Nasal septum perforation refers to a permanent defect that penetrates both sides of the nasal cavity due to various causes. The shape, location, and size of the perforation can vary.
Etiology
Trauma
Nasal septal abscess caused by nasal septum trauma and ulcers resulting from long-term irritation of the nasal septum mucosa by corrosive or irritating substances (such as chromic acid, silica dust, arsenic, mercuric chloride, cement, lime, etc.) are potential causes. Persistent nose-picking habits can occasionally lead to nasal septum perforation.
Iatrogenic Injury
Symmetrical damage to the mucosa on both sides of the nasal septum caused by nasal septum surgery or other treatments, such as the use of chemical cauterization or radiofrequency for treating nasal septum mucosal bleeding, can result in perforation.
Infection
Acute Infectious Diseases
Diseases such as diphtheria, typhoid fever, and scarlet fever can contribute to nasal septum perforation.
Specific Nasal Infections
Tuberculosis, lupus, and leprosy may cause necrosis of the nasal septal cartilage, leading to perforation. Syphilis is associated with perforation of the bony portion of the nasal septum due to necrosis, which may further result in saddle nose deformity.
Tumors and Malignant Granulomas
Tumors originating from the nasal septum or nasal cavity tumors exerting pressure on the septum can lead to perforation.
Others
Long-term pressure from nasal foreign bodies or rhinoliths can cause secondary infection and necrosis, ultimately resulting in nasal septum perforation.
Clinical Manifestations
The diverse etiologies of nasal septum perforation mean that it can present as an independent condition or as a local manifestation of a broader systemic disease. As an isolated condition, its main symptoms typically include nasal dryness and crust formation, often accompanied by headache and epistaxis.
Small perforations in the anterior nasal septum may produce a whistling sound during breathing, while posterior perforations generally do not.
Perforations caused by tuberculosis or syphilis may result in foul-smelling crusts.
Examination may reveal nasal septum perforation with crusting at the site. The edges of the perforation may appear eroded and bleed easily.
Diagnosis
Diagnosis is usually straightforward based on the symptoms and examination. The location and size of the perforation should be accurately identified, and the underlying cause should be determined. Smaller perforations may sometimes be obscured by crusting, requiring careful removal of crusts for thorough inspection.
Treatment
For non-independent nasal septum perforations with a clear underlying cause, priority is given to treating the primary disease. For isolated nasal septum perforations, surgical repair may be considered. The choice of repair method and materials depends on the location and size of the perforation. The main techniques include tension-reducing suturing of the nasal septum mucoperiosteum, transposition and suturing using pedicled mucoperiosteal or mucosal flaps (e.g., middle turbinate mucoperiosteal flap or inferior turbinate mucosal flap), free tissue grafts, and silicone sheet placement.