Risk of Perforated Septum After Another Septoplasty?

Question

I underwent Septoplasty a few years ago, but to inadequate satisfaction. I wonder, if I have the procedure again, do I risk a 'perforated septum'? If that is a danger, is it possible to just take some cartilage from the 'narrow' side and move it to the other? Would such cartilage just be a loose 'piece' stuck under a blanket of flesh, or would it 'fuse' to what would be beneath? Thanks very much.

Oakley Smith, MD, FRCSC · Answer

As a general rule all surgical risks are increased with any revision surgery. A perforated septum is a complication after Septoplasty where the central wall (septum) of the nose develops a hole. The risk is in the 1% range but certainly increases with another Septoplasty. By placing cartilage or leaving cartilage sandwiched between the two linings of the septum, the risk can be reduced. The cartilage will fuse with other cartilage with time and healing.

Raffy Karamanoukian, MD, FACS · Answer

Septoplasty or rhinoplasty revision has added risks, including perforation of the septum, chronic deformity, scar, and malalignment of the cartilaginous structures of the nose. Discuss the risk of septal perforation with your surgeon. The specific risks depend on the amount of structural support and mucosal lining that is preserved in the nose prior to surgery.

Houtan Chaboki, MD · Answer

RandomNick,
Perforated septum is a low risk after septoplasty surgery. However, there are many factors which increase the risk of developing a hole in the septum:

revision septoplasty
nasal or facial trauma, broken nose
nasal piercing
severely deviated septum, usually from trauma
cocaine or drug use
infection
medical conditions: radiation, cancer, autoimmune disorders, etc

A deviated septum is not the only cause of nasal or sinus symptoms of  nasal congestion / obstruction. Only after a comprehensive nasal evaluation can a nasal surgeon best advise you regarding treatment options. There may be other procedures that may be more appropriate than another septal surgery. Best of luck.

Benjamin C. Marcus, MD · Answer

I perform at least 175 Septoplasty surgeries a year. Many of these are revisions. The normal rate of perforation for a primary (1st time) Septoplasty is less than 2%. I believe that number is as high at 5% in revision cases. If you still have obstruction after your 1st procedure you should be assessed by someone who is very experienced and does many revisions. This ensures the best chance of a good outcome with the lowest chance of complications.

Steven Wallach, MD · Answer

Anytime you go back into the nose, you have an increased risk of complications. Ths soft tissue enveope is usualy thinner, and if you had septal work before, you may not have a lot of septal cartilage to work with.

Pat Pazmino, MD, FACS · Answer

When patients are considering receiving a revision of their septoplasty a great deal of care must be taken in planning this revision surgery. Patients usually request a revision due to some persistent airway obstruction. Your septum and nasal walls must be closely examined to determine what is the root cause of this persistent obstruction. You may require additional procedures such as surgery addressing the turbinates, or spreader grafts to alleviate a collapse of the internal nasal valves.

D.J. Verret, MD · Answer

Greetings,
A perforated septum is always a risk with septoplasty surgery. The risk is fairly small though it does increase slightly with revision surgery. There is really nothing that can be done to prevent a septal perforation except careful surgical technique. Should you get a septal perforation, don't worry. Most septal perforations are not even noticed by the patient - they have no symptoms. For patients who suffer from the feeling of nasal airway obstruction or whistle when they breathe, a septal perforation repair can be undertaken or a septal button placed to repair the hole.

Randolph Capone, MD, FACS (in memoriam) · Answer

Revision septoplasty is a procedure performed to alleviate persistently deviated septal remnants, and improve the nasal airway.  It is often performed on individuals who didn't have as much benefit as they perhaps should have after their first septoplasty.  Revision septoplasty is usually quite safe in non-smoking, nondiabetic, and well nourished individuals, providing their surgeon is a nose expert.  As stated elsewhere, septal perforation is always a remote, yet present, risk.   

	It is very likely that you might have some degree of internal nasal valve incompetence, in addition to a deflected septal remnant.  You might need an open nasal valve reconstruction to correct this problem and enhance your nasal airway.   My advice is to see a rhinoplasty expert who can examine your nasal airway and make you breathe more comfortably.

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