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Beverly Hills Profiles Blog

What are the risks of a septal perforation if it’s left untreated?

Wednesday, March 12th, 2014

If you have been told that you have a septal perforation, it is best to have it evaluated and treated as soon as possible even if you are asymptomatic. Although some people may not feel discomfort by a small septal perforation, it is important to understand that a septal perforation—even if seemingly minor—can pose risks. Leaving a septal perforation unmonitored and untreated increases the chances of it enlarging and potentially causing more serious complications.

Understanding a septal perforation. A septal perforation is a hole that has developed in the partition that separates your nasal passages (know as the septum). The septum consists of three layers, a middle layer of cartilage and bone sandwiched between a lining surface on either side. If a septal perforation is detected, it means that all three layers of the septum—the outermost layers (the nasal lining, consisting of mucosa on both sides) and the inner layer (cartilage and/or bone) have been punctured through. The result is an open hole or communication between the two nasal passages.

The risks of not seeking treatment. When medical care is not sought, a person with a septal perforation may develop:

  • A chronic cycle of nasal irritation. Unfortunately, when a hole exists, the septum tissue cannot patch itself or heal over. In effect, the cartilage and bone have permanently disappeared. A perforation makes the septum more fragile and susceptible to breakdown. If the hole gets larger, it can create significant discomfort including excessive dryness, crusting, obstructed breathing, bleeding and chronic infections. Moreover, symptoms can be cyclical: dryness leads to crusting, the crusting leads to blocked nasal passage and bleeding, which can lead to chronic infections. When the crust is cleared, the whole cycle will often repeat itself. Repeated cycles of crusting and bleeding along the edges of the perforation can erode the lining tissue and residual cartilage along the edges of the perforation, allowing it to enlarge.
  • Heightened problems with airflow. When there is a septal perforation present, nasal airflow is compromised with airflow traveling abnormally through the perforation. When a perforation is very small, this abnormal airflow may cause the nose to whistle when breathing. When a perforation is larger, crusts can develop that can cause nasal obstruction.
  • Complications that are difficult to resolve, even with skilled surgery. Surgery for a perforated septum at any stage is complex, requiring advance surgical skill by highly trained specialists. This is because all three layers of the perforation must be closed in order to maximize chances for a complete, successful closure. Small perforations less than 1cm in diameter have a nearly 100% closure rate in our practice. When the hole has enlarged far beyond that, it becomes more challenging to treat. This is because there can sometimes be a shortage of available lining tissue with enough redundancy to allow for full closure of the hole. Despite this challenge, we have had great success in closing larger perforations.
  • Bridge collapse. A septal perforation that is sufficiently large or high up in the nose can result in a complete loss of structure, causing the bridge of the nose to collapse, known as a saddle nose deformity. In cases like these where the perforation is too large to allow for closure, we focus on reconstructing a stable, well supported nose that will not collapse over time.

There are different options available to treat a septal perforation, depending on the location and severity. A septum that has been damaged to the point of tissue erosion is a cause for concern. Not only is it more likely to worsen, it is more likely to be more difficult to address. Therefore, to minimize risks and maximize chances for a successful outcome, it is advised that treatment is sought early.

As one of the few offices in the United States to treat septal perforations, Profiles Beverly Hills stands out as a leader in the evaluation and care of even the most difficult septal perforation cases. Nose surgery specialists Drs. Solieman and Litner are nationally-known experts in the treatment of septal perforations. Both have undergone highly specialized training and have expertise in the advanced techniques required to perform septal repair surgery. Visit us now to see how Drs. Solieman and Litner have successfully helped patients suffering from septal perforations regain a favorable nasal appearance and function! If you are suffering from nasal infection unrelated to septal perforation, we recommend contacting the ENT experts at eos sinus, who specialize in nasal and sinus disorders.  Contact their San Francisco or San Jose offices to schedule an appointment.

Come in for a Consultation with Drs. Solieman and Litner

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(310) 276-6800 or click here.

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