Septal Perforation Repair

A septal perforation is a hole in the nasal septum, which is the cartilage and bone that separates the two nostrils

Septal Perforation Repair: A Procedure to Address a Hole in the Nasal Septum

Common Causes of a Septal Perforation

Septal perforations may result from various factors, including nasal trauma, prior nasal surgeries, or prolonged/repetitive nasal irritation. Other potential contributors include chronic nasal inflammation, infections, and certain autoimmune conditions.

Symptoms of a Septal Perforation

Symptoms associated with septal perforations can vary but may include nasal crusting, frequent nosebleeds, a whistling sound while breathing, and changes in the sense of smell. Some individuals report nasal dryness or a sensation of breathing discomfort.

Approaches to Septal Perforation Repair

There are several surgical techniques that may be considered for septal perforation repair, including various types of flaps, cartilage grafts, and fascial grafts. Dr Honeybrook has experience performing two main techniques for addressing septal perforations: the temporoparietal fascia graft with cartilage or bioabsorbable plate, and the anterior ethmoid artery flap.

Fascial Repair

The temporoparietal fascia graft involves using tissue from the individual’s own body to support the repair of a septal perforation. The temporoparietal fascia is a layer of tissue located near the temple. This technique includes harvesting a small section of this fascia underneath the skin and wrapping it around a segment of cartilage or a bioabsorbable plate.

During the procedure, an open rhinoplasty approach may be used to access the nasal septum. This involves making a small incision on the columella (the tissue between the nostrils) and lifting the soft tissues to visualise the nasal structures. The graft is then positioned to support the nasal septum and provide structural reinforcement.

This technique uses vascularised tissue, which may provide structural support during healing. It is typically considered for septal perforations up to 1-3 cm in diameter.

Nasal Flaps

The anterior ethmoid artery flap technique involves repositioning a flap of tissue from the internal nasal cavity to cover a septal perforation. This approach includes making an incision inside the nose and elevating a flap of tissue supplied by the anterior ethmoid artery, a blood vessel located in the nasal cavity.

The flap is then rotated into the septal perforation and sutured in place. This technique is often considered for smaller septal perforations and uses tissue from within the nasal cavity.

The choice of surgical approach depends on factors such as the size and location of the septal perforation, as well as individual anatomical considerations. A consultation allows for assessment of available options and discussion of expected outcomes.

Recovery After Septal Perforation Repair

Individuals may require prolonged internal nasal splinting after the procedure to protect the healing tissues. They may also experience swelling and bruising that can persist for several months if an open rhinoplasty approach was used. Most individuals are typically able to return to normal activities within two weeks after the surgery.

Who May Consider Septal Perforation Repair?

Septal perforation repair may be considered by individuals who experience persistent symptoms such as chronic nasal crusting, nosebleeds, or whistling. Additionally, younger individuals with a smaller, asymptomatic perforation may discuss surgical options, as some perforations may enlarge over time.