Perforated septum: should I have the hole repaired?

Question

I just had a consultation regarding my hanging columella following a septo/rhinoplasty that I had over 20 years ago and I was very surprised to learn that I have a large hole through my septum as a result of that previous surgery. My question is should I have the hole repaired? I do get recurrent nostril infections but no breathing issues. I would like to raise the columella and I'm told this can be done under local anesthesia, but to fix the hole would be a far more extensive surgery. Is this worthwhile?

P. Daniel Ward, MD · Answer

Thank you for the question. If you are not having any symptoms from the perforation, I would probably  recommend against doing anything with it.Good luck and have a great day!

Edwin F. Williams, III, MD · Answer

Hello and thank you for the inquiry! A perforation in the nasal septum is a risk of septorhinoplasty surgery, especially if there is a significant anatomic abnormality (i.e. deviation) in the septum. Often these perforations are slow to develop after surgery and your previous surgeon may not have seen the perforation unless you had long term follow-up. Perforations can be anywhere from very small to very large. Smaller perforations can sometimes produce a whistling noise with nasal breathing, while this typically does not occur when the perforations are large. Larger perforations can sometimes cause problems with chronic crusting and bleeding due to turbulence in the nasal airflow. If you are not having any of these issues, I often council patients that it is not necessary to do anything. Large perforations can be very difficult to repair surgically and can cause more problems in the end. Alternatively, if you feel strongly about doing something (or you are having some of the symptoms listed above) some people find relief with a septal button. Again, however, I would stress, unless the perforation is symptomatic, I would probably not do anything about it. I do always stress the importance of nasal saline in maintaining nasal hygiene. Hope this helps!

Philip Michael, MBBCh, FRACS, FRCS(Ed) · Answer

Thank you for your query. Perforated septum need only be repaired if they are causing issues. These typically include crusting and bleeding around the edges of the perforation and whistling if the perforation is small. In your case, you mention that it was large. The problem when perforations are large is that they do not respond as well to surgical closure and most of the time we suggest avoiding surgery. Using vaseline around the edges of the perforation or sesame oil formulated for the nose can help with crusting and if bleeding is a bigger concern, then an antibiotic ointment will help. Your issue with the hanging columella is relatively minor and would be a much smaller procedure to undertake than repairing the perforation and my suggestion would be to leave things be if it is not causing any concern. Best Wishes.

Perforated septum: should I have the hole repaired?

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Perforated septum: should I have the hole repaired?

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