Before Septal Perforation Surgery
Before deciding to have septal perforation surgery there are a number of things you will need to do.
First and foremost, you will need to select a board certified facial plastic surgeon specializing in procedures of the nose. Your surgeon will assess your overall health and perform an examination of your nose to determine if you have a septal perforation as well as the cause and the best course of treatment; septal perforation surgery may or may not be the best option. The surgeon will also need to establish whether or not you are a good candidate for septal perforation surgery. Finally, if you are deemed a good candidate for surgery, there are a number of steps you will need to take to prepare for your surgery.
What Causes Septal Perforations?
The septum is the nasal structure located between the right and left nasal cavities. It is comprised of bone, cartilage and two mucous membrane layers on either side. A septal perforation is a hole in this structure.
There are a number of potential causes of septal perforations, including the following:
- Nasal fracture or other trauma
- Inhalation of drugs such as cocaine
- Inhalation of harmful chemicals (e.g., sulfuric acid)
- Previous nasal surgery
- Inflammation and/or infections
- Diseases such as cancer, syphilis, tuberculosis or Wegner granulomatosis
- Excessive, prolonged use of nasal steroid sprays
The inhalation of chemicals and drugs can cause septal perforations by leading to vasoconstriction, or narrowing of the blood vessels. This, in turn, restricts the supply of blood to the cartilage and membranes (tissue ischemia) of the septum. The reduced blood supply can cause tissue loss in the cartilage and membranes, in turn leading to a perforation.
Septal perforation symptoms can be functional or cosmetic. Functional symptoms are different from patient to patient, depending on the size of the perforation. However, generally speaking they include bleeding, infection, crusting, runny nose and a whistling sound when breathing. The main cosmetic symptom of septal perforation is a saddle nose deformity, which forms as a result of a collapse of the cartilage in the nasal bridge.
Do You Need Septal Perforation Surgery?
If you have a septal perforation you may or may not need surgery. The first line of treatment is medical management, not surgery. The goal of medical management is to create a moist environment inside the nose using saline sprays, gels, and over-the-counter ointments aimed at halting the growth of bacteria. In some cases the surgeon may recommend placing a plastic prosthesis called a septal “button,” although for many patients this proves ineffective or too bothersome.
If none of these measures are effective, you may need septal perforation surgery. However, it is important to note that septal perforation repair surgery has a failure rate of 40 to 60 percent. In other words, it is the last resort, and should only be performed after medical management has proved ineffective.
Who Is a Candidate?
Before being cleared for surgery, you will need to speak with a nasal surgery specialist to determine whether or not you are eligible for septal perforation surgery. It is extremely important that you have realistic expectations of the outcome, as septal perforation surgery is a highly complicated procedure.
As with any surgery, good candidates for septal perforation surgery are in good health. It is imperative that you inform your surgeon of any and all health conditions, because certain conditions, such as diabetes, may preclude you from having this surgery.
Patients with smaller perforations generally have better success with surgery. Because it is very difficult to establish proper blood flow to the treated area, patients with large perforations are often poor candidates for surgery.
Preparing for Surgery
It is very important that you properly prepare for your surgery, taking healthy measures, as septal perforation repair is a very complex, invasive procedure. It’s a good idea to read up on what a surgeon can and cannot accomplish with this procedure. Also read about the potential risks and the recovery process.
One of the most important healthy steps you can take prior to your surgery is to avoid smoking. Smoking can have devastating effects not just on your health as a whole but specifically to your healing after surgery. Smokers are not good candidates for septal perforation surgery — or any other plastic surgery, for that matter.
Before going to your preoperative consultation, collect any medications, over-the-counter products and supplements you take so that you can show your doctor, just in case any of them need to be avoided in the weeks before your surgery. For example, anti-inflammatories, aspirin and herbal supplements can cause bleeding, and therefore must be avoided.
At your consultation your surgeon will provide you with preoperative instructions. For example, you will need to avoid nose picking and must remove any nasal piercings. It is important that you follow the preoperative instructions closely.
The surgeon will also provide you with a list of things you will need to purchase in preparation for your recovery, and may ask you to undergo lab tests and/or further medical evaluations.
Make sure to arrange for friends and family members to assist you during your recovery from surgery.