Septal Perforation

Septal perforation (a hole in the septum) is a relatively uncommon problem faced by patients after prior nasal surgery. This can occur during surgery if there is a hole made in each side of the mucoperichondrium, the lining on each side, when cartilage is taken from the center of the septum. Other causes include a septal hematoma or septal abscess, both of which are rare after rhinoplasty surgery. Other nonsurgical causes include cocaine use, nasal trauma, nasal spray use, or cauterization of the septum for nosebleeds.

There are several common symptoms associated with septal perforations, including whistling, nosebleeds (epistaxis), crusting, obstruction, congestion, and runny nose. If the perforation does not cause any issues, it is not necessary that it be repaired, though it is a good idea to have it followed over time by an ENT surgeon. Frequent use of nasal saline spray can be helpful to reduce symptoms.

There are a few options for repairing a perforation of the septum during revision rhinoplasty:

• The first is to rotate a flap of tissue from the front, back, or top of the septum, where the lining is intact. This can be a good option for small perforations.
• The second approach is to rotate a flap from the inferior turbinates, which are the structures which run along the sides of the inside of the nose, next to the septum.
• The third approach, used for larger perforations, is to bring in temporalis fascia, which is the thin covering of the temporalis muscle. This muscle is the one which bulges in one’s temple during chewing, and the fascia can be taken by making a tiny incision behind the hairline, above the ear. There is no need to shave any hair and the incision heals very inconspicuously.
• The fourth approach is to use a PDS™ Flexible Plate, which is a 0.15 mm perforated, absorbable plate which helps to stabilize the septal repair when using any of the above techniques. Dr. Mehta is one of the earliest surgeons in the United States to begin using this cutting-edge technology as it significantly increases the likelihood of successful repair. The plate gradually dissolves over a few month after the surgery, during which time the lining grows over the repair site. This plate also shortens the surgical time, as the fascia graft or rotation flaps can be quite flimsy without the extra support of the plate.

After surgery, the septal perforation repair site is stabilized with Doyle nasal splints, which are rubberized silicone tubes which sit along each side of the septum, providing increased support and allowing the patient to breathe during the recovery process. Dr. Mehta generally leaves these splints in for ~1 week after surgery.

Septal perforations can be quite problematic for patients after prior rhinoplasty surgery. Using the cutting edge PDS plate, Dr. Mehta is one of the foremost experts in repairing large septal perforations previously thought to be too large to repair. If you would like to schedule your consultation, please contact us.