Perforated Septum: Symptoms, Causes and the Best Treatment Options

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A perforated septum, sometimes called a nasal septum hole or septal perforation, occurs when a gap forms in the thin wall of cartilage and bone that the two nasal . When a hole develops in the nasal septum, it can breathing, cause or bleeding, and in some cases alter the external shape of the nose. The condition ranges from small, asymptomatic defects to large that cause significant and cosmetic .

At Centre for Surgery in Baker Street, London, we expert diagnosis and treatment for the nasal septum, perforated nasal and nasal reconstruction. Our are highly experienced in both and take a to every case, from minor symptomatic management to major reconstructive .

What is a Perforated Septum?

The nasal septum is a wall made up of cartilage at the front and bone further back, lined on each side by a thin mucous membrane. This structure the nasal cavity into left and right sides, directing and providing structural to the nose. A septal when both sides of this lining and the underlying are damaged simultaneously, forming a direct opening the two nostrils.

The size of a nasal wall defect can range from a few — often producing a whistling sound during breathing — to centimetres, which may result in significant nasal collapse and a visible change in the shape of the nose from the outside. Smaller are often located anteriorly, towards the front of the septum, while larger ones may extend further back towards the bony .

Causes of a Perforated Septum

There are numerous possible causes of a nasal septum perforation, and establishing the cause is an part of the most treatment.

Nasal trauma is one of the most common causes. A blow to the nose that the blood supply to the cartilage, or a septal haematoma — a of blood the lining and the cartilage — that is not promptly drained can lead to death and subsequent perforation.

Previous nasal surgery, or rhinoplasty, can occasionally result in when the lining is torn on both sides simultaneously during the procedure, the blood supply from a segment of cartilage. This is a but complication of nasal surgery.

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Overuse of topical nasal sprays — vasoconstrictors such as — can impair blood flow to the septum over time, to damage and eventually perforation. drug use, most notably cocaine, is a well-recognised cause due to its direct vasoconstrictive and tissue-toxic effects.

Inflammatory and including granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), sarcoidosis, lupus, and relapsing can cause septal destruction as part of their . infections, including tuberculosis, syphilis, and fungal infections, may also cause perforation in some cases. to fumes or dusts in certain occupational is an additional risk factor.

Symptoms of a Perforated Septum

The of a perforated septum depend significantly on the size and location of the perforation. Small perforations near the front of the septum often cause a whistling sound when air passes through during breathing — this is sometimes the first sign that alerts patients to the problem. Nosebleeds are another common symptom, as the edges of the are to crusting and cracking, leading to particularly in dry environments or on waking in the morning.

Nasal crusting is a persistent complaint for many patients, as the airflow created by the leads to drying and mucous accumulation around the edges of the defect. A of nasal blockage, dryness, or congestion is also frequently reported, despite no obstruction being present. Some patients notice a reduced sense of smell as a result of the airflow .

Larger nasal septum holes may cause more pronounced symptoms including discomfort, a sense of something being wrong within the nose, and in cases, changes in the external shape of the nose. When sufficient cartilage has been lost, the bridge of the nose may begin to sink inward — a known as a — which can become a significant cosmetic as well as a one.

Non-Surgical Treatment for a Perforated Septum

Not all septal perforations surgical repair. When symptoms are mild and the cause has been addressed, management may be sufficient to keep the patient comfortable. Regular saline sprays or rinses help to maintain moisture within the nose, reduce crusting, and keep the edges of the perforation clean. Applying a thin layer of ointment or gel around the inside of the nose can also help the vulnerable tissue and reduce dryness. Using a in sleeping areas is often recommended, particularly during the winter months when indoor air tends to be drier.

A nasal septal button — a small prosthesis designed to fit within and seal the — is a non-surgical option for whose perforation is a suitable shape and size for this device. When properly fitted, a septal button can whistling, significantly reduce crusting and bleeding, and a more normal pattern of nasal almost immediately. It requires periodic removal and cleaning, and is not suitable for all perforations, but for the right it represents an effective and management option.

Surgical Treatments Anti-Wrinkle for Men a Perforated Septum

repair of a septal perforation aims to close the defect by a continuous lining across the septum. The procedure involves the mucosal lining away from the edges of the perforation and or rotating local tissue flaps to cover both sides of the defect. A is often placed between the two layers to structural support and a for .

The surgical approach varies depending on the size and position of the . Smaller, located perforations can sometimes be repaired through the nostrils using a closed technique. Larger or more perforations require an , where a small across the columella provides wider access to the internal of the nose. The rate of repair is influenced by the size of the defect, the of the tissue, and whether any condition has been fully before surgery is attempted.

is a technique to straighten and stabilise the septum. In the context of a perforated septum, it may be performed with repair to any coexisting or structural that could impair the outcome of the repair. When performed together with perforation repair, it ensures the septum heals evenly and that nasal breathing is fully restored across both sides of the nose.

When a nasal has caused visible collapse or of the bridge — particularly in cases of saddle nose deformity where the nasal dorsum has sunk due to loss of septal support — a may be . This combined procedure addresses both the internal aspects of the septum and the external concerns, using cartilage grafts to nasal height, projection, and structural .

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At Centre for Surgery, we are in nasal and facial plastic surgery, providing expert treatment for septal perforation and related nasal conditions using the most techniques available. Our consultants combine surgical with a precise of nasal anatomy, that every receives a treatment plan tailored to their specific perforation, symptoms, and goals. We offer a full continuum of care from initial assessment and conservative through to complex repair and follow-up.

For expert advice or to book a consultation, Centre for Surgery, Baker Street, London W1U 6RN.
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