New York, NY | Septal Perforation | Lee Ann M. Klausner, MD, FACS
A septal perforation is a hole in the nasal septum. The nasal septum is the room divider for the nose so it separates the uh nose into two nasal passages. Symptoms of septal perforation can include nasal obstruction, dryness, irritation, crust accumulation, bleeding, whistling and it gives a patient the sensation that they cannot breathe in the air. There are multiple causes of septal perforations. Commonly what we see are patients who have abused cocaine. Other causes included chronic nasal picking. As a complication of nasal septal surgery, a perforation can be caused. A septal perforation cannot heal itself and the reason for that is that once the hole is made there is an absence of tissue. The mucosal cells will travel through the hole and form a bond with the other side of the septum thereby leaving the hole open so the only solution is to physically close the hole if the hole is not too big. Non-surgical options include irrigation and cleaning but this is a daily routine that is required which can be cumbersome for patients and time-consuming and difficult. Other treatments that are non-surgical involve the placement of a button that will physically block the hole however it is not always the most positive approach to uh dealing with a perforation because of that fact that there are still problems with keeping the area clean and there is a risk of infection and there is the risk of making the perforation bigger. In preparing a patient for septal perforation repair uh there are so many things that need to be discussed. One major issue is if they’ve had any problems with addiction they have to be in a place where they are not using anymore and the risk of them uh using again in the future is uh close to none. So, there’s that level of commitment and recovery from their addiction that’s essential. Another very common thing in many of the patients are smokers and uh they absolutely cannot smoke, they cannot be exposed to second-hand smoke for many months before and after the procedure so these are very honest conversations that I have to have with patients to ensure that they are in a place where they uh can have the most successful outcome. The ability to close septal perforations is a highly specialized uh technique and I was fortunate enough to have the opportunity in fellowship to work with someone who is probably one of the best in the world. It’s my surgical training that has enabled me to be able to execute the operation. The greatest satisfaction I have in managing and uh performing this operation is the impact it has on patients' lives.