In the complex structure of the nose, the septum plays an important role in lending the nose shape, ensuring proper breathing, and maintaining the airways. You see your septum every day from the front when you look in the mirror. But what happens when the septum becomes weak or has perforations? It can cause breathing issues. A whining sound when breathing is the most common indication of septal perforation.
In most cases, people go through their lives without even knowing about the perforations in the septum. However, it is important to realize that even slight perforations can cause serious health hazards for some. Septal perforation has a chance of increasing in size and therefore should be monitored and treated as soon as possible.
The septum is a thin wall made up of cartilage in the front and bones in the back. It separates the left and right nostrils. The length and width of the septum differ from one person to another. The size of the septum impacts the appearance and function of the nose. The general measurements of the septum are
- Length: The length of the nasal septum, often referred to as the “height,” typically ranges from about 5 to 6 centimeters (2 to 2.4 inches). However, this can vary, and some individuals may have longer or shorter septum.
- Breadth (width): The breadth of the septum, often referred to as the “width,” can also vary. It typically ranges from about 1.5 to 2 centimeters (0.6 to 0.8 inches) at its widest point. Like the length, the width can differ between individuals.
Variations in septal size and shape can influence the appearance of the nose and may also play a role in nasal breathing and overall nasal function.
What is nasal septum perforation?
It is a tear or hold in the septum. Untreated, it can cause many issues such as difficulty breathing, pain in the nose, nasal hemorrhage, sinusitis, headache, decreased sense of smell, noisy breathing, a feeling that the nose is blocked or obstructed at all times, etc. People who are born with a deviated septum are more likely to develop a perforation.
Another issue common with septal perforation is scab formation and blood gathering in the area, making breathing even more difficult. Larger perforations can also cause changes in the nasal structure and physical deformities.
What causes nasal septal perforation?
There can be many reasons for a septal perforation or injury to the septum. Some common ones include
- Trauma to the nose: Injury because of accidents or trauma to the nose can cause the septum to tear or develop a hole.
- Chronic nasal irritation: This happens when there is long-term use of specific medications or a nasal spray. Also, repeated nose picking can cause perforation.
- Use of illicit drugs: Snoring cocaine or crushed-up pills can damage the lining of the nose and the septum.
- Infections, such as acute or chronic sinus infections, can lead to septal perforations.
- Cancer
- Medical conditions such as Wegnener’s disease, recurring polychondritis or sarcoidosis, lupus syphilis, and tuberculosis can also cause tearing or holes in the septum.
- Congenital disabilities.
It is essential that you seek the advice of a good doctor if you suspect a septal perforation. The treatment depends on the amount of perforation and the cause of the same. In some cases, the tear might heal itself independently. Others need the intervention of an expert ENT surgeon or a rhinoplasty surgeon.
Does an untreated septum pose a risk?
Yes, people with deviated septum is generally more susceptible to sinus infections, which can disturb their normal lives. The nasal passages become irritated and inflamed in such conditions and can run the risk of severe illnesses and infections to the brain and eyes. In rare cases, an untreated sinus infection can even increase the risk of seizures and brain damage.
Treatment for Septal Perforation
Treatment options for septal perforation aim to alleviate symptoms and, in some cases, close the perforation. Your doctor will examine your nose and discuss other issues to find out the cause of the perforation. The choice of treatment depends on the size of the perforation, location, and the severity of the symptoms. Here are some common treatment options:
- Observation and Symptom Management: For small, asymptomatic septal perforation that don’t cause significant problems, a “watch and wait” approach may be recommended. This involves monitoring the condition and managing symptoms as they arise. Saline nasal sprays can help keep the nasal passages moist, and avoiding irritants that worsen symptoms is advisable.
- Septal Button or Prosthesis: A septal button or septal perforation prosthesis is a non-surgical option. It’s a silicone or plastic device designed to block the hole in the septum and improve symptoms like nasal crusting, bleeding, and whistling sounds. A healthcare provider can place the septal button.
- Nasal Irrigation: Regular nasal irrigation with a saline solution can alleviate symptoms by keeping the nasal passages moist and preventing crusting. Over-the-counter saline nasal sprays can be used for this purpose.
- Topical Medications: Your doctor may prescribe topical medications, such as antibiotic or corticosteroid creams, to manage symptoms like crusting, infection, or inflammation associated with the perforation.
- Surgical Repair: In cases of larger or symptomatic perforations that don’t respond to conservative treatments, surgical repair may be necessary. This procedure, known as septal perforation repair, septal reconstruction, or septoplasty; involves closing the hole in the septum using tissue grafts. These grafts can be taken from other parts of the body, such as the mouth, or may be synthetic materials. The surgical approach used depends on the size and location of the perforation. The surgery usually takes about 1–3 hours, and it can be done as day care procedure. There are various techniques for surgically closing septal perforations, including traditional open-septal surgery and minimally invasive endoscopic procedures. The choice of technique depends on the individual case, the surgeon’s expertise, and the size and location of the peroration.
Recovery from septal perforation surgery
Recovery from septal perforation surgery can vary depending on the extent of the surgery, individual healing factors, and the surgical technique being used. Here is a general overview of the recovery process:
Immediate Postoperative Period (Days 1–7):
- Hospital Stay: In most cases, septal perforation surgery is performed as an outpatient procedure, and you can return home on the same day.
- Pain and discomfort: You may experience mild pain, discomfort, or congestion in your nasal passages. Your surgeon may prescribe pain medications or recommend over-the-counter pain relievers.
- Nasal Packing: In some cases, nasal packing or splints may be placed inside your nose to support the repaired septum. This can be uncomfortable but is typically removed within a few days.
- Bleeding and Drainage: Some bleeding or discharge from your nose is normal initially. Gently damp your nose with a clean tissue to manage it.
- Rest and Activity: Rest is crucial during the early recovery period. Avoid strenuous activities, heavy lifting, and bending over, which can increase blood flow to the nose and potentially lead to bleeding.
First Few Weeks (Weeks 1-2):
Follow-Up Appointments: You will have several follow-up appointments with your surgeon to monitor your healing progress and remove any packing or splints.
Nasal Care: Your surgeon will provide instructions on how to clean and care for your nose. This may include saline nasal sprays to keep the nasal passages moist. Also, avoid any stress to the nose from activities such as bending, sneezing, and strenuous activities.
Swelling and Bruising: Some swelling and bruising around the nose and eyes are common but should gradually improve over the first few weeks. Don’t try to touch the nose or massage it.
Breathing: As the nasal passages heal, you may notice improvements in your ability to breathe through your nose.
Longer-Term Recovery (Weeks 3 and Beyond):
Return to Normal Activities: You can gradually return to your normal activities and exercise routine, following your surgeon’s guidance.
Final Results: It may take several months for the full effects of the surgery to become apparent. Your surgeon will monitor your progress during follow-up appointments.
Scar Care: If any external incisions were made, follow your surgeon’s recommendations for scar care to minimize scarring.
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