Septal Deviation and Perforation
Deviations of the nasal septum due to developmental abnormalities or trauma are common but often are asymptomatic and require no treatment. Symptomatic septal deviation causes nasal obstruction and predisposes the patient to sinusitis (particularly if the deviation obstructs the ostium of a paranasal sinus) and to epistaxis due to drying air currents. Other symptoms may include facial pain, headaches, and noisy night breathing.
Septal deviation is usually evident on examination, although a flashlight and examination of the anterior nasal passage may not be sufficient.
Treatment consists of septoplasty (septal reconstruction).
Septal ulcers and perforations may result from nasal surgery; repeated trauma, such as chronic nose picking; cosmetic piercing; toxic exposures (eg, to acids, chromium, phosphorus, or copper vapor); chronic cocaine use; chronic nasal spray use (including corticosteroids and over-the-counter phenylephrine or oxymetazoline sprays); transnasal oxygen use; or diseases such as tuberculosis, syphilis, leprosy, systemic lupus erythematosus (SLE), and granulomatosis with polyangiitis (GPA, formerly known as Wegener granulomatosis).
Crusting around the margins and repeated epistaxis, which can be severe, may result. Small perforations may whistle. Anterior rhinoscopy or fiberoptic endoscopy can be used to view septal perforations.
Topical bacitracin or mupirocin ointment reduces crusting, as may saline nasal spray. Symptomatic septal perforations are occasionally repaired with buccal or septal mucous membrane flaps; closing the perforation with a silicone septal button is a reliable option.