What is Septum Perforation? Intranasal Hole and Treatment Methods

Prof. Dr. Gediz Murat Serin Explains

A hole in the septum, which forms the compartment inside the nose, medically known as  septum perforation , can create many functional and aesthetic problems for patients.  As an Ear, Nose and Throat specialist who has been working in the field of rhinology for nearly 20 years  , I have focused the last  12 years specifically on septum perforation . My special interest in this area has allowed us to increase our rate of successfully treating  this complex problem that very few physicians have studied in depth  .

What is Septum Perforation?

The septum is a structure that divides the nasal cavity into two, consisting of cartilage at the front and bone at the back. A hole that occurs anywhere in this structure is called a “septum perforation.” This condition is often referred to as a “nasal hole” among the public.

As this hole grows, it can cause significant problems in both the internal structure and external appearance of the nose. Especially as the hole approaches the front of the nose  , complaints such as collapse of the nasal dorsum, sagging of the nasal tip and a whistling sound while breathing  may develop.

What Causes Septum Perforation?

Septum perforation may be related to many different factors rather than a single cause. The most common causes are:

• Previous nose surgeries (septoplasty, rhinoplasty)
  Perforations may occur, especially as a result of bilateral mucosal damage.
• Traumas
  Sports injuries, blows or accidents.
• Long-term use of nasal sprays
  Uncontrolled use of steroid-containing sprays or vasoconstrictors.
• Drug
  use, especially cocaine, causes serious damage to nasal tissue.
• Infections and autoimmune diseases
  Some systemic diseases such as septal hematoma, Wegener’s granulomatosis.

What are the symptoms of septum perforation?

Not every hole in the septum may initially cause symptoms. However, as the hole grows or approaches the front of the nose, the following complaints may occur:

• Whistling sound when breathing
• Nasal congestion
• Dryness and crusting inside the nose
• Frequent nosebleeds
• Deformity in nose shape and aesthetic concerns
• Loss of self-confidence

How is Septum Perforation Treated?

The treatment plan varies depending on many factors such as the location and size of the perforation, the patient’s level of complaints, and the condition of the external nasal structure. Therefore, an individual approach is required for each patient.

1.Internal Repair (Nose hole closure surgery)

If there is no deterioration in the shape of the nose and no external aesthetic intervention is required, the only goal is to close the perforation. For this purpose:

• Nasal mucosal flap techniques
• Membrane taken from the leg (fascia lata)
• Rib cartilage and membrane (perichondrium)

These surgeries are usually
performed under general anesthesia and patients are usually discharged after 1 day.

2.Combined Surgery (Perforation Repair + Aesthetic Intervention (Rhinoplasty or Revision Rhinoplasty)

If there is a deterioration in the external nasal structure along with the perforation, then the nose is reconstructed both internally and externally with the revision rhinoplasty approach. It is especially preferred in the following cases:

• Collapse of the nasal dorsum
• Drooping nose tip
• Asymmetry and deformities
• Perforation after previous rhinoplasty

In these surgeries, intranasal mucosal rotation flaps and rib cartilage and membrane are often  used.

Why Is Rib Cartilage Used?

Rib cartilage  is a tissue that is extremely strong in terms of strength and can be taken in sufficient quantities.  It stands out as the only safe option  , especially for patients who have had nose surgery before and do not have any usable cartilage left inside  .

With rib cartilage:

• The support structure of the nose is re-established
• The perforation is covered securely.
• Aesthetic deformations are corrected

Post-Operative Recovery Process

• Silicone supports can be used in the nose for 2-3 weeks  .
• There may be mild tenderness in the rib area  , but it usually returns to normal within 48 hours.
• If aesthetic intervention has also been performed, a splint is applied to the outside of the nose.
• The average recovery period  is 2-4 weeks, and most patients can return to their daily lives within 1 week.

Conclusion: Septum Perforation Is No Longer a Fate

Having a hole in the nose, that is,  septum perforation , is a serious health problem that disrupts both breathing and aesthetics. However, today, thanks to advanced surgical techniques and individualized approaches,  this condition can be treated permanently .

With my nearly  20 years of experience in rhinology , as a surgeon who has focused on the treatment of septum perforation, especially in recent years,  I can clearly say this:

“With the right patient selection and the right technique, septum perforation can be closed permanently to a large extent.”

If  you experience symptoms such as difficulty breathing, nasal dryness, whistling, or nasal deformity  , seek professional evaluation without delay.

Prof. Dr. Gediz Murat Serin
Ear Nose Throat Specialist
Revision Rhinoplasty & Nose Structural Surgery

“Difficult noses require meticulousness.”