By Prof. Dr. Gediz Murat Serin – ENT Specialist, Rhinologist

The nasal septum serves as the central wall separating the two nostrils. When a hole—called a septal perforation—develops in this delicate structure, it can disrupt not only nasal airflow but also the overall function and health of the nose. While some may assume that small perforations can be left untreated, the truth is far more complex. Untreated septal perforations can worsen over time and lead to serious complications, including aesthetic, functional, and surgical challenges.

What Is a Septal Perforation?

A septal perforation is a full-thickness hole in the nasal septum, the wall made of cartilage and bone that divides the nasal cavity. These perforations may arise due to:
– Previous nasal surgeries (especially septoplasty or rhinoplasty)
– Chronic use of nasal sprays or drugs (such as cocaine)
– Trauma
– Inflammatory diseases (e.g., Wegener’s granulomatosis)
– Infections or excessive cauterization

Why Should It Be Closed?

Progressive Enlargement and Tissue Loss

Left untreated, small perforations can become larger due to turbulent airflow, crusting, and mechanical trauma. As the edges dry out and ulcerate, cartilage and mucosal tissue continue to erode. Over time, this leads to further collapse of nasal structures, making future surgeries more complex or even impossible.

Nasal Deformity and Collapse

Septal perforations disrupt the mechanical integrity of the nasal septum. If the supporting cartilage weakens, patients may experience saddle-nose deformity or collapse of the nasal bridge—both functionally and aesthetically devastating changes. These often require structural grafting, typically using costal cartilage, to restore form and function.

Breathing Difficulties

Even small perforations can disturb laminar airflow in the nose, resulting in:
– Whistling sounds
– Sensation of nasal obstruction
– Paradoxical breathing difficulty
– Postnasal drip

Chronic Crusting and Bleeding

Exposed cartilage within a perforation is prone to drying, chronic crusting, and recurrent bleeding. These symptoms are often resistant to medical treatment and significantly impact quality of life.

Infection and Mucosal Breakdown

The area around a perforation can act as a chronic inflammation site, harboring bacterial growth and leading to mucosal breakdown. This often creates a vicious cycle of crusting, bleeding, and pain.

Modern Solutions: Endoscopic Repair with Tailored Techniques

Since 2016, I have treated septal perforations with a focus on minimally invasive, endoscopic techniques. Each case is individualized. Depending on the size, location, and nasal anatomy, I may employ:
– Fascia grafts (commonly from the thigh)
– Costal cartilage grafts for structural support
– Local flap techniques to ensure mucosal coverage and vascularity

All of these are performed endoscopically when possible. However, if the patient has nasal deformities from previous surgeries or collapse due to perforation, open or closed revision rhinoplasty with structural reconstruction is incorporated, using rib cartilage as needed.

Why Early Intervention Matters

Delaying repair allows more tissue loss, scarring, and destabilization. Early intervention not only simplifies surgery but also improves:
– Graft success rate
– Aesthetic outcomes
– Long-term nasal health

Final Thoughts

Septal perforations are more than just “a hole in the nose.” They are an evolving structural defect that can compromise breathing, appearance, and mucosal integrity. As a rhinologist with nearly a decade of focused experience in septal perforation repair, my advice is clear: Don’t wait for it to worsen. Timely evaluation and tailored treatment can make all the difference.

If you are experiencing symptoms of a septal perforation, or have been diagnosed and are unsure of the next steps, consider booking a consultation. Every nose deserves structural harmony and proper care.