Septum Perforation (Nasal Septal Hole) Surgical Treatment (Repair)
Septum perforation, commonly known as nasal septal hole, refers to openings that form in the nasal septum (middle wall of the nose). Medically defined as septal perforation, this condition can cause both functional and aesthetic complaints in patients. Surgical treatment is considered especially when problems such as whistling sounds during breathing, frequent nosebleeds, crusting, dryness, infections, or nasal deformity occur.
Septum Perforation Treatment Options
Septum perforation does not heal spontaneously. For small perforations that do not cause complaints, nasal comfort can be provided only with moisturizing sprays or ointments. However, if there are significant complaints, surgical repair is required. Endoscopic (camera-assisted) and microsurgical methods: More precise and safe surgical repair can be performed with nasal endoscopic guidance.
The main surgical methods are:
- Septal button: Devices made of silicone or similar materials are placed over the perforation to reduce symptoms. However, it is not a permanent solution. I do not apply this method in my own practice.
- Flap techniques: The hole can be closed with local mucosal flaps or vascularized rotation flaps prepared from inside the nose.
- Graft placement: Permanent closure is achieved by placing the patient’s own cartilage, fascia, or perichondrium tissues over the perforation.
- Flap + Graft combination: This is the method I prefer most in my surgical practice. Both mucosal flaps are prepared and grafts are added in between to achieve strong and permanent closure.
Surgical Challenges: Cocaine and Previous Surgeries
One of the frequently discussed topics in septal perforation surgery is nasal septal holes due to cocaine use. Cocaine causes dryness, crusting, recurrent bleeding, and cartilage erosion in the nasal mucosa, leading to septum perforation development.
Cocaine use makes surgery more difficult by impairing the blood supply and quality of the mucosa. However, based on my experience, in cocaine patients who have not had surgery, rotation flap techniques can be applied more easily since there are fewer adhesions inside the nose.
In contrast, in patients who have had previous nasal surgery, adhesions are very pronounced, making it more difficult to release flaps and place grafts. If there is both a history of surgery and cocaine use, surgery requires much more meticulous planning.
Size and Location of the Perforation
One of the most important factors determining the difficulty level in septum perforation surgery is the size and location of the perforation:
- Perforations larger than 2.5–3 cm,
- Nasal septal holes located in the most anterior region and upper parts,
- Previously operated septums constitute the most difficult group surgically.
In such cases, I usually prefer to close with two or three-layer mucosal flaps and fascia or cartilage grafts placed in between.
Success Rates in Septum Perforation Surgery
When the correct technique is chosen, with the surgeon’s experience and the patient’s compliance with postoperative care, success rates in septum perforation surgery can reach 90% or even higher.
In the postoperative period:
- Regular saline irrigations,
- Keeping the inside of the nose moist,
- Preventing crusting,
- Protecting the nose from trauma,
are the most important factors that increase success.
Conclusion
Septum perforation (septal perforation), or nasal septal hole, is a condition that can seriously affect quality of life. In cases that cannot be controlled with simple methods, surgical repair is the most effective solution. The difficulty level of surgery depends on the size and location of the perforation, previous surgeries, and tissue quality. Success rates are quite high in surgeries performed with appropriate technique by an experienced surgeon.
Frequently Asked Questions (FAQ)
1-) Does septum perforation heal spontaneously?
No. Nasal septal holes do not heal spontaneously. Small perforations may remain asymptomatic, but permanent closure is possible with surgery.
2-) Is septal perforation surgery difficult?
Difficulty depends on the size and location of the perforation, previous surgeries, and tissue quality. Large and anteriorly located perforations are technically more difficult.
3-) Can perforations due to cocaine use be closed?
Yes, they can be closed. However, since tissue quality is impaired, surgery must be planned more carefully. Success rates are higher in cocaine patients who have not had surgery.
4-) What should be considered after surgery?
Regular saline irrigations, moisturizing sprays, not drying the inside of the nose, and avoiding trauma are of critical importance in the healing process.
5-) What is the success rate in septum perforation surgery?
With an experienced surgeon and correct technique, the success rate can exceed 90%.
