Perforated septum
Encyclopedia
A nasal septum perforation is a medical condition in which the nasal septum
, the cartilaginous
membrane dividing the nostrils, develops a hole or fissure.
This may be brought on directly, as in the case of nasal piercing
s, or indirectly, as by long-term topical drug use like cocaine
or decongestant nasal spray
s, chronic epistaxis
, aggressive digital nasal cleaning (nose picking) and as a complication of nasal surgery like septoplasty
or rhinoplasty
. Much less common causes for perforated nasal septums include rare granulomatous inflammatory conditions like Wegener's granulomatosis
. It has been reported as a side effect of anti-angiogenesis
drugs like bevacizumab
.
In a small percentage of patients surgery is necessary to alleviate symptoms. There are several different surgical procedures with reported success rates between 40 to 95%. Often these can't be reproduced by other surgeons which suggests the actual rate is lower.
Nasal septum
The nasal septum separates the left and right airways in the nose, dividing the two nostrils.It is depressed by the Depressor septi nasi muscle.-Composition:The fleshy external end of the nasal septum is sometimes also called columella....
, the cartilaginous
Cartilage
Cartilage is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs...
membrane dividing the nostrils, develops a hole or fissure.
This may be brought on directly, as in the case of nasal piercing
Body piercing
Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice...
s, or indirectly, as by long-term topical drug use like cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
or decongestant nasal spray
Nasal spray
Nasal sprays come in a variety of forms. Medicated such as Astelin, Afrin and Nasonex and natural such as Sinusoothe and Sterimar. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump mechanism.-Antihistamine nasal...
s, chronic epistaxis
Nosebleed
Epistaxis or a nosebleed is the relatively common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils...
, aggressive digital nasal cleaning (nose picking) and as a complication of nasal surgery like septoplasty
Septoplasty
Septoplasty is a corrective surgical procedure done fix to straighten the nasal septum, the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Often the...
or rhinoplasty
Rhinoplasty
Rhinoplasty , also nose job, is a plastic surgery procedure for correcting and reconstructing the form, restoring the functions, and aesthetically enhancing the nose, by resolving nasal trauma , congenital defect, respiratory impediment, and a failed primary rhinoplasty...
. Much less common causes for perforated nasal septums include rare granulomatous inflammatory conditions like Wegener's granulomatosis
Wegener's granulomatosis
Wegener's granulomatosis , more recently granulomatosis with polyangiitis , is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression...
. It has been reported as a side effect of anti-angiogenesis
Angiogenesis
Angiogenesis is the physiological process involving the growth of new blood vessels from pre-existing vessels. Though there has been some debate over terminology, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for the formation of new blood...
drugs like bevacizumab
Bevacizumab
Bevacizumab is a drug that blocks angiogenesis, the growth of new blood vessels. It is commonly used to treat various cancers, including colorectal, lung, breast, kidney, and glioblastomas....
.
Symptoms
A perforated septum can vary in size and location, and is usually found deep inside the nose. It may be asymptomatic, or cause a variety of symptoms. Small perforations can cause a whistling noise when breathing. Larger perforations usually have more severe symptoms. These can be a combination of crusting, blood discharge, difficulty breathing, nasal pressure and discomfort. The closer the perforation is to the nostrils, the more likely it is to cause symptoms.Treatment
The majority of septal perforations can be managed without surgery. The hole will never close but if the open, raw trailing edge of the perforation can heal, the vast majority of symptoms resolve. The open irritated and raw surface must be continuously covered with a cream using a cotton applicator. This will prevent this area from drying out, cracking, bleeding, forming a scab and crusting up. A few months of successful application will allow the ulcerated edge to heal and reduces or resolves symptoms.In a small percentage of patients surgery is necessary to alleviate symptoms. There are several different surgical procedures with reported success rates between 40 to 95%. Often these can't be reproduced by other surgeons which suggests the actual rate is lower.