Deviated Septum PrNew Jersey
A Septal Perforation can be a very troublesome problem to have, and usually results in significant distress to patients. It is a full thickness hole in the nasal septum, affecting all three layers of the septum. Typically patients will complain of trouble breathing through their nose, pain, excessive crusting, noisy breathing (whistling) and bleeding. In more severe septal perforations, the septal hole can cause a saddle nose deformity, or sinking of the bridge of the nose, causing it to appear flat and smaller than normal. The cause in most cases is rather straight forward, as most are caused by having previous nasal surgery. In other instances, they are caused by using topical medications and drugs. Lastly, and more rarely, connective tissue diseases such as Wegener’s Granulomatosis, and Lupus can cause them. Prior to any correction of your septal perforation, it is important that you discuss the cause of your septal perforation, as it has implications in your care.
Dr. Undavia is one of a small number of facial plastic surgeons in the country that has the unique expertise in closing septal perforations. His fellowship with Dr. Kridel at the University of Texas Health Sciences Center in Houston focused heavily on rhinoplasty, revision rhinoplasty nasal reconstruction and septal perforation closure. Dr. Undavia has coauthored scientific papers and book chapters which detail septal perforations and discuss techniques to close them.
During your consultation with Dr. Undavia, it is very important to discuss the cause of the septal perforation, as untreated causes can often result the recurrence of perforations following surgery. Because a septal perforation can result in a cosmetic deformity of the nose at times, computer imaging might be used to show you realistic goals for surgery. Other procedures may be combined during the closure of the septal perforation.
Surgery is performed under general anesthesia, and is performed on an outpatient basis. A small hidden incision is made on the skin between the nostrils, while all the remaining incisions are done inside the nose. Intranasal flaps are raised above and below the septal perforation. Each layer is closed individually, and a graft is placed between the nasal lining to help strengthen the closure. Not all perforations can be closed intraoperatively, so this graft has a very important role in further increasing the likelihood of closure. Soft silastic splints are then used to protect the closure, and left in place for a short period until the closure heals.
After surgery, pain typically is not a problem. Most patients are tired from anesthesia, and there is some discomfort. Patients are ready to return back to work (depending on what the activities of work are) or school within one week. Much of the swelling comes down within a few weeks. The nose will continue to improve everyday. The soft splints remain inside the nose for at least one week to help protect the closure. You will be able to breathe well through your nose, although there is some congestion. This will likely still be better than your preoperative breathing status. Light exercise can be initiated around 3 weeks (no heavy lifting or impact exercise). Dr. Undavia will schedule visits for you at one day after surgery, and then every week for a period of a few weeks to help clean your nose clean and to check on the closure. Regular cleaning of the nose helps you breathe better while you are healing and prevents scar bands from forming inside your nose during the healing period.