septum is a wall that separates the left side of the nose from the right
side. You may have heard of a "deviated" septum, wherein
the septum doesn't sit exactly in the middle, between the two sides.
In that circumstance, the deviated septum can obstruct the free flow of
air through the nose, and a "septoplasty" operation can be
performed, to straighten the crooked or deviated septum.
septal perforation is a hole in the nasal septum. It can occur as a
result of previous nasal surgery, or as a result of a nasal fracture, and
there are many more causes as well. A septal perforation is often
thought of as resulting from cocaine use, but it takes a lot of
money worth of cocaine to cause a hole in the septum, and trauma or
previous surgery are much more common causes.
photograph below shows a septal perforation. We are looking into the
patient's right nostril. The Q-tip was placed into her left nostril,
but we can see the Q-tip through the hole in her septum.
septal perforation can cause several problems. The perforation, or hole, can collect
crusting (also known as boogers) along its rim. The edges of the
perforation can bleed. Air passing through the perforation can
whistle noticeably. Also, air passing through the perforation causes
an increase in air turbulence, which the patient perceives as
obstruction. The crusting can exacerbate the obstruction problem.
septal perforation can grow slowly over time. If it is close to the
bridge of the nose, the bridge may collapse, making the nose look as if
there were a dent along the bridge.
can complicate a rhinoplasty. For example, if a hump is removed from
the nose, after surgery there may be too little septal cartilage
supporting the bridge of the nose, and the bridge may collapse, causing a dent.
The two diagrams below represent a hypothetical hole in the septum that is
too close to the nasal profile after removal of a hump, and the resulting
collapse of the nasal bridge.
septal perforation can be closed surgically, but it is often a difficult
procedure. A skilled surgeon can routinely close a perforation that
is less than one-half inch in diameter, but perforations larger than that
size can be exceedingly difficult to close, and not every nose surgeon has
the technical dexterity to accomplish that task.
a perforation has been present for a long time without growing, and it
doesn't cause the patient any symptoms, and it's not of a size or position
to interfere with the rhinoplasty operation, it's okay to proceed with the
rhinoplasty without fixing the perforation. Otherwise, the
perforation should be closed before the rhinoplasty. But make sure
that the doctor who helps you with that decision is the doctor who can
close the perforation, not the doctor who will perform the
rhinoplasty. The rhinoplasty doctor could be motivated to perform
his operation, and let you deal with the consequences of the still-present
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