Septal Perforation Repair

Septal Perforation Repair
21
Jul

Septal perforation repair is a surgical procedure aimed at closing holes that have formed in the nasal septum. This condition may lead to difficulty breathing, nosebleeds, and noisy breathing. Repair surgery significantly improves the patient’s quality of life and respiratory functions.

The size and location of the perforation determine the surgical approach. Local flaps are used for small perforations, while larger holes may be repaired with cartilage or mucosal grafts. Selecting the appropriate technique is the most important factor for successful closure.

Regular moisturization and protective care are integral parts of treatment after septal perforation repair. Preventing dryness inside the nose during the postoperative period accelerates wound healing and reduces the risk of complications.

Untreated septal perforations may enlarge over time and lead to more serious respiratory problems. Therefore, early intervention is critically important for preventing permanent functional loss. Surgical repair should be planned under the supervision of a specialist physician.

Causes of Perforation Septal perforation may occur due to nasal surgeries, trauma, prolonged use of nasal sprays, infections, or autoimmune diseases.
Purpose of the Surgery The surgery aims to repair the septal perforation, improve airflow inside the nose, and reduce symptoms such as dryness and crusting. It also aims to preserve the aesthetic appearance.
Preoperative Preparation A detailed nasal examination is performed. If necessary, nasal endoscopy and imaging methods are used to determine the size and location of the perforation. Blood-thinning medications should be discontinued before surgery, and smoking should be stopped.
Repair Techniques Various surgical techniques may be applied depending on the size of the perforation. For small perforations, tissues are brought together and sutured, while larger perforations may be repaired with flaps taken from surrounding tissues. If necessary, cartilage grafts taken from the ear or rib are used.
Type of Anesthesia General anesthesia is preferred.
Postoperative Care Silicone splints or packing placed inside the nose after surgery are removed after approximately 1 week. Nasal dryness is prevented by using moisturizing nasal sprays and ointments.
Complications Complications such as infection, bleeding, recurrence of the perforation, or nasal obstruction may occur. Regular postoperative check-ups and intranasal care are important for minimizing these complications.
Healing Process The healing process may take approximately 4-6 weeks. During the first weeks, care should be taken to avoid impacts to the nose, strenuous exercise, and to follow the care instructions recommended by the doctor.
Alternative Treatments For small perforations, moisturizing nasal sprays and ointments may relieve symptoms. However, surgical repair is the most effective treatment option for large perforations.

What Is Septal Perforation?

Septal perforation is the formation of a hole in the septum, the wall that divides the nose into two. This condition may occur as a result of trauma, surgical interventions, infections, or the prolonged use of certain medications. If the perforation is small, it generally causes no symptoms; however, larger holes may lead to problems such as nasal obstruction, crusting, nosebleeds, or a whistling sound while breathing. Treatment may be medical or surgical depending on the cause and size of the hole.

What Is Septal Perforation Repair?

This treatment is a surgical procedure performed to close holes in the middle partition of the nose. This surgical intervention varies depending on various factors and requires a comprehensive evaluation process. During this process, the surgeon considers the patient’s general health condition and the characteristics of the septal defect.

How Is Septal Perforation Repair Performed?

Septal perforation repair is a complex surgical procedure performed to treat holes in the nasal septum. This procedure is personalized according to the location and size of the hole. Surgical techniques and the methods applied during the procedure are of great importance. First, during the preparation stage, local anesthetic solutions are applied to the nasal septum and floor to control bleeding. The damaged area is then accessed through various incisions, and the necessary repair procedures are performed. The success of the procedure depends on selecting the correct techniques and the surgeon’s experience.

Endoscopic Extended AEA (The Anterior Ethmoidal Artery) Flap Technique:

  • Incisions: Incisions are made beginning at the sphenoid rostrum and continuing to the level of the middle turbinate.
  • Flap Creation: A flap consisting of anterior and posterior incisions connected by lateral incisions is prepared.
  • Closure: The flap is sutured to the septal mucosa to cover the perforation.

Posterior Septal Artery Flap Technique:

  • Incision and Elevation: The mucosa is elevated through incisions around the perforation.
  • Closure: The elevated mucosa is rotated to the opposite side of the nasal cavity and sutured.

Interposition Grafting:

  • Approach: Acellular dermal grafts are placed between the mucoperichondrial flaps.
  • Procedure: After the grafts are placed, the flaps are sutured together.

Layered Repair Techniques:

  • Approach: Two pedicled mucoperichondrial flaps are advanced.
  • Procedure: The defect between the flaps is sutured.

Who Are Suitable Candidates for Septal Perforation Repair?

Determining suitable candidates for septal perforation repair is based on various criteria. First, symptomatic patients may benefit from surgical repair. These include:

  • Recurrent nosebleeds
  • Persistent nasal obstruction
  • Crusting and infections
  • A whistling sound while breathing

These symptoms generally reduce the patient’s daily quality of life and may require surgical intervention. Second, the size and location of the perforation are important. Medium to large septal perforations generally benefit from repair. On the other hand, smaller perforations may be managed with conservative methods if the symptoms do not cause significant discomfort. Third, unsuccessful conservative treatments may lead to the decision to proceed with surgery. If methods such as saline irrigation or ointments are insufficient, surgery may be considered.

Fourth, healthy nasal tissue is essential. Having sufficient mucosal tissue for surgical repair facilitates flap creation. Fifth, the success of septal repair is higher in individuals who do not smoke and do not have diabetes. Smoking and diabetes impair blood flow and negatively affect the healing process. Finally, individuals without autoimmune diseases are more suitable candidates. Active autoimmune conditions may complicate healing, and surgery should be postponed until the condition is under control.

What Surgical Techniques Are Used in Septal Perforation Repair?

Various surgical techniques are used in septal perforation repair. The size and location of the perforation determine the selected method.

  • Bilateral mucosal flap closure technique; in this procedure, mucosal flaps are elevated from both sides of the septum, advanced, and sutured. An interposition graft is used to support the repair, and the area is stabilized with silicone sheeting.
  • Large holes are effectively closed with a posterior septal artery flap. The flap is a vascularized structure and is incised and separated from the mucoperichondrium before being sutured.
  • The racquet-ring technique is a variation of the greater palatine artery flap method. A racquet-shaped flap larger than the perforation is cut, the mucoperichondrial flap is rotated and sutured. Support is provided with silicone splints.
  • The extended anterior ethmoidal artery flap is preferred for endoscopic repairs. In this method, a flap extending from the sphenoid rostrum mucosa is advanced to cover the perforation.
  • The sandwich graft technique is used for medium and large holes. An autologous tissue graft is placed between two mucosal advancement flaps. This structure restores septal integrity while reducing the risk of recurrence.
  • The reverse-edge technique involves making a fringed incision around the perforation and removing the mucoperichondrium. This allows the perforation to be closed completely or partially, and closure is performed using the mucosa from the opposite side.

What Is the Healing Process Like After Septal Perforation Repair?

The healing process after septal perforation repair requires various stages and careful care. Patients are kept under observation immediately after the operation, during which emergencies are rapidly detected and treated. Absorbent packing used to support the nasal septum remains in place for several days to control bleeding. External silicone splints are left in place for approximately 15 days.

Postoperative Care:

  • Remaining under observation in the hospital
  • Use of absorbent packing
  • Placement of silicone splints

Antibiotics are administered after the operation to reduce the risk of infection. Pain management is important to ensure that the patient has a comfortable healing process. Regular saline irrigation keeps the nasal passages moist and prevents crusting.

Medication Use:

  • Antibiotic treatment
  • Painkillers
  • Saline irrigation

Patients need to meet with their surgeons regularly. During these visits, any remaining packing or splints are removed, and the condition of the repair is evaluated through an endoscopic examination. Physical activity restrictions are important during the healing process to prevent damage to the septum. Patients should avoid strenuous activities, heavy lifting, and bending over. Blowing the nose is generally restricted, and sneezing should be done with the mouth open.

Activity Restrictions and Nasal Care:

  • Restriction of physical activities
  • Restriction on blowing the nose
  • Keeping the mouth open while sneezing

What Should Be Considered After Septal Perforation Repair?

Care after septal perforation repair is critically important for accelerating the patient’s recovery and preventing possible complications. Some important points to consider during the postoperative period are as follows:

Nasal Hygiene and Moisturization:

  • It is essential to keep the nasal passages continuously moist. For this purpose, nasal sprays and ointments must be used. These applications prevent crusting and facilitate the healing process.

Splint and Packing Management:

  • Nasal splints are generally removed within 10-15 days.
  • The use of nasal packing may be preferred in certain special cases to prevent tissue damage caused by pressure on the repaired area.

Antibiotics and Pain Management:

  • Prophylactic antibiotics may be prescribed to reduce the risk of infection.
  • Pain management is provided with nonsteroidal anti-inflammatory drugs or paracetamol depending on the patient’s condition.

Long-Term Postoperative Care:

  • Regular follow-up appointments should be scheduled with the surgeon to monitor the healing process.
  • These appointments are extremely important for the early diagnosis and treatment of any complications.

Activity Restrictions:

  • Patients should avoid strenuous activities that may affect the repair.
  • Strenuous sports and actions that may increase pressure inside the nose should be avoided.

Avoiding Irritants:

  • Smoke, dust, and chemicals should be avoided to support healing and prevent inflammation.

Management of Underlying Conditions:

  • Managing the underlying causes that led to septal perforation is vital for preventing revision surgery.

What Are the Risks and Complications of Septal Perforation Repair?

Septal perforation repair is a process involving various risks and complications. One of the most common complications is the recurrence of the hole. This condition generally results from an inadequate healing process. Another factor that makes healing difficult is insufficient blood flow to the surgical area.

  • Infection: Postoperative infections may complicate healing and impair the repair.
  • Bleeding: Bleeding both during and after the surgical procedure may be a serious concern, especially if blood loss is extensive.
  • Nasal Obstruction: After repair, some patients may experience obstruction due to swelling and scar tissue that block nasal airflow.
  • Crusting and Dryness: Crusting and dryness inside the nose are common after surgery. This condition results from altered physiology and the healing process.
  • Changes in the Sense of Smell: Anosmia or hyposmia are changes in the sense of smell that may occur after surgery.
  • Septal Deviation: Surgical techniques and the healing process may sometimes lead to incorrect positioning of the septum.
  • Graft Rejection: The graft materials used carry a risk of rejection or extrusion. This condition may compromise the integrity of the repair.
  • Adhesions and Synechiae: Adhesions caused by scar tissue may form between the nasal walls after surgery.
  • Aesthetic Deformities: Changes in the nasal structure after surgery may cause aesthetic problems.
  • Persistent Symptoms: Even if an anatomically successful repair is achieved, some patients may continue to experience troublesome symptoms such as crusting or dryness.

Frequently Asked Questions

Septal perforation repair is a treatment option that may be considered when the hole in the nasal septum causes complaints such as difficulty breathing, crusting, frequent bleeding, a whistling sound, or chronic dryness.
Dryness inside the nose, recurrent bleeding, noisy breathing, and a sensation of obstruction may occur. These symptoms may increase over time and negatively affect sleep quality, comfort, and daily activities.
Nasal surgeries, trauma, chronic infections, the prolonged use of certain medications, and exposure to harmful substances may lead to septal perforation. Certain systemic diseases may also create a risk.
An ear, nose, and throat examination, endoscopic evaluation, and imaging methods when necessary may be used. The size and location of the perforation and the condition of the surrounding tissues are important in treatment planning.
During the surgical procedure, the perforated area is closed using specialized techniques, and support is provided with the patient’s own tissues when necessary. The aim is to restore the integrity of the nasal septum.
The diameter and location of the perforation, the health of the surrounding tissues, smoking, and the patient’s general health condition may affect success. The surgical success rate may generally be higher for small perforations.
The healing time may vary according to the surgical technique applied and the size of the perforation. While noticeable improvement is seen in most patients during the first weeks, the complete healing process may continue for several months.
Keeping the inside of the nose moist, using the care products recommended by the doctor, and avoiding trauma are important. Regular check-ups also contribute to the healthy progression of the healing process.
In some patients, the perforation may reopen. Smoking, infections, trauma, and failure to follow care recommendations may increase this risk. Regular follow-up helps prevent complications.
After a successful repair, airflow inside the nose becomes more regular in many patients. Bleeding, crusting, and discomfort while breathing may decrease, thereby improving quality of life.
Updated Date: July 21, 2026

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