Septal perforation

, Rhinoplasty
Nov 15, 2020  0 comments

The perforation of the wall separating the right and left nostrils is called “septal perforation”. The most common cause of septal perforation is previous nose surgeries.

Why does a hole form in the nose?

The most common cause of septal perforations is “previous” nasal surgery. It occurs mostly in unsuccessful surgeries. On occasion even if the surgery is successful, the septum can be punctured in the future and septal perforation may occur. Cocaine use, blood accumulation in the nose, nose picking habits as well as some vascular diseases can cause a hole in the nose. A hole may occur in the nose especially in childhood such as nasal traumas and pacemakers.

3 cm septal perforasyon

3 cm perforation – Dr. Salih Aydın’s archieves 

What discomfort do patients experience in the nostrils?

The complaints of the patients vary according to the location and size of the septal perforations. The holes located in the front of the septum (at the entrance of the nose) create more serious problems for patients. Dry nose, crusting, mild or severe nosebleeds may occur. Especially in very small holes such as 1-2 mm a whistling sound may be heard from the nose. The biggest problem is the serious breathing problem due to the circulation of the air passing through this hole in the nose. However, patients sometimes have no complaints with holes in the back east part of the nose. No intervention or surgery is required for the patient who have no complaints. Therefore, it is necessary to evaluate the patients in the examination and make a decision.

Septal perforation treatment

The only treatment for septal perforation is surgery. Successful results of this surgery are complete closure of the hole. The most important thing that determines successful surgery is the diameter of the hole.

# 1 mm-10 mm diameter perforations are closed with ⇒95 – 100% success.

# Perforations with a diameter of 10 mm-20 mm are closed with ⇒85-95% success.

# Perforations with a diameter of 20 mm and above are closed with ⇒70-90% success.

In large perforations, the hole does not close completely and its decrease in diameter can be considered as a successful surgery.

3 cm septal perforasyon

Obliqe splitting tecnique – Dr.Salih Aydın’s archieves

Techniques used in surgery: 

Especially in large perforations, a supporting cartilage tissue should be placed in the hole in the septum. The flatness of this cartilage is important for breathing and its strength for endurance. It is not my preference as ear cartilages are more susceptible to bending and may cause deformities in the ear. While I am operating septal perforations, I take ribs, divide the ribs into flat slices with the technique described by our teacher professor, Prof. Dr. Eren Taştan and sew these straight slices together to form a strong block.

3 cm septal perforasyon

Block cartilage formed by slices– From the archive of Dr. Salih Aydın

Surgery and postoperative care:

 After placing the blocks you see in the picture inside the nose and forming a solid septum, we lay the flaps I have created from the mucous membranes in the nose (nasal skin) on these cartilages to heal them. During this period silicone tubes remain in the patient’s nose for 3 weeks after surgery and patients cleanse the nose with sea water sprays and creams.

Video: Block cartilages placed in perforation in the nose – From Dr. Salih Aydın’s surgery archive

Assoc. Prof. Dr. Salih Aydin

Otorhinolaryngology Specialist

Faculty member, Istinye University Faculty of Medicine

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