Septal perforation is a condition where there is a hole or a perforation in the nasal septum, which is the thin wall of cartilage and bone that separates the two nostrils.
Symptoms of a perforated septum include:
- Nasal congestion
- Nasal crusting
- Difficulty breathing
- Frequent nosebleeds
- Altered sense of smell
- Whistling sounds when breathing
A hole in the septum can also change the external shape of the nose, leading to saddle nose deformity (collapsed nasal bridge) and loss of nasal height. This is more common when there is a larger perforation.
However, depending on the size and location of the septal perforation, some patients may have no symptoms at all.
What causes nasal septal perforation and how is it treated?
Septal perforations can be caused by a variety of factors. Some of these include:
- Trauma to the nose from sports injuries, accidents or surgery. These can result in a septal haematoma where a blood clot forms under the lining of the septum and leads to necrosis or breakdown of the septal cartilage leading to a septal perforation.
- Digital trauma and nose picking can lead to septal perforations
- Chronic nasal infection or inflammation
- Systemic inflammatory conditions such as allergic rhinitis
- Inhalational irritants such as cocaine use
Medical management for septal perforation may include surgical and / or conservative measures such as humidification, topical antibiotics and nasal sprays.
Perforated septum surgery
Septal perforation repair is a reconstructive surgical procedure. This nasal surgery aims to close the perforation and restore the normal structure of the nasal septum.
The procedure involves creating a local flap of tissue from the nasal mucosa (the lining of the nasal cavity) and using it to cover the perforation. The flap typically can be either based on the anterior ethmoid artery, or the nasoseptal artery. These special fashioned flaps utilises blood vessels within them to improve blood supply and higher chance of healing. The flap is then secured in place with sutures, and sometimes supported with additional tissue or materials. For example, cartilage grafts or synthetic implants.
A septal button is a less frequently used technique where a prosthetic is used to fill the hole in the septum.
Septal repair surgery is usually done as a day procedure under a general anesthetic.