Not really sure if this is the right place but I have a hole in my nose from doing cocaine about 5 years ago. This hole is growing in size even though I've stopped the drugs for over 3years now. My nose is falling apart and its really depressing me. What can I do to fix it, I know the cartilage wont grow back so for the last 1.5 yrs I've been putting Ayr nasal gel and petroleum jelly on the exposed cartilage. Now the whole nose is caving in on me and there is a hole the size of my index finger that can almost fit through from one side to another. PLEASE HELP in any way possible.
What to do about the hole in my nose?
Doctor Answers 25
Need to see an ENT surgeon ASAP
You should see an ENT surgeon ASAP for proper evaluation and instructions on performing nasal washes to prevent a chronic nasal infection. It's unwise to place any oil based product inside the nose as this can cause lipoid pneumonia if it gets into the lungs. Ayr is water based and would not be in this category, but petroleum jelly is oil-based.
Nasal septal perforations and saddle nose deformity
Septal Perforation closure may not be necessary
Few surgeons actually have a lot of experience with septal perforations (hole in your septum) and as a result finding someone who can help can be difficult.
Luckily, we have a lot of expereince with this procedure and can help you determine whether attempting closure is possible or worth pursuing. In those case when the hole is very big and closure cannot be accomplished, patients can often have problems with the bridge of the nose or even the tip collapsing. In those cases, we can speak to you about how we can build up the necessary support so that your nose can be stable and function long term.
Peyman Solieman, MD
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Nasal septal perforation
A hole in the septum can be repaired along with reconstruction of the nasal dorsum to address the sinking nose. The procedure will fail in cases of ongoing cocaine use. It is important to maintain good nasal hygiene before and after surgery.
How to treat a hole in the nose after cocaine use
It’s ironic in answering this question that it touches on the history of Rhinoplasty. Cocaine placed in the nose is absorbed into the mucosa and causes two things: constriction of the blood vessels (decreasing bleeding) and numbing. These two properties are ideal for performing rhinoplasty under what is commonly called “local” anesthesia, and was the standard for decades when general anesthesia was very risky. Times have changed and Rhinoplasty is most commonly performed under general anesthesia supplemented with Lidocaine, since Cocaine can also cause an irregular heart beat as well as unsafe elevation of blood pressure
Repeated recreational use of Cocaine causes repeated constriction of the tiny blood vessels that supply the lining of the nose (i.e. the mucosa). In essence, it is like putting a tourniquet on the inside of the nose. Over time, this lack of blood supply thins the lining of the nose to the point where it eventually dies. The underlying cartilage of the septum relies on its blood supply from the overlying mucosa, and so when it loses its blood it dies as well resulting in a hole in the septum. Small holes in the septum will create a whistle nose with breathing; large holes will develop crusting on the perimeter of the hole along with occasional bleeding. In extreme cases of perforation, the bridge of the nose can even collapse.
A septal perforation can be surgically closed, but it is important to know that there is no guarantee this will occur even in the hands of the best of surgeons. In general, the smaller the perforation, the better the odds are of complete closure. However, a perforation caused from previous surgery or trauma still has a normal blood supply surrounding it, and therefore will have a success rate of closure; a perforation from Cocaine use has a compromised surrounding blood supply that will never return to normal. That being said, by a surgeon skilled in this procedure, you still have a relative chance for success and you should at least give the surgery a chance to see if it can be closed.
The procedure can be done in a “closed” approach in which all incisions are inside the nose. However, this approach is creates a limited view and access for this technically challenging surgery, and is especially true for large perforations, or ones that are farther back in the nose. The more common approach is “open” which is the identical approach for an “open rhinoplasty.” In this approach, one small incision is placed along the base of the nose (the columella”) and all other incisions are internal. This one small incision allows the surgeon to elevate the skin of the underlying structures of the nose, giving excellent visualization and access to obtain the optimal result for the patient.
The procedure consists of elevating the mucosa on each side of the septum and covering the hole with these two pieces of elevated tissue referred to as “mucosal flaps.” It is now fairly common to place a layer of human tissue such as Alloderm in the hole prior to rotating the flaps over the hole, in order to provide additional support for the flaps to attach to. What is crucial for success is for these flaps to live during the first 4-6 weeks as they heal over the perforation. Studies have shown that one of the key elements for this to occur is moisture in order to keep the flaps alive. To that end, it is common for the surgeon to place a thin layer of soft clear plastic sheeting in each nostril against the flaps to help trap the nose’s natural mucous which is Mother Nature’s version of moisture. These thin sheets are removed typically at six weeks after surgery at which time the septum can finally be re-assessed.
Hope you found my answer helpful. All the best!
What to do about the hole in my nose?
This is a very complex and significant problem. It is important to be seen sooner rather than later for proper evaluation and then a discussion about treatment options. This may not be able to be corrected in one surgery. Continue to use the water based products and work to eliminated to oil based products inside your nose.
Collapse of your nose may require evaluation and possibly a biopsy.
Repair of a saddle nose and septal perforation
Treating the Hole in Your Nose
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.