Septal Perforation

A nasal septal perforation is a through-and through defect of the nasal septum.  There are many possible causes of nasal septal perforation including trauma, infection, cocaine use, and previous nasal surgery.  Septal perforations are frequently symptomatic due to the change in nasal airflow.  Patients may have crusting, bleeding, atrophic rhinitis, and neuralgia. Septal perforation surgery can alleviate these problems.

Diagnosis:

Dr. Bray, Jr. will perform a careful history and physical exam.  Diagnosing the cause of the perforation is essential to treatment.  In some cases specific lab work will be ordered to help make the diagnosis.  The nose will be examined externally and internally.  The location and size of the perforation will be determined prior to septal perforation surgery.

Septal Perforation Surgery:

A nasal septal prosthesis or button may be placed as a temporary or permanent treatment.  This prosthesis fits into the perforation to improve nasal airflow.  Many patients prefer surgical repair to avoid the long-term care required with a prosthesis.  The surgical treatment depends on the size of the perforation.

Small septal perforations may be closed with opposing septal mucosal flaps with a transnasal approach. Larger perforations require an open rhinoplasty approach.  In some cases local septal mucosal flaps may be used to close the perforation; however in more severe cases a flap of tissue from the turbinate or oral mucosa may be required.  Tissue expanders have also been used to create more tissue to close the nasal septal perforation.  During repair a graft of periosteum, cartilage, or alloderm may be placed between the mucosal flaps.

Before/after images of Dr Bray, Jr.’s rhinoplasty work is in the image gallery.