Nasal septum is the three layered wall between left and right nasal channels. The pathological break of this wall is called a nasal septum perforation. This wall consists of two layers of nasal skin covering a stiff wall of cartilage and bone in the middle. Inner nasal skin which is called mucosa is a pink, soft, moisturized tissue with robust blood supply. This three layered structure is the primary defense mechanism against physical chemical and biological attacks to our respiratory system. This system is very resilient because of its high blood supply and regenerative capacity. But in case when all three layers of the septum is severely injured at the same level a communication between left and right passages occur. This troublesome situation is called nasal septal perforation. These holes do not close themselves and the problems that they cause do not dissolve without closing the holes. The treatment of this problem is surgery.
You would know better than anyone if you have this problem. Nose obstruction, crusting, bleeding, pain turns into a nightmare. The worst part of septal perforations is the difficulty of treatment. As the patient searches for treatment he or she is discouraged by the information received from the doctors. Many doctors are not willing to perform the operation (by good heart) and discourage the patient from having the operation by stating high levels of failure rates. Many patients quit searching for a cure and try to living with it. Years pass by in misery. Unfortunately closing of the perforation is the cornerstone of cure.
The main principle of this operation is it reconstructing a three layer septal wall just like the origin. This operation requires every high-level of expertise and surgical precision. We cannot directly suture the sides of the hole because mucosa do not stretch. Any mistake done at the operation causing a tiny gap at the healing site causes recurrence of the disease. During the healing process of mucosa, the cells do not know which way to go. Instead of following a linear growth on the same side, they tend to cross to the other side from a microscopic opening. Let me explain you what we do during a septal perforation operation. In order to close the perforation, we as surgeons have to carry ample amount of healthy vascularized mucosa from the adjacent septum. In plastic surgery this is called flaps. We start the operation by separating the layers of septum around perforation delicately. All tissue should be preserved. Actually the hole we see is the visible part of an iceberg. The tissue around the whole is usually very fragile. (Think about dividing two book leafs glued together.) After the separation which we name dissection, the tissues are rotated and advanced to the defect. We perform a delicate microsurgical suturing. In order to reconstruct the hard tissue in the middle of the septum I use ear cartilage and soft tissues of the patient.
Nose operations are the love of my life. Septal perforation reconstruction is the hardest operation that can be performed on the nose. I feel a huge satisfaction performing the hardest operation. Human nose is a very labile organ which tends to repeat its pathologies. “Doing the best operation I can” has been a lifetime journey invading my dreams. As I started having the results I want and my self-confidence increased I became very happy. About seven years ago I started giving full guarantee to my functional and aesthetic rhinoplasty operations. I take whole responsibility of the outcome of these operations pay for all expenses in case a revision is needed.
Septal perforation surgery is the last frontier for me. I believe most of my colleagues will agree with me that these are the hardest nose operations. For me years I did not have full confidence in me to take full responsibility off any outcome of the operation. After some years of complete healing of this problem I set a new challenge for myself. If I fail to close the perforation I payback all the money that charge.
I do not need to get such a grantee legally or morally. No doctor can be hold responsible as long as they perform the best possible treatment. On the other hand we are living in a Country where people have tight budgets. Other than giving to best medical possible treatment I feel it’s more suitable for my characters to be also take the whole economic responsibility.
I believe all these three problems should be addressed during the same operation. Many people who have a septal perforation also have occluded and crooked nose. All this problems are interconnected and solving one problem also solves the other.
The most common reason is trauma. The most common reason in the patients that apply to my clinic is previous surgery. Septal perforation happen in every 1% of functional or aesthetic nose surgery. Nose surgeries is hard to perform and complications may occur. Contrary to other operations the primary surgeon cannot be held responsible for correcting this problem. It is a very special field of interest. Corrective operations may make everything worse.
It must be understand that there are certain doctors who are interested in correcting septal perforation problems. I believe I can certainly close a septal perforation, that is why I sign a written contract promising a full money refund in case the perforation does not close or reoccur.
Other than previous operations, traumatic causes are nasal intubation, nose fractures, tears, foreign bodies, blood accumulation, continuous nose picking. Infectious reasons are tuberculosis, nose abscess, yeast infections, syphilis. The chemical causes are cocaine abuse, steroids and other local drugs, glass dust. Rarely cancer is the cause.
First of all be sure that whatever anyone says you have a curable disease. When a doctor says that the operation is very hard and they are not willing to do it, respect the doctor for their honesty and keep on searching for the doctor who would do the operation and be confident to do it. I have been giving full guarantee to functional and aesthetic surgery for many years, now for sometime I also decided to give a written concent to pay all fees back in case I am not successful in septal perforation surgery too. The doctor whom you talk to will also inform you about the concequence in your own situation. Search for your doctor you will find your cure.
I do not treat the patients who continue to abuse cocaine, who have a psychiatric disorder to continuous nose picking, patients with cancer and inflammatory diseases.