Septal Deviation and Perforation

Deviations of the nasal septum due to developmental abnormalities or trauma are common but are often 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. If present, the severity of any associated obstructive sleep apnea can also increase. 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), although evidence supporting its effectiveness is lacking (1). Septoplasty in patients with obstructive sleep apnea may make treatment with continuous positive airway pressure (CPAP) more successful.

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 glucocorticoids and over-the-counter phenylephrine or oxymetazoline sprays)Chronic nasal spray use (including glucocorticoids and over-the-counter phenylephrine or oxymetazoline sprays)

• Transnasal oxygen use

• Diseases such as tuberculosis, syphilis leprosy, systemic lupus erythematosus (SLE)

• Granulomatosis with polyangiitis (GPA)

Septal Deviation (CT Scan)

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© Springer Science+Business Media

Crusting around the margins and repeated epistaxis, which can be severe, may result. Small perforations may whistle when air blows through them. Anterior rhinoscopy or fiberoptic endoscopy can be used to view septal perforations, but care should be taken to not worsen existing damage. Endoscopy can also help with obtaining cultures and biopsies of mucosal tissue. Blood tests may be required help to rule out systemic rheumatic disorders.

Topical 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.Topical 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.