Its is very interesting how many ways surgeons choose to approach the repair of septal perforation. I find that this is a very difficult problem to fix and that patients must understand this fact. Like most things in health care and medicine, patients would like to believe that there is an easy remedy that can make their problem go away. However, when they think about the series of events or disease processes that have led them to have a septal perforation, they begin to realize that there is nothing easy about this situation.
Causes of Septal Perforation
Common causes of septal perforation include use of vasoconstrictive agents such as neosynephrine (Afrin), cocaine, and other, as well as trauma, Wegner’s granulomatosis, infection, and of course, previous surgery.
Understanding how one has acquired a septal perforation helps to understand how it can be fixed. Some of the causes for septal perforation in my practice have been – previous surgery – by far the most common. Surgeons will call me and tell me that they did a great operation, but somehow wound up with a septal perforation. I have cause septal perforations myself with septoplasty after trauma! It happens. However, the key is whether or not it is symptomatic and significant.
What can you do about a septal perforation?
The way I repair septal perforation today is VERY different then the way I repaired these 10 years ago. At this point, I am very clear that there needs to be a component of mucosal coverage and a mechanical barrier of cartilage and/or fascia. Nothing less than this will do the job. Thus, I am telling all of my patient that the odds of complete resolution of the SYMPTOMS of septal perforation are about 50%. Even though I know I will get the perforation closed, it may re-open and it could even be worse!