What are my options for ~2cm Nasal septal perforation? 2 years post septoplasty.

Question

I've had a septoplasty almost 2 yrs ago and it resulted in a septal perforation. It is roughly 1-1.5cm length and around 0.5cm in height/ a qtip is unable to pass through. I've tried living with it, and I'm sick of the constant nosebleeds, crusting and having to clean my nose multiple times a day. I am looking into permanent solutions to this problem. I'm terrified of my nose collapsing.Is it fixable with 1 surgery?What is the best type of surgery for this?And how do I find a reliable doctor?

Umang Mehta, MD · Answer

Thanks for the question. A perforation that size should be able to be repaired. I use a combination of an absorbable PDS plate and temporalis fascia. it might be possible to perform the surgery just working through your nostrils (endonasal), though larger perforations can require an open approach. It's better to repair it sooner rather than later, as perforations can enlarge with time. Also, be careful with Q-tip cleaning as trauma could enlarge it as well. Best regards,Dr. Mehta

Anil R. Shah, MD · Answer

Hello,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 MD

Colin Pero, MD, FACS · Answer

While a perforation that size could possibly be repaired, I would make sure you consult with a surgeon that has experience closing perforations of that size.  A Double-Board Certified Facial Plastic Surgeon/Otolaryngologist (ENT) with extensive rhinoplasty experience is most likely the best bet.  Good luck.

Bradford A. Bader, MD · Answer

A septal perforation that size can likely be repaired. There are many techniques to achieve this but none of them guarantee success. I recommend you consult with an ENT surgeon or facial plastic surgeon who has extensive experience in closing septal perforations.

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