good luck.  

A perforated septum can happen following a septorhinoplasty although it is not common.  Its important that you follow-up with your surgeon.  The consequences of a perforation are determined mainly from its size and location.  A smaller, anterior perforation can result in a whistling sound when you breathe in. Perforations can also get crusty and be a source of nosebleeds.  Some are completely asymptomatic.  A perforation can certainly be repaired, although some repairs are easier than others dictated mainly by size and location.   Wish you the best!