Treatment of Nasal Septum Perforation
The treatment of nasal septum perforation depends on the patient’s condition. In some patients who are asymptomatic or have perforations in the posterior section, medical treatments such as saline solutions and nasal gels can be beneficial. In patients with large perforations that cannot be closed with medication, additional treatments like surgery to close the nasal septal perforation are recommended.
Surgery to Close the Septal Perforation
Small perforations are often treated using the endonasal (within the nose) method. In this technique, the tissue is locally repositioned and closed. Medium-sized perforations can also be closed using several techniques. The inferior turbinate flap is commonly used for small to medium perforations. This method involves using a flap taken from the tissue around the turbinate and using it to close the hole in the septum. The main issue with this flap is that it has limited length and application for larger perforations.
Larger perforations that are symptomatic are usually closed using local tissue. The advantage of local flaps is that there is a lower risk of disrupting the blood supply. Lastly, free flaps (transferring tissue from one part of the body to the nose and connecting it to blood vessels) are another option, typically used for the largest septal perforations.
Important Points for Closing a Septal Perforation
Ensuring proper blood supply to the area
Maintaining moisture and proper nourishment of the mucosa
Avoiding tension around the treated area
A major principle in closing a nasal septum perforation is to ensure the blood supply to the treated area. Blood supply from inside the nose or surrounding areas is evaluated to select the best tissue for closing the septal perforation.
Pre-surgical Care for Septal Perforation Closure
Before closing a septal perforation, the patient should moisturize the nose with saline solution. This is beneficial for patients with dry noses, whether they have a septal perforation or not.
When closing the septal perforation, care must be taken to avoid causing tension in the surrounding tissues.
Techniques for Closing Large Septal Perforations
In the past, closing a septal perforation was one of the challenging techniques in surgery. Nowadays, a specific method is used for closing septal perforations, where an endoscopic incision is made, and a flap with blood supply is taken to close the perforation.
Do all septal perforations need to be closed?
No, septal perforations that cause few symptoms often do not require closure.
If a septal perforation is asymptomatic, does it need to be closed?
If the perforation is small and the patient does not experience any symptoms, it does not need to be closed.
Is this procedure painful?
No. Most patients who have undergone this surgery describe it as a procedure with tolerable pain.
How long after septal perforation closure surgery can a patient blow their nose?
Patients should wait until their doctor gives permission. Forceful nose blowing can damage the closed perforation, and patients should avoid this until advised by the doctor.
Who is at risk of septal perforation?
Patients with poor nasal hygiene, those with dry noses, and patients with a history of septal surgery are at greater risk of developing septal perforations.
Is septal perforation closure surgery technically challenging?
Yes, repositioning a very thin flap in the nose requires deep knowledge, and the surgeon needs to be fully familiar with the anatomy and structure of the pericranial region, nasal anatomy, and the function and grafting to the nose.
Is rib cartilage grafting necessary in septal perforation closure surgery?
Many patients may require grafting because septal perforation can lead to cartilage collapse and the development of a saddle nose, and in some cases, rib cartilage may be needed for reconstruction.
Is the recovery period for this surgery long?
It takes about 6 weeks for the patient to fully recover. Patients are advised not to blow their nose or engage in heavy activities during this period.
