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Nasal septum perforation: causes, pathology, symptoms, treatment

Septal perforation is usually asymptomatic. However, according to severity, many symptoms and signs appear and require medical or even surgical care.

Etiology (Causes):

a. Traumatic: 

  • Surgical: Submucous resection (SMR).
  • Cauterization for epistaxis.
  • Nose picking.
  • Placement of nasogastric tube.
  • Septal hematoma.
  • Cocaine addiction (snuff takers perforation).
  • Pressure necrosis (prolonged pack).
  • Turbulent airflow
  • Accidental: (rare).

b. Inflammatory: 

  • Septal abscess
  • Lupus
  • Leprosy
  • Syphilis and midline granuloma.
  • Sarcoidosis
  • AIDS
  • Crohn's disease
  • Rheumatoid arthritis.
  • Dermatomyositis.

c. Neoplastic: 

  • Carcinoma.
  • Cryoglobulinemia
  • T-cell lymphomas

All perforation affect cartilage (anterior), except syphilis affects bone (posterior).

Symptoms and signs: 

  • May be asymptomatic especially if posterior.
  • If symptomatic, patients present with history of Irritation, crustations, nasal block, epistaxis, or whistling sound.
  • Taking detailed history is essential in diagnosis, because septal perforation is associated with many other systemic diseases as mentioned above.
  • Medication history is also important, as chronic use of vasoconstrictive and steroid nasal sprays may cause septal perforation.
  • For cocaine abusers, other nasal damage should be examined like Nasal perforation, Nasal septum necrosis, Nasal erythema or ulceration and even other related organ damage like Pharyngeal ulceration and Palate damage.

Treatment of nasal septum perforation:

  1. Saline or alkaline nasal lotion, for crustations.
  2. Silastic obturator.
  3. Surgical repair, by rotational pedicled mucosal flaps (nasal or oral mucosa).


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