The nasal septum refers to the thin structure of cartilage and bone that divides the right and left nasal cavities. It plays a critical role in both the appearance and functionality of the nose. While the septum helps to define the nasal tip and serves as a support for the structure of the mid-nose, it also contains sensory tissues that allows for optimal smelling function. When this important nasal structure suffers damage or perforation, it can cause distortion in how the nose looks as well as impact how a patient smells and breathes. To correct this, Dr. Ransom proudly offers septoplasty as part of our comprehensive menu of plastic and reconstructive surgeries for the nose. Septoplasty is the surgical modification of the structure of the nasal septum, which often involves straightening it, repairing a fracture or removing spurs (tissue blocking the nasal passage).
What Causes Septal Perforation?
A hole in the septum, or perforation, can occur from several different factors, including external nasal trauma in which the nose may not actually be broken. This occurs when a patient develops a septal hematoma (collection of blood within the septum) after the injury. If left untreated, the hematoma may cause the septum to perforate or collapse. A collapsed nasal septum often produces a saddle nose deformity that can have lasting consequences. Complications from a prior nasal surgery (rhinoplasty, septoplasty or sinus procedure) can also result in a delayed development of septal perforation. Lastly, some patients suffer from septal damage from chronic use of nasally inhaled medications and certain illicit drugs.
Repairing A Damaged or Perforated Nasal Septum
Septal perforations can result in a sensation of nasal obstruction, chronic nosebleeds (epistaxis), recurrent infections and an audible sound during normal breathing. While surgical repair can be challenging, Dr. Ransom is considered an elite rhinoplasty surgeon who uses special surgical techniques to maintain a high success rate with this type of procedure. To fill in the hole within the septum and promote healing of the surrounding nasal tissue, Dr. Ransom uses a multi-layered repair. This includes a layer of a patient’s own connective tissue (fascia) to rebuild each side of the septum, as well as a central layer that is more rigid and comprised of PDS flexible plate (Ethicon). This is a thin sheet of polydiaxonone, a material used in long-acting dissolvable suture. It is customizable in shape and size and considered highly effective for nasal septum repair. Depending on a patient’s unique needs, Dr. Ransom can perform septal perforation repair using an open or closed approach.
As a nose surgery specialist, Dr. Ransom offers the unique advantage of addressing both the internal and external concerns of the nose. While functional rhinoplasty is not considered a cosmetic surgery, Dr. Ransom can use a comprehensive approach to ensure that any desired or necessary cosmetic changes to the nose are added to a functional nasal surgery, including septal perforation repair. We realize the importance of helping patients feel confident in the appearance of their nose while also enabling them to breathe better.
What to Expect
When undergoing septal perforation repair, you will not be sent home with packing in the nose, which can significantly improve the recovery experience. Septal stents are used bilaterally to protect the repair and should remain in place for 7 to 10 days following your procedure. Patients can expect limited pain and occasional spotting, but any heavy bleeding should be reported promptly. It is also normal to feel tired for a couple days after surgery and adequate rest is important to your healing process.
For more questions about septal perforation repair at the San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery, please contact us today to schedule a consultation. Keep in mind that while many insurance providers will cover nasal surgeries that involve functional improvement to the nose, insurance does not pay for cosmetic changes. However, cosmetic alterations can be added to septal perforation repair. Dr. Ransom is in-network with most major PPO plans as well as Medicare. We are happy to answer your questions about your benefits or about the procedure itself.