What is the nasal septum?

The nasal septum divides the nasal cavity into two sides.  It extends from the front of the nose all the way to the back.  Near the front, it is composed of cartilage, changing to bone about half way back.  The septum is lined by tissue on each side, called mucosa.  An intact septum, along with other structures inside the nasal cavity, is vital to channel airflow from the nostrils to the back of the nose and down into the lungs. 

What is a nasal septal perforation?

A septal perforation is a hole in the nasal septum.  This allows communication from one side of the nasal cavity to the other.  There are usually not any external signs of a septal perforation unless the hole is large enough to compromise the structural integrity of the nose, which is rather rare.

What causes a septal perforation?

The most common causes of septal perforation include previous surgery, trauma (including chronic nasal picking), cocaine use, and chronic use of nasal decongestants such as Afrin or Neosyneprhine.  Other less common causes include autoimmune diseases such as Wegeners Granulomatosis, Lupus, etc.

What are the symptoms of a septal perforation?

Common symptoms include crusting, bleeding, whistling, and nasal congestion.

Why does a septal perforation cause nasal congestion? This seems couterintuitive.

Airflow through the nasal cavity criss-crosses through the hole in the septum causing turbulence.  This actually ads drag to the air as it flows through the nose, causing the sensation of obstruction.

How is a septal perforation repaired?

Repairing a nasal septal perforation is a tedious, complicated surgery.   Typically an open rhinoplasty approach is used.  Tissue from above and below the perforation on each side is brough together and closed separately (bilateral double mucosal advancement flaps), and then a graft is placed between the repaired mucosal layers.  The graft can be composed of the patient's own tissue, such as temporalis fascia, mastoid periostium, and others.  More commonly, Dr. Bridges uses tissue bank material, called acellular dermis.  This is proven technique that avoids the need to harvest the patient's own tissue through other incisions that might risk scarring or infection. 

Why don't more surgeons perform this type of operation?

The repair of nasal septal perforations is ultra specialized, requiring very advanced knowledge of rhinoplasty techniques as well as tissue advancement and grafting.  Placing sutures deep in the nose is extrememely delicate and takes supreme concentration and patience.   Dr. Bridges trained with a world-renowned expert in rhinoplasty and septal perforations.  He has extensive experience and special interest in the repair of septal perforations.