Perforated septum repair (septal perforation) in Turkey

Symptoms follow size and position. A small hole at the front whistles and dries. A larger hole crusts, bleeds when the crusts come off, and disturbs airflow so the nose feels blocked despite the extra opening. A very large or long-standing hole can weaken the bridge and let it sink, a saddle nose, which then needs cartilage reconstruction as well as closure. Holes further back often cause nothing at all and are found by chance.

Not every perforation needs an operation. One that causes no symptoms is usually left alone and watched. Mild crusting and dryness are managed with saline rinses, ointment and humidified air, which many people find enough. A silicone septal button that plugs the hole from both sides is an option for people who are not fit for surgery, are still using the drug that caused it, or have a hole too large to close. Repair is for symptomatic perforations in a nose whose cause has been removed.

• Small or medium hole, symptoms, cause stopped

  The case repair suits. Closure with lining flaps and a graft is realistic, and the symptoms it treats are whistling, crusting and bleeding.

• Large hole

  Closure becomes uncertain and may need an open approach and a rib cartilage or fascia graft. Some large holes are better managed with a button than with a failed repair.

• Cause still active

  Ongoing drug use, uncontrolled autoimmune disease or continued spray use. No repair until it stops, and for drugs a long confirmed gap first.

• Saddle nose or previous failed repair

  A combined reconstruction with cartilage for the bridge and lining for the hole, in experienced hands only, often through an open approach.

A crooked septum without a hole is a different operation, described under septoplasty. If the bridge has sunk or the nose has changed shape, closure may be combined with rhinoplasty, and a perforation after earlier nose surgery is often dealt with as part of revision rhinoplasty.

1. 1

   Assessment

   Endoscopic examination, measurement of the hole, examination of the lining, and the cause: surgical history, sprays, drugs, piercing, injury. Blood tests and sometimes a biopsy if autoimmune disease or infection is possible.
2. 2

   Preparation

   Sprays stopped, drug abstinence confirmed over months where relevant, autoimmune disease controlled, crusting treated with saline and ointment so the lining is as healthy as it can be on the day.
3. 3

   Anaesthesia and approach

   General anaesthesia. Through the nostrils for small holes; an open approach for larger ones or when the bridge also needs work.
4. 4

   Closure

   Lining flaps raised from both sides and advanced over the hole; a graft placed between them; flaps stitched. Cartilage reconstruction of the bridge in the same operation if needed.
5. 5

   Splints and early recovery

   Splints inside the nose for a period, no nose blowing, saline rinses, antibiotic ointment. Blocked nose and crusting are expected while the lining heals.
6. 6

   Result

   The lining heals over months. Closure is confirmed by endoscopy, and a repair that has held at several months is likely to last. A repair that fails usually shows early, as the flap edges separate.

• Anyone still using the drug or spray that caused it. The repair will fail. Stop first, for a long confirmed period, then plan.
• Anyone with an undiagnosed cause. A perforation with no obvious explanation needs investigation for autoimmune disease before anyone operates on it.
• Anyone with no symptoms. A hole that causes nothing is watched, not repaired.
• Anyone with a very large hole and no appetite for uncertainty. A septal button may serve better than a repair that is unlikely to hold.
• Anyone who cannot attend endoscopic follow-up. Closure is confirmed by looking, at weeks and months, and early failure needs early attention.

• Size and position of the hole. Small anterior holes are shorter operations; large holes mean more dissection, more graft and often an open approach.
• Graft type and donor site. Fascia or septal cartilage from the same field costs less than rib cartilage, which adds a second operative site.
• Combined reconstruction. Rebuilding a sunken bridge or combining with rhinoplasty adds time and material.
• Hospital and anaesthesia. General anaesthesia and a night in hospital for larger repairs.
• Follow-up included. Splint removal, endoscopic checks before you fly and any remote review afterwards.
• Revision policy. Failure is a known outcome. Ask what is covered and for how long.

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