Q: Dr. Eppley, I am inquiring about septal perforation repair. I haven’t touched cocaine in years, but unfortunately, my perforation has grown. It’s between the size of a pencil eraser and a dime. I’m crushed and afraid and want it repaired. So far, it’s still standing (my nose) and I want to keep it that way. I read most traditional surgeries do not succeed but stem cell is working for larger holes. Can you help?
A: While it is true that the larger a septal perforation is, the lower is its success rate. But that does not mean that a septal perforation repair can not be successful, it is just that they are not easy and are often performed poorly. When talking about ‘stem cell therapy’, which is not really clinically available and is a misrepresentation of what is available ( injection options include autologous fat injection which coincidentally may contain some stem cells or platelet-rich plasma (PRP) which is a platelet conecntrate), such injections are not a method by themselves that can heal a septal perforation. Any such injections can be used as a concomitant treatment with conventional surgical techniques. PRP injections are what is used in septal perforation repair. It is important to realize that whether PRP injections are used before or during septal perforation repair, there is no medical evidence that proves septal perforation repairs are more effective because it is used. But because it is a natural extract from the patient, there is no harm in using it. In short, the use of PRP injections in septal perforation repair is largely based on the hope that the platelet concentrate may help in some fashion with the healing problem of a known difficult internal nasal problem.
The best approach for septal perforation repair is from above through an open rhinoplasty. This allows mucosal flaps to be raised on both sides and a PDS plate combined with temporalis fascia and a cartilage graft to be properly placed and covered.
Dr. Barry Eppley