I've had a large perforated nasal septum for years. Can it be repaired, and what are the pros and cons?

Question

Started several years after deviated septum and rhinoplasty procedure (combined 20 years ago now). Gradually progressed. Recently nose has been very dry and often crusty in morning. I am 40 and can tolerate it at the moment, but am afraid of things progressing and becoming more problematic in future (i know this sounds silly, ,but i had a nightmare that my nose would collapse!). Advice?

David Reinstadler, MD · Answer

Septal perforations are notoriously hard to deal with. if they are small, repair is fairly straightforward. When they are larger than a centimeter, things become significantly more difficult. I would see a surgeon in your area with experience fixing these to get a better idea. I have had good success in the past using some remaining septal cartilage along with a fascia graft usually from the temporalis muscle. It is true that it may cause you more problems in the future so I would see someone sooner rather than later.Best of luck

Myriam Loyo, MD · Answer

Hi Amy,Thanks for question. Septal perforations do cause problems with crusting, plugging, and bleeding. Depending on the size, different things can be done to treat them.Smaller perforations can be easily repaired by stretching the remaining tissue in the septum. Repairing medium and large perforations becomes trickier because stretching the remaining tissue can pull on structures of the nose that change its appearance. For medium and large perforations I recommend trying a septal button. A septal button is apiece of silastic that fits in the hole and patches it. It is easy to put it in, and it requires changing only every 5-10 years. Not everyone tolerates it. Some people don't feel it and it takes away the crusting and irritation. Some people can fill the edge of the plastic and it bother them. For patients who can't tolerate the septal button, other options are reconstructing by using tissue in the inner lining of the lip or even making the hole bigger so it doesn't trap secretions. I recommend  you consult a surgeon near you.A large septal perforation can eventually affect the structure of your nose, but those cases are rare. Your surgeon can examine the support of your nose and give you advice.hope this helps!

James Owusu, MD · Answer

Septal perforations can cause build-up of nasal crusting, obstruction, whistling noise and ocassional bleeding. Some of these issues can be improved with a nasal septal button. A septal button is a plastic splint that can be used to close the septal perforation, it can be done in the clinic with no downtime. Septal perforations can be fixed depending on the size of the perforation. The larger the perforation the more complex the repair and higher the chance of recurrence following repair. If the size of the perforation is > 1.5 cm, my suggestion will be to try a septal button if this is well tolerated it saves you a surgery and possibly multiple surgeries. If you unable to tolerate the septal button then consult with a surgeon who is comfortable repairing septal perforations.

I've had a large perforated nasal septum for years. Can it be repaired, and what are the pros and cons?

Answers (3)

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