Septal Perforation

A nasal septum perforation is a hole in the nasal septum, which is the divider that separates the right nasal passage from the left nasal passage. The septum is made up of hard, cartilaginous tissue, soft bone, and two layers of mucous membranes that are present on either side of the septum. Dr. Rizk indicates that the treatment to repair a nasal septum perforation can be either medical or surgical, depending on the size of the hole in the septum. The surgery required is very complicated and requires a high degree of experience and skill, as well as a deep knowledge of the rhinoplasty procedure.

A nasal septum perforation may be present for many reasons, and can result from a variety of physical or medical causes. The most common causes include:

• Tremendous shock or fracture of the nasal bone
• Prolonged use of inhaled drugs, such as cocaine, or harmful chemicals, like sulfuric acid
• Prior nose surgery
• Tuberculosis, syphilis, and Wegner granulomatosis, which can cause inflammation and infection, thus leading to a hole in the nasal septumCancer
• Long-term, regular use of nasal sprays containing steroids

The inhalation of harmful chemicals can narrow the nasal blood vessels (known as vasoconstriction), which inhibits the flow of blood to the cartilage and membranes of the septum. The inhibition of blood supply can lead to the rupture of the mucous membrane(s) and the cartilaginous tissue in the nose, causing a perforation.

There are two main types of symptoms that result from a nasal perforation, which are known as functional or cosmetic. Functional symptoms include bleeding or constantly runny noses, and crusting with regular infection, and a tendency to snore at night. Cosmetic symptoms appear when the cartilage collapses, resulting in a deformity of the nose. The medical treatment of a collapsed bridge involves the creation of a moist environment in the nose via application of gel, spray, or ointments, such as Borofax ointment, which inhibit bacterial growth. In some cases, septal buttons are used, but Dr. Rizk does not commonly recommend this approach as many patients cannot tolerate this treatment.

The procedure for repairing a septal perforation is highly technical and complicated, as it involves slowly rebuilding three different layers of mucous membranes, followed by cartilage repair, and restructuring of the nose. The cartilage that will be used in the nose is obtained from either the patient’s ears or ribs. This surgical technique ensures a greater success rate with smaller perforations; however, Dr. Rizk does not often suggest this method, as it does not ensure proper blood flow.