Can a Septal Perforation Be Fixed? Does It Need To Be?

Septal perforation come in different shapes and sizes.  Usually posterior perforations cause very few problems, and often go unnoticed by the patient.  Anterior perforations can be a bit more problematic as they may disrupt normal nasal airflow, sometimes resulting in the sensation of obstruction and even a "whistling" sound.  In addition, an anterior perforation can disrupt the humidifying ability of the nose and result in significant crusting, sometimes malodorous, and frequent epistaxis (nosebleeds).  With very large perforations, the structural support can be compromised.  

The question of whether or not a perforation needs to be fixed depends on if you are having any or all of the above issues.  If you didn't know it was there until a physician looked inside your nose, then you are probably ok to live with it until it becomes problematic.  If you are having issues, then look around.  There are many qualified surgeons performing the surgery for less than $50k.    

Greetings,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

Smaller septal perforations can be repaired, but I find it very uncommon to need to correct a septal perforation. The most common problem that I see patients complain of related to a septal perforation is crusting due to dryness and turbulent air flow. This can almost always be managed medically with good nasal hygiene, saline sprays, gels, etc.
If the perforation is not causing any problem, there is no reason to pursue surgical repair.
Be sure to see an expert who can review the options with you and discuss realistic expectations.
All the best,

Septal perforations can indeed be repaired.  Common symptoms for which people seek repair are crusting, bleeding, whistling, difficulty breathing, and loss of nasal support.   The most common causes of perforations are prior surgery, intranasal drug use, and repeated trauma.  Perforations up to 2.5 cm in diameter can often be fully closed; larger perforations have little chance of complete closure are frequently left alone.

Thanks for the question. Septal perforations (holes in the septum) can absolutely be repaired by ENTs, Facial Plastic Surgeons or Plastic Surgeons. Perforations can occur from nasal trauma, surgery, or exposure of the septum to drugs such as cocaine. This surgery does require specialized training so be sure to consider the surgeon's training and experience carefully before making a decision. 

The bottom line is that a perforation is worth fixing if the patient is experiencing symptoms. The symptoms which can be associated with a septal perforation include difficulty breathing, nasal congestion, persistent crusting, epistaxis (bloody nose), and whistling with breathing. Patients who do not have any of these symptoms may not necessarily need to have the perforations fixed, as long as the perforation is not affecting the structural integrity of the bridge of the nose. 

In general, smaller perforations and perforations closer to the front of the nose are simpler to repair.  Depending on size and location, the perforation can be closed by rotating local flaps in the septum, moving tissue from the turbinates, or bringing in fascia from another location. This temporalis fascia, the thin covering of the temporalis muscle, is harvested by making a tiny incision behind the hairline in the temple.

An exciting new development in septal perforation repair is the use of the PDS plate, approved by the FDA in 2010. This is a very thin (0.15 mm), perforated plate which dissolves slowly over a few months. In my practice, I have successfully repaired many perforations using these plates, covered on each side by septal flaps or temporalis fascia. 

Lastly, surgeons certainly have the right to charge whatever they feel is appropriate for septal perforation repair, or any surgery for that matter, but $50,000 USD does sound exorbitant to me. You shouldn't have to choose between sending your kids to the best colleges and fixing your nose! You may want to consider consulting with other surgeons who also have the specialization and technical skill to perform this delicate operation. 

Best of luck,

Dr. Mehta

Great question. The decision to repair or attempt to repair a septal perforation should be based entirely on symptoms and quality of life. There a many patients who have septal perforation that is completely asymptomatic. They breathe great, the don't have excessive crusting or whistling and no change to the shape of the nose. In those situations there is no real good reason to attempt repair. However there are patients who either have whistling, or excessive crusting or a change in the shape of the nose as a result of the perforation. In those situations a repair is reasonable to attempt, only if there is a fairly decent chance of repair. The size and position of many perforation make them virtually impossible to repair, in which case the only options are a septal button/implant. Occasionally purposely making the perforation larger is the only viable option, especially for whistling. Hope this helps. 

Determining whether a perforation can be repaired depends on the size and position or location. This can be determined during examination with an experienced surgeon who performs septal perforation repair. There many people and patients of mine that have gone a long time with a septal perforation, sometimes without knowledge of it. It can be a complication of a septoplasty or other sinus related surgeries. They are not always something to be concerned about. But when they lead to or show signs of a potential collapse or deformity surgery may be required. Speak with an ENT that specializes in septal perforation repair. As for the cost it could potentially be covered under insurance so make sure to find someone that works with your insurance provider.

septal perforation can result from trauma or disease processes.

they can be very difficult to repair, and the outcome is never assured ;  re-perforation is common

luckily, not all perforations need to be repaired 

frequently symptoms can be made less severe by treating co-existing disease states

hope this helps

  Septal perforations can cause whistling with breathing and as such can be an issue for patients.  These perforations can be anterior or posterior and fixing either can be challenging.  No, if the septal peforation is clen, without crusting, well healed and without symmptoms...there's no reason to have it fixed.  If however, inflammation continues around exposed cartilage in the perforation, the perforation and septal damage may continue to expand to the point of creating a dorsal collapse and saddle nose deformity.  For that reason, IMHO, you may want to have a full evaluation and examination by an ENT surgeon that specializes in septal repair.