Septoplasty, scared of septum perforation

Question

Hi I have a deviated septum with spur growth blocking my left nostril which makes it difficult to breathe.I am considering septoplasty/rhinoplasty . Although I am very scared of developing a perforated septum as a consequence to this procedure making the original condition worse. Is it common or it completely depends on the surgeon? Is open rhinoplasty better than closed for avoiding septum perforation. What should the surgeon look out for to prevent it from happening in the first place. Thanks

Afshin Parhiscar, MD · Answer

Dear JasonThe risk of a septal perforation will depend on your anatomy as well as your surgeons skill set. Depending on the location of the spur, there might be a difference in the risk of perforation based on approach. An open book approach during an open rhinoplasty can be advantageous to reduce the risk of perforation in my experience. Look for an experienced and well trained plastic surgeon certified by the American board of plastic surgery or facial plastic surgery, see more than one consult and make a well informed decision.

Ziyad Hammoudeh, MD · Answer

Septal perforation is a potential complication of septoplasty, but fortunately it is rare in a surgeon well trained in rhinoplasty.  Septoplasty alone can certainly be performed in a closed fashion.  Rhinoplasty can be performed either open or closed depending on the surgeon's experience level with both techniques and the maneuvers required to achieve the desired result.  The open technique offers greater visualization to the surgeon as well as some maneuvers that cannot be performed well with a closed rhinoplasty technique.  I would recommend consulting with a surgeon well versed in rhinoplasty who can thoroughly examine you and provide more specific recommendations to achieve the natural result you desire.  Best of luck.
Ziyad Hammoudeh, MD

Kapil Saigal, MD, FACS · Answer

So it is dependent on the type of septal deformity but in the hands of an experienced nasal surgeon Septal perforation is an exceedingly rare complication. I would ask your surgeon how many of these he/she performs annually and what their complication rate may be. I typically order a CT of the nose and sinuses before complex septoplasty and perform them all closed, and my personal perforation rate is much less than 1%. Best of luck to you.

William Portuese, MD · Answer

Septum perforation is a rare, but known complication from a septoplasty procedure. Small septal perforations are usually asymptomatic depending on the location. A large hole will simply create cross ventilation, tumbled air with crusting and nosebleeds. A septal perforation can be closed with a simple  septal button, or surgically closed. In our practice, we perform  septoplasty and rhinoplasty  with a closed approach.

Septoplasty, scared of septum perforation

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