About this page. Detailed consent information for repair of a nasal septal perforation using silastic sheeting. Surgical closure techniques for septal perforations vary; this page covers the silastic sheeting approach.
What the Operation Is
A septal perforation is a hole in the central nasal septum — the partition that divides the nasal cavity into two sides. Perforations can result from previous nasal surgery, repeated nose-blowing, cocaine use, certain inflammatory conditions (granulomatosis with polyangiitis, sarcoidosis, lupus), repeated trauma, or sometimes from no obvious cause. Symptoms can include whistling on breathing, crusting inside the nose, nosebleeds, nasal dryness, and a sensation of blockage despite the airway being structurally open.
Repair with silastic sheeting is a minimally invasive technique. Two thin sheets of medical-grade silicone are placed against the septum, one on each side, sandwiching the perforation. The sheets are held in place with non-absorbable sutures and act as a scaffold across which the lining of the nose can heal. Over weeks to months, mucosal tissue grows over the sheets and effectively bridges the perforation. In some patients, the silastic sheets remain in place permanently; in others, they can be removed once healing is established.
The technique is best suited to small to medium perforations. Large perforations sometimes require more substantial reconstructive surgery using local flaps from inside the nose.
Risks & Complications
1. Bleeding, infection, pain
As with any nasal operation, there is a risk of bleeding, infection and pain. Pain after this procedure is generally mild and either nasal sprays or paracetamol are usually all that is required. Some spotting of blood from the nose in the first two to three weeks is normal and settles relatively quickly.
2. Infection
Although infection at this site is a possibility, this has not been seen in my practice before. If infection were to develop and become particularly severe, it could actually enlarge the perforation — which is why any worsening pain, increasing tenderness, or foul-smelling discharge after the operation should prompt urgent review.
3. Loosening or extrusion of the silastic sheets
The silastic sheeting is held in place with non-absorbable (permanent) sutures. There is a chance that the sutures may come undone and the silastic sheet ends up coming out of the nose. If this happens, the operation needs to be repeated.
4. Discomfort from the silastic sheets
Very rarely, some patients notice discomfort from having silastic sheeting inside the nose. This can usually be improved by trimming the sheeting in clinic. In severe cases, complete removal of the sheets may be required.
5. Failure to fully heal the perforation
Not every perforation heals completely. Some patients have a smaller residual perforation after this procedure, which may still be a substantial improvement on the original symptoms. Larger perforations are more likely to need a flap-based reconstructive technique rather than silastic sheeting.
6. Anaesthetic risks
As with any operation under general anaesthetic, there are standard risks. The anaesthetist will discuss these separately.
Aftercare
- Pain control. Paracetamol is usually sufficient. Avoid aspirin and high-dose ibuprofen in the first two weeks (bleeding risk).
- Saline rinses. Regular saline washouts (NeilMed Sinus Rinse) and isotonic saline sprays (Sterimar) keep the nose clean and prevent crusting around the silastic sheets.
- Do not blow your nose forcefully for at least two weeks.
- Avoid strenuous exercise for two weeks.
- Time off work: usually one to two weeks.
- Stop smoking and vaping — at least three months before surgery and permanently afterwards if possible.
When to Call the Hospital or Attend A&E
- Heavy nosebleed that does not settle with simple pressure.
- Worsening pain after the first few days.
- Tenderness over the nasal tip when pressed.
- Fever, foul-smelling nasal discharge, or general unwell feeling — possible infection.
- Sudden visual disturbance, severe headache or neck stiffness.
Booking, Consent and Next Steps
If you have been told you have a septal perforation and would like to discuss whether silastic sheet repair is suitable, the secretarial team can arrange a consultation. See also Septoplasty & Turbinate Reduction Consent and Blocked Nose.