The nose, though a small organ on appearance, performs a multitude of functions. If there is an obstruction or problem in any one of the functions, the entirely bodily functions get affected. Septal perforation is a condition in which there are perforations in the septal section of the nose like the bones and cartilage sections. Nasal septal perforations mean that the left and right cavities of the nose are not entirely separate. The perforations can be of various sizes:
- Small perforations with diameter less than 0.5 cm
- Medium perforations with diameter from 0.5 to 2 cm
- Large perforations with diameter greater than 2 cm
Sometimes when the perforations are very small, they go undetected and sometimes they present symptoms which cause great difficulties for the patient. The common symptoms of septal perforation include:
- Anterior septal perforation
- Nasal crusting
- Nasal dryness
- Bleeding from the nose
- Whistling sound when the patient breaths
Nasal obstruction is caused, because of all the above mentioned symptoms. This is because of the perforations, the net of amount of air that passes through the nose decreases, which in turn causes low supply of air to the nasopharynx, which leads to the nasal congestion.
Septal perforation can have many causes, the most common of them is previous nose surgery. Other causes include trauma to the nose, nose picking, cocaine abuse, acid fumes and cauterization of epistaxis. Septal perforation repair represents a challenge to the surgeons because of the complexity of the structure and repair dynamics. Septal perforation can be treated with non-surgical options such as saline treatment and use of petroleum based ointment in the nose a few times of the day to combat the dryness.
However, these treatments are only temporary and as the perforations enlarge they can pose life threatening problems too. Surgical septal perforation repair becomes necessary in patients with serious complications. Since there are so many different causes of septal perforations a careful and detailed evaluation has to be done by the surgeon to determine the cause. In many cases a biopsy is also performed to rule out and ulcer or wounds which can indicate other diseases. Only after a careful evaluation and physical examination can an expert surgeon decide on the need and type of surgery required for septal perforation repair.
Septal Perforation Repair
Septal perforation repair is a complicated process. Because of the complicated causes of the perforations, the septal repair does not have a defined method for surgery. Various methods and techniques are used to make the repairs successful. The goal of septal perforation repair is to close the gaps and restore natural function as close as possible. Although there is no definitive technique, four basic principles are generally followed by all the surgeons worldwide. These include dissection of the nasal mucosa, rotation of the mucosa from the septum, floor and roof of the nasal cavity; avoid mucosal incision and a clean multilayer closer with grafts if needed.
The perforation does not happen in one single layer it includes the mucoperichondrial flaps of both sides and the main cartilage in between. Hence the three layers have to be separated from each other and individual repairs have to be made in each one of them. For perforations greater than 1.5 cm in size septal repair becomes especially if they are high vertically and therefore greater tissue manipulation becomes necessary.
Risks and Contradictions
Septal perforation repair should only be performed after the surgeon has done a detailed examination of the patient’s medical and physical history. In case of cocaine user a psychiatric evaluation is necessary to determine the patient’s mental health.
During the surgery, the surgeon will place splint on both sides of the septum to ensure proper repair. The sutures that are placed are usually removed after a maximum of ten days. Post the surgery the patient will have to take care of ensuring that the recovery is aided by avoiding trauma and injury to the nose.