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One of NYC's Leading Female Double Board Certified Facial Plastic and Reconstructive Surgeons

Septal Perforation Repair from an Experienced Septal Perforation Nose Surgeon


What is a septal perforation?

The nasal septum is a wall that splits the nose into two nasal cavities located behind each nostril. The nasal septal wall allows for streamlined airflow from the nostrils into the throat.  A nasal septal perforation occurs when a hole develops in this septal wall creating one unified cavity. Streamlined airflow is interrupted and chaotic causing symptoms of nasal dryness, inflammation, infection, bleeding and crusting.  Lee Ann Klausner, MD is an experienced surgeon in septal perforation repair with a very high success rate in closing septal perforations. As a nasal septal perforation repair specialist, she has the experience and knowledge to treat you.

Video: Dr. Klausner explains septal perforation repair

Video Transcription

A septal perforation is a hole in the nasal septum. The nasal septum is the room divider for the nose so it separates the uh nose into two nasal passages. Symptoms of septal perforation can include nasal obstruction, dryness, irritation, crust accumulation, bleeding, whistling and it gives a patient the sensation that they cannot breath in air. There are multiple causes of septal perforations. Commonly what we see are patients who have abused cocaine. Other causes included um chronic nasal picking. As a complication of nasal septal surgery a perforation can be caused. A septal perforation cannot heal itself and the reason for that is that once the hole is made there is an absence of tissue. The mucosal cells will travel through the hole and form a bond with the other side of the septum thereby leaving the hole open so the only solution is to physically close the hole if the hole is not too big. Non-surgical options include irrigation and cleaning but this is a daily routine that is required which can be cumbersome for patients and time-consuming and difficult. Other treatments that are non-surgical involve the placement of a button which will physically block the hole however it is not always the most positive approach to uh dealing with a perforation because of that fact that there are still problems with keeping the area clean and there is risk of infection and there is risk of making the perforation bigger.  In preparing a patient for septal perforation repair uh there are so many things that need to be discussed. Um one major issue is if they’ve had any problems with addiction they have to be in a place where they are not using anymore and the risk of them uh using again in the future is uh close to none. Um so, there’s that level of commitment and recovery from their addiction that’s essential. Um and another very common thing is many of the patients are smokers and uh they absolutely cannot smoke, they cannot be exposed to second-hand smoke for many months before and after the procedure so these are very honest conversations that I have to have with patients  to ensure that they are in a place where they uh can have the most successful outcome. The ability to close septal perforations is a highly specialized uh technique and I was fortunate enough to have the opportunity in fellowship to work with someone who is probably one of the best in the world. It’s my surgical training that has enabled me to be able to execute the operation. The greatest satisfaction I have in managing and uh performing this operation is the impact it has on patients lives.

What are symptoms of a septal perforation?

Symptoms of septal perforation can be very debilitating. The nasal septum normally is a solid wall that divides the nose into two cavities. Normally this wall allows for streamlined airflow through the nose, into the throat to reach the lungs. When there is a hole in the nasal septum (a septal perforation), airflow into the nose is disrupted. When the normal nasal airflow is disrupted, symptoms of nasal obstruction, chronic nasal dryness, nasal and sinus soreness, chronic nasal and sinus infection, frequent nasal bleeding, nasal crusting,  and even whistling can occur. Some patient’s chronic infections which originate at the site of septal perforation extend to affect the sinuses and in severe cases can lead to bronchitis and pneumonia. Patients tend to deal with these symptoms on a daily basis which has a negative impact on their quality of life. Even the quality of an individual’s sleep can be harmed by the nasal obstruction caused by a septal perforation. 

What causes a septal perforation?

Septal perforation may be associated with events such as complications from emergency medical or surgical procedures , a complication of routine deviated septum surgery and nasal trauma. However, it is also linked to the abuse of recreational drugs that are inhaled through the nostril, most notably cocaine. Septal perforations can be caused by chronic nasal picking and chronic use of over the counter nasal decongestants such as oxymetazoline/ phenylephrine ( Afrin®/ Neo-sinephrine®).  Cocaine and these topical over the counter nasal decongestants cause chronic constriction of the blood vessels nourishing the septal membranes and cause the membranes to die from lack of oxygen to the tissues. Some septal perforations are associated with underlying auto-immune conditions. Septal perforations can become larger over time due to continued picking to remove septal crusting and recurrent bleeding. If the septal perforation becomes too large it can cause worsening of symptoms and collapse of the nasal bridge/ nose called a saddle nose deformity. Perforation repair is  indicated in patients who have symptoms and who may be at risk of nasal collapse. 

What does a septal perforation repair entail?

The process of perforation repair depends on the size of the perforation and on its location. The septal perforation is a hole in three layers: mucosal membrane on the right and left side of the septum, and cartilage and bone in between the membranes; therefore, repair to close the perforation must be done in three layers as well. This is a complex and technically challenging operation which must be done by an experienced facial plastic surgeon with specific training in septal perforation repair. Successful septal perforation repair is best accomplished by an open operation in which the septum is seen directly and the mucosal membranes above and below the perforation on both the right and left side of the septum are carefully elevated and advanced over the hole to cover it.   A graft such as Alloderm® can be placed between the advanced membranes to support the repair and allow it to heal. 

The success of a perforation repair mainly depends on a technically sound operation, protection of that repair after surgery and good post-operative blood flow to help the repair heal. A successful outcome is not fully realized until several months after surgery when it is clear that the closure has remained intact. Factors that can cause failure of a septal perforation repair in the post-operative period include: smoking, exposure to second-hand smoke, inadequately treated diabetes, cocaine use, picking and the use of topical nasal decongestants and topical nasal steroids.

Dr. Klausner guides her patient’s before and after surgery in order to help yield the best outcome for her patients.

Contact a Septal Perforation Specialist

Lee Ann Klausner, MD is a septal perforation specialist. Please contact our office with any questions regarding your medical needs or to make an immediate appointment.

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