Nasal surgery is my passion. My goal: to find the best possible solution for each individual situation, so that you can soon return to pursuing your personal passions without worry.
For your health
Secure closure
of septal perforations
The successful closure of a nasal septal defect, i.e., a hole in the nasal septum or septal perforation, is one of the most complex procedures in modern nasal surgery. The particular challenges lie, on the one hand, in the demanding microsurgical technique and, on the other hand, in the unfavorable tissue properties due to scarring and poor blood circulation in the area surrounding the defect. Because holes in the nasal septum (nasal septum perforations) are very rare, individual ENT doctors only encounter them occasionally. In contrast, I began reconstructing nasal septum defects 25 years ago as a young senior physician—at that time exclusively using the so-called bridge flap technique, which my long-time boss and teacher Prof. Dr. Schulz-Coulon established in international nasal surgery in 1989.
Many years of experience are crucial, especially for such specialized procedures. As an internationally recognized rhinoplasty surgeon specializing in microsurgery with more than 1,200 successful septum reconstructions, I offer you the highest level of surgical precision in this demanding field.
The most proven method for restoring nasal function is three-layer reconstruction techniques (e.g., the bridge flap technique). In most cases, these guarantee permanent and functionally successful closure of the nasal septum. Thanks to these microsurgical techniques, stable and very good long-term results can be achieved—for free breathing and a better quality of life.
I would be happy to accompany you on your journey – from the beginning to the end of your symptoms.
Causes and symptoms
Holes in the nasal septum
There are many causes of holes in the nasal septum (nasal septum defects or septum perforations). Unfortunately, most septal perforations are due to previous surgery on the nasal septum, e.g., nasal septoplasty, septorhinoplasty (nose correction), or nasal septum surgery as part of sinus surgery. More rarely, accidents involving the nose or specific autoimmune diseases play a causal role. However, the use of toxic substances (e.g., cocaine) can occasionally lead to significant inflammation of the nasal mucosa, which then causes perforations of the nasal septum. In some cases of septal defects, no cause can be found.
Regardless of the causes, the condition manifests itself in patients with clear symptoms: problems with nasal breathing, nosebleeds, and aesthetic changes are part of the clinical picture.
Other symptoms:
- Whistling noises when breathing in, caused by turbulent air currents through the hole in the nasal septum
- Impaired nasal breathing or alternating congestion due to crust formation
- Dryness of the nasal mucosa, which promotes crusting and bleeding
- Bleeding from the nose
- Pain or pressure in the nose
- Sinking of the bridge of the nose (saddle nose) and the tip of the nose
- Psychological impairment due to daily confrontation with the symptoms, anxiety disorders, and feelings of helplessness
Healing with three-layer surgical techniques
Reconstruction of the nasal septum
A hole in the nasal septum is a three-layer organ defect. Only by restoring these three layers (two layers of mucous membrane and the septal cartilage between them) can the nasal septum be reliably reconstructed and the physiology of nasal breathing restored. My long-time boss and teacher, Prof. Schultz-Coulon, first introduced a three-layer surgical technique using the bridge flap technique in 1989 and established it as a routine procedure in nasal surgery. Through my own further developments of this technique and combination with other mucosal transpositions in the nasal cavity, I have been able to perform over 1,200 three-layer nasal septum reconstructions since 2001 with a long-term success rate of approximately 90%. This is the world's largest study on the treatment of nasal septum defects. The individual success rate of a complete reconstruction of the nasal septum depends on the size of the defect, the condition of the mucous membrane, and the cause of the defect.
Why have I been working with three-layer surgical procedures for the reconstruction of septal perforations since 2001, why do I use them, and what advantages do these techniques offer in my experience?
All major studies show that three-layer reconstruction methods are by far the most successful surgical techniques for closing septal defects. An additional advantage is that only one operation is required, access is always via the inside of the nose, and therefore no visible scars are left behind. Last but not least, the very rare recurrence defects are almost always significantly smaller than before the operation and can be closed again with the same three-layer surgical technique and the same high success rate, if any symptoms remain.
Details and procedure at Dr. Stange
Three-layer reconstruction of the nasal septum
Initial outpatient consultation at the ENT Center in Neuss
The initial consultation always takes place during my surgery consultation hours at the ENT Center in Neuss. There, your nose will be examined microscopically and endoscopically, and the condition of the nasal mucosa and the cartilaginous-bony support structure of the nose will be assessed. In most cases, a special X-ray image of the nose with a high resolution 3D reconstruction of the nasal septum (Cone beam computed tomography: CBCT) must also be performed. Only then can the relative size of the hole (septal defect/septal perforation) be determined in relation to the total size of the nasal septum. Once all the examination results are available, the prognosis for complete closure can usually be assessed very accurately. Whether a nasal septum reconstruction is recommended or even medically necessary will be discussed with you individually. After that, a date for surgery can be arranged, if necessary.
01. Hospital and anesthesia
The operation is performed either at the ENT clinic of the Schön Klinik in Düsseldorf, or at the Helios Klinikum in Krefeld (ENT clinic or private clinic). Depending on the distance from your home, the operation requires a hospital stay of two to three days. The procedure is always performed under general anesthesia with access via the inside of the nose (endonasal access).
02. Microsurgical preparation
I perform all surgical steps using a modern surgical microscope. Only one incision is required through the inside of the nose (endonasal), so there are no external scars. After incising the mucous membrane at the entrance to the nose, the entire remaining mucous membrane is microsurgically detached from the remaining cartilage and bone of the nasal septum. The entire nasal mucosa of the nasal floor and roof is also mobilized using microsurgery.
03. Mucosal flaps
The mucous membrane of the nasal septum is reconstructed by shifting the prepared mucous membrane of the inside of the nose, known as mucosal flaps. Bridge flaps (in accordance with the bridge flap technique) can be used for this purpose. Two such mucosal flaps are usually required on each side. The choice is made separately for each side of the nasal cavity based on the size of the defect, the condition of the mucosa, and the condition of the remaining septal cartilage and bone. The mucosa is shifted over the defect and secured microsurgically with fine, self-dissolving sutures.
04. Cartilage reconstruction
The missing cartilage or bone of the nasal septum must always be replaced, as otherwise a new defect may form. I always perform this reconstruction using the patient's own cartilage. In most cases, cartilage is taken from the outer ear via an incision on the back of the ear. The shape of the outer ear remains unchanged. Rib cartilage is only required in exceptional cases. The transplanted cartilage is then fitted into the cartilage defect and secured with self-dissolving sutures.
05. Wound closure and fixation
Several self-dissolving mattress sutures are used to stabilize and fix the entire nasal septum (mucosal flap and transplanted cartilage) and to close the mucosal incision at the entrance to the nose. Thin, individually cut silicone sheets are then applied to each side of the nasal septum and fixed with a suture. Finally, a very thin rubber finger cot tamponade (internal dressing) is inserted into each nasal cavity to stabilize the mucosal flaps.
06. Follow-up treatment
The tamponades are removed on the second day after the operation while you are still in the hospital. As these are very thin rubber finger cot tamponade, removing them is somewhat uncomfortable but practically painless. The septum foils still present in the nose are removed on an outpatient basis after about two weeks. In the first few weeks, you will need to apply ointment several times a day and occasionally have your nose treated at your ENT practice.
So you can breathe easily again!
My philosophy
Specialization and experience for healing
My goal for every treatment is a convincing result—and patients who can breathe freely again and feel good about themselves. But the path to get there is crucial. It begins with trust, care, and experience. From the initial consultation to successful surgical treatment, you are in the best hands with me, right from the start.
Passion
Experience
With more than 25 years of experience, further training, and teaching in specialized nasal surgery, I am an established specialist for highly demanding procedures and treatments.
Specialization
Specialization is the key to outstanding results. As an ENT sub-specialist, I focus exclusively on nasal surgery—in particular, reconstruction of the nasal septum. I combine microsurgical precision with many years of surgical experience.
FAQ
Do you have questions about reconstructive nose surgery or the treatment process?
We provide answers.
A hole in the nasal septum (nasal septum or in Latin septum nasi) is medically referred to as a nasal septal defect. The nasal septum (Latin: septum nasi) divides the main nasal cavity into two almost equal halves. The term septal perforation (nasal septal perforation or septum perforation) is also used as a synonym, although it is not entirely medically correct.
The nasal septum divides the nasal cavity into two parts. It has a three-layer structure: the inner supporting layer consists of cartilage in the front and bone in the back. On both sides, this cartilage or bone is covered by the nasal mucosa. An intact nasal septum ensures normal (laminar) flow of inhaled air. The nasal mucosa is made up of many different cells, which together are responsible for the nose's climate control function, i.e., warming and moistening, but also for the feeling of free nasal breathing.
A hole in the nasal septum leads to turbulent flow of inhaled air in the nose, which causes drying and increased inflammation with crust formation. Furthermore, the feeling of free nasal breathing is no longer present. Secondly, since the nasal mucosa is no longer completely intact, the missing cells lead to reduced humidification and warming of the inhaled air.
Septoplasty refers to the straightening of the nasal septum. When surgical treatments of the nasal septum first began in the early 20th century, only the bent cartilage or bone of the nasal septum was removed (resected). This type of procedure is called submucosal septum resection, as the (bent) cartilage or bone was removed from under the nasal mucosa (submucosal). However, this surgical technique has many disadvantages, which is why it has not been performed since the 1960s and should no longer be performed. The operations currently performed to straighten the nasal septum are known as plastic septum corrections: after dissecting the nasal mucosa, the bent parts of the septal cartilage and bone are first removed, straightened, and then repositioned between the mucosal layers of the nasal septum. Hence the term septoplasty.
If the nasal septum is perforated, i.e., there is a septal defect or perforation, then the nasal septum must be restored (reconstructed). Since a total of three layers of the nasal septum are no longer present in a nasal septum defect, these three layers (two layers of mucous membrane and the cartilage or bone between them) must also be reconstructed. Hence the term septum reconstruction.
Holes in the nasal septum (nasal septum defects or septum perforations) are not very common. Individual ENT doctors rarely encounter patients with holes in their nasal septum in their practices (or in clinics). This is probably one of the reasons why there is still a great deal of uncertainty surrounding the treatment of nasal septum defects. Scientific literature describes nasal septum defects in 1–2% of the population.
The reconstruction of a nasal septum in cases of septal defect (hole in the nasal septum, septal perforation) is one of the most difficult nasal surgical procedures. Probably for this reason—and also because nasal septum perforations are very rare—surgical nasal septum reconstructions are rarely performed. There are very few nasal surgery centers in Europe that specialize in these procedures and perform a significant number of such nasal septum reconstructions.
The procedure depends on the complexity of the case, but you can generally expect the following:
The initial examination takes place at the ENT center in Neuss. Here, your nose will be examined microscopically and endoscopically. Very often, a special 3D X-ray examination (cone beam computed tomography: CBCT) of the nose must be performed on site in order to make a final assessment and determine the exact size of the defect and the condition of the bony structures of the nose. This special cone beam x-ray (CBCT) is also required for 3D surgical planning. In most cases, this X-ray examination can be performed during the initial examination appointment. Once all the information is available, Dr. Stange can usually assess the prognosis for a successful septum reconstruction very accurately and will advise you accordingly. Once it has been determined that surgery can be performed and you have agreed to the operation, a surgery date can be arranged. This can be done either immediately after the initial examination or, after a period of consideration, by email or telephone (see contact details below). The relevant documents will be handed to you during the surgery consultation.
The operation itself is always performed personally by Dr. Stange under general anesthesia at one of the two surgical locations: Düsseldorf (SCHÖN Clinic) or Krefeld (HELIOS Clinic). Reconstruction of the nasal septum takes about 1 to 1.5 hours. The inpatient stay in the hospital is two to four days, depending on the distance from your home. The follow-up phase with regular check-ups can then be carried out by the ENT doctor in your home town.
The prognosis for complete restoration of the nasal septum depends on the relative size of the septal defect (septal perforation), the condition of the mucous membrane, and the condition of the remaining cartilage and bone structures. If the nasal septum has already been operated on during septoplasty or septorhinoplasty, the degree of difficulty of the operation is significantly higher and the prognosis for complete reconstruction is somewhat worse. It is most difficult to reconstruct a nasal septum if an attempt at surgical nasal septum reconstruction has already been made, especially if this reconstruction attempt was not performed using a three-layer surgical technique.
However, the success of nasal septum reconstruction surgery depends primarily on the personal experience of the respective nasal surgeon. In such a difficult operation, the surgeon can only be expected to have sufficient qualifications after many years or decades of specialization at a rhinoplasty center.
Address
Dr. Thoralf Stange, MD
Reconstructive Nasal Surgery
HNO-Zentrum Neuss
Batteriestraße 1
41460 Neuss, Germany
Contact:
Simone Kirschbaum
My assistant Simone Kirschbaum handles communication with all patients—
by phone, WhatsApp, or email.
Ms. Kirschbaum is occasionally represented by Sarah Bern.
Surgical departments
- SCHÖN Clinic Düsseldorf
- HELIOS Clinic Krefeld
With a view of the Rhine and the Düsseldorf skyline, I work part-time as chief physician at the SCHÖN Clinic.
At the HELIOS Clinic in Krefeld, I perform nasal surgery both at the ENT clinic and as an independent attending physician at the clinic's private clinic.