Getting Ready for Septal Perforation Repair

How is the surgery done?

• The septum is the wall of cartilage and bone that divides the nose into two sides. A septal perforation is a hole in it, which can cause crusting, bleeding, dryness, a whistling sound when you breathe, or a blocked nose.
• The goal is to close the hole, with the aim of improving airflow and reducing crusting, bleeding and discomfort.
• If the septum is also bent, a septoplasty may be done at the same time to straighten it and make the repair easier.
• The incisions are inside the nose, so there are usually no scars on the face.
• The lining around the hole is carefully lifted and moved into place over it. This is called a mucosal advancement or rotation flap.
• A thin graft is placed between the two layers of lining to support the closure. It may be temporalis fascia (a thin layer of tissue from near the temple, taken through a small incision hidden in or near the hairline), a biosynthetic graft (a manufactured material), or both.
• Soft plastic splints are usually placed inside the nose to protect the repair. They usually stay in for at least 2 weeks, sometimes longer, and are removed in our office.
• The surgery is done under general anesthesia (completely asleep).

Our septoplasty page explains how the septum is treated.

What are the risks?

Every surgery has risks. Your surgeon will go over them with you before surgery, and you can ask about any of them.

• Anesthesia is safe, but it has some risks. The anesthesia team can go over them with you. Tell us if anyone in your family has had a problem with anesthesia.
• Pain, bleeding and infection are risks of any surgery.
• Congestion, pressure, drainage, crusting and mild bleeding are common while the nose heals.
• Numbness of the upper front teeth, upper lip or tip of the nose. This is usually temporary.
• The hole may not fully close, or it may open again while it heals. More treatment or another surgery may be needed.
• Some symptoms may continue even if the hole closes, such as dryness, crusting, bleeding or a blocked nose.
• Scar tissue can form inside the nose and may need treatment in our office or, rarely, another surgery.
• A blood clot in the septum (septal hematoma) can lead to infection or damage to the cartilage if it is not treated.
• An infection or abscess in the septum may need antibiotics or drainage.
• Changes in the shape or support of the nose, such as widening or a sunken bridge, are rare.
• A change in or loss of smell is uncommon.
• If tissue is taken from near the temple, that area may be sore, swollen, bruised, numb or tender for a while, and may leave a small scar near the hairline.
• Toxic shock syndrome is very rare, but it can be life-threatening.

How do I get ready?

• As soon as surgery is scheduled

  • Give us a list of every medicine, vitamin and supplement you take. We will tell you which to stop and when.
  • If you smoke or vape, stop now. Stopping helps your body heal and makes anesthesia safer, and the earlier you stop, the better: aim for at least 4 weeks before surgery, though even 2 weeks helps. Stay off until your surgeon says you have healed.
  • Plan time off. Plan about 1 week off work or school, depending on your job and how you feel.
  • Arrange for an adult to drive you home. After general anesthesia, we recommend having an adult stay with you the first night.

• 1 to 2 weeks before

  • Aspirin is usually stopped 1 to 2 weeks before surgery. If you take aspirin or a blood thinner for your heart, a stent or stroke prevention, do not stop it on your own: your surgeon will check with whoever prescribes it.
  • Ask us whether to pause ibuprofen (Advil, Motrin) or naproxen (Aleve).
  • Ask about herbal remedies and supplements, such as fish oil, vitamin E, ginkgo or garlic pills, which can raise the chance of bleeding.
  • If you take insulin or other diabetes medicines, ask how to take them before surgery.
  • Get the supplies in the next section.

• The night before

  • Follow the eating and drinking instructions from our office or the surgery center exactly. If you eat or drink when you should not, surgery may need to be postponed for safety.
  • Many places ask for nothing to eat after midnight, and some allow clear liquids until a few hours before.
  • Take only the medicines we said to take that morning, with a small sip of water.
  • Get a good night’s sleep.

• The day of surgery

  • Wear comfortable clothes and a top that buttons or zips in the front, so you do not pull it over your nose afterward.
  • Wear glasses instead of contact lenses, and leave jewelry and valuables at home.
  • Bring your photo ID, insurance card and list of medicines.

What happens after surgery?

• Most people go home the day of surgery.
• Expect congestion, drainage, crusting and mild bleeding for several days. Some bloody drainage is normal for the first few days; call us if bleeding is heavy, does not stop or worries you.
• Do not blow your nose until your surgeon says it is OK, and sneeze with your mouth open.
• Use saline spray or rinses as instructed to keep the nose moist, and do not pick at crusts or touch the inside of your nose.
• Plan about 1 week off work or school. No strenuous activity, heavy lifting or exercise for at least 2 weeks, or until your surgeon clears you, and protect your nose from bumps while it heals.
• Your first visit is usually within the first week. More visits are often needed to check healing and clean out crusts. The splints usually stay in for at least 2 weeks, sometimes longer, and come out in our office.

When should I call before surgery?