Conditions: Nasal Septal Perforation
The nasal septum is the wall between the right and left sides of the nose. A hole in it is called a nasal septal perforation.
What is the nasal septum?
The nasal septum is the wall between the right and left sides of the nose. The septum normally spans the length of the nose, from nasal tip to the throat, terminating at the junction between the hard and soft palate. The nasal septum consists of cartilage toward the front of the nose and bone toward the back, and these rigid structures are covered by a thin layer of perichondrium (over the cartilage) and periosteum (over the bone), covered by a layer of the pink mucosa seen on the surface.
What is a nasal septal perforation?
A hole in the nasal septum is called a nasal septal perforation. It may be small or large, toward the front or toward the back.
Why is nasal septal perforation a problem?
A nasal septal perforation may not cause any problems whatsoever. The size and location of the perforation seem to contribute to whether problems arise and which problems occur. Some problems include crusting, resistance to nasal airflow, bleeding, whistling, and a change in the shape of the nose including the saddle nose deformity.
What causes a nasal septal perforation?
Trauma, lack of blood flow, and infection are the most common causes of a nasal septal perforation. Trauma may come in many forms, including direct impact to the nose or nasal surgery. Repeated finger trauma to the septum can lead to a perforation. In this scenario, a wound on the septum causes scabbing which is irritating, and an individual removes the scabs, unknowingly perpetuating and deepening the wound. Repeated use of a nasal steroid spray directed toward the septum also may create a wound that ultimately develops into a perforation. Cocaine use can cause a septal perforation because this drug causes constriction of the blood vessels to the septum, leading to decreased blood flow and oxygen delivery, ultimately causing death of septal tissues. A collection of blood between the septal cartilage and the overlying perichondrium also causes death of cartilage because in this situation, called a septal hematoma, the normal oxygen diffusion into the cartilage from the perichondrium is disrupted. Some autoimmune conditions, such as granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), can also cause septal perforation.
How is nasal septal perforation identified?
A nasal septal perforation may be identified by physical examination, but may also be apparent on imaging studies, such as a CT scan.
How is nasal septal perforation treated?
A septal perforation that causes no or minimal problems may be left alone. Depending on the degree of symptoms resulting from a septal perforation, different efforts may be undertaken to treat it. On the least invasive side of the spectrum, a person may use humidified air in their room or use nasal saline periodically to minimize buildup of mucus crusts. A nasal septal button is a silicon device placed over the perforation to cover the hole and protect the inner rim of the perforation from dry air. Surgery may be undertaken to try to close or improve the symptoms from the perforation, one example of which is shown here in animation.