NOSE RECONSTRUCTION SURGERY

Septal Perforation Repair

PROCEDURE

What is Septal Perforation Repair?

A septal perforation is the formation of a hole in the nasal septum, the wall of cartilage and bone that separates the two nasal passages or nostrils. Some temporary, non-surgical treatments can help, but it cannot be closed without surgery.

Although the hole is rarely visible, it can cause other issues, such as whistling, bleeding, crusting, and nasal blockages. It can also induce changes to the external appearance of the nose.

A perforated septum can be caused by injuries to the nose or from nose picking. Nasal surgical procedures, nasal intubation or aggressive cautery for recurrent nosebleeds carry the risk of septal perforation. It can be a rare complication of certain autoimmune diseases or health conditions. Recreational use of cocaine can also cause perforations.

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Treatments for septal perforation

In many instances, a hole in the septum will cause no problems and requires no intervention. If it is causing issues, Mr Annakan Navaratnam can offer certain non-surgical treatments to manage the condition, including saline solutions and lubricating gels to hydrate and clean the nose.

Another option for septal perforation management is a septal button, temporarily filling the hole and reducing symptoms.

Surgical repair may be advised if these non-surgical treatments fail to manage the symptoms. Mr Navaratnam is a highly skilled ENT & Facial Plastic Surgeon specialising in nasal reconstruction and repair.

Mr Navaratnam may employ several surgical techniques to close the hole. Under a general anaesthetic, he may use tissue from the nose for smaller holes. For larger perforations, tissue transplanted from another part of your body is used to either stitch in the hole or to create a flap.

At a glance

Surgery time

1 – 3 hours

Anaesthetic

General

Time off work

2 weeks

Hospital stay

Day Case

Shower

After 1 day

Reasonable mobility

After 2 days

Exercise

After 6 weeks

Sleeping on back

4 weeks

Full recovery

6 – 8 weeks

Driving

2 weeks

ENT SPECIALIST

Mr Annakan Navaratnam

Annakan Navaratnam is a Consultant Ear, Nose & Throat (ENT) Surgeon whose private practice is based at Harrow and Welbeck Hospital in Central London and The Clementine Churchill Hospital in Harrow. In his NHS practice, he works at Royal National ENT Hospital, University College London Hospital (UCLH) and is an honorary consultant at Great Ormond Street Hospital.

He has a subspecialty interest in rhinology and facial plastic surgery, with particular expertise in septorhinoplasty and nose reshaping.

Annakan is excellently placed to manage general adult and paediatric ENT presentations and, in particular, is able to assess and treat complex problems related to the form and function of the nose. This includes endonasal (scarless) rhinoplasty, revision septorhinoplasty, as well as advanced endoscopic sinus surgery.

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What to expect

Here you will find some essential information to help you prepare for surgery and the arrangements you should make to ensure you have the support you need and that everything runs smoothly on the day. However, we are on hand to answer any questions you may have.

01. The consultation

The first stage is always a comprehensive consultation and pre-operative assessment with your surgeon Mr Annakan Navaratnam.

During the consultation, he will listen carefully to your concerns and desired outcomes, and recommend whether surgery is appropriate at this time. The potential risks, post-surgery expectations, and recovery details of the specific procedure will also be discussed. A detailed medical history will be obtained to ensure your fitness for surgery.

Examination of the nose will be performed during the consultation to assess the nasal structures and to evaluate for any presence of nasal disease. This will often involve a procedure called nasoendoscopy to examine the underlying nasal anatomy.

Something investigations in the form of imaging such as a CT scan may be required as part of the assessment to help guide treatment.

A two-week reflection period follows the initial consultation, during which you can return for additional consultations free of charge.

02. Preparing for surgery

If you decide to proceed, you’ll receive guidance on preparing for surgery. Pre-surgery tests may be required. Mr Navaratnam will advise you on stopping smoking as far in advance of surgery as possible due to its impact on healing, infection risks, and complications during anaesthesia. Guidance on discontinuing blood-thinning medication and fasting before surgery will be provided.

03. Day of the procedure

Upon arrival at hospital, you’ll be escorted to a private room, and vital signs will be assessed. Your surgeon will finalise markings, and the anaesthetist will visit you. Clinical photography will document the pre-op and post-op phases.

The procedure is performed under general anaesthesia, followed by recovery in a specialist recovery room. Surgery can be performed as a day case so once you have recovered sufficiently you will be discharged into the care of a friend or family member.

04. Your recovery

Post-surgery pain varies for each individual, but most patients find it minimal and can be managed with over-the-counter painkillers. It typically subsides within the first week or so along with any bruising.

A comprehensive recovery guide, including follow-up appointment dates. Our team will be on hand if you have any concerns.

Frequently asked questions

What causes a septal perforation?

The most common causes are previous nasal surgery, nasal trauma, or repeated nose picking. Less commonly, perforations can result from aggressive cautery for nosebleeds, certain autoimmune or inflammatory conditions, overuse of some nasal sprays, or recreational drug use such as cocaine.

What does a septal perforation feel or sound like?

Many people first notice a whistling sound when breathing through the nose, particularly with smaller holes near the front of the septum. Other symptoms can include crusting, nosebleeds, a feeling of nasal blockage, or a dry, uncomfortable sensation inside the nose.

Can a septal perforation heal on its own?

A septal perforation will not close by itself, as the tissue on either side of the hole cannot regenerate to bridge the gap. Some smaller perforations cause no noticeable symptoms and don’t need active treatment, but the hole itself remains unless managed with a surgical repair.

Is a septal perforation serious?

Most septal perforations are not dangerous, but left untreated, larger or worsening perforations can occasionally lead to changes in the external shape of the nose, such as a saddle-nose deformity. Any new or worsening nasal symptoms are worth having assessed, particularly if bleeding, crusting, or a whistling sound develops.

Am I a suitable candidate for septal perforation repair?

Septal perforations often do not cause symptoms, but some can be very painful or result in whistling, nasal crusting, bleeding, scabbing, and airway obstruction. A larger, long-term perforation may also result in a saddle-shaped deformity, requiring surgery to correct these problems.

If you have a nasal perforation causing these symptoms and any underlying causes have been ruled out or treated then you could consider a septal perforation repair to alleviate your symptoms.

How is a septal perforation diagnosed?

Mr Navaratnam will examine the inside of your nose, usually with a nasoendoscopy, to assess the size, position, and edges of the perforation. This examination also helps rule out any underlying cause that may need to be addressed before repair is considered.

What is a septal button and how does it work?

A septal button is a small silicone device fitted into the perforation to plug the hole without surgery. It can reduce whistling, crusting, and bleeding, and is often used as a first step for patients who are not ready for, or not suitable for, surgical repair.

What is the downtime after septal perforation repair?

After surgery, it can take two to three weeks for the repair to heal, and you will need to rinse your nose with saline several times a day. Internal splints may be placed in the nose for the first week for proper healing. You will be advised to avoid blowing your nose and strenuous exercise for this period.

What are the risks associated with septal perforation repair surgery?

There are risks associated with a general anaesthetic. Bleeding and infection can occur after any surgical procedure. Sometimes, the perforation may reopen, and you may need further surgery. You must avoid any nose picking or recreational drugs after surgery to prevent failure of the repair or re-perforation of the septum.

How successful is septal perforation repair surgery?

The success of the surgery generally depends on the extent of the perforation. Quitting smoking is critical as it reduces blood supply to the septum. Medical conditions such as diabetes can also increase the chance of failure. A specially trained otolaryngologist or ENT surgeon has the necessary skill and experience to perform this challenging procedure.