Trauma is the most common use, Injury to mucosal flaps during SMR ,cauterization of septum with chemicals or galvanocautery for epistaxis and habitual nose-picking are the common forms of traums . Occassionally ,septum is deliberately perforated to put ornaments.
They can be caused by :
- Septal abscess.
- Nasal myiasis
- Rhinolith or neglected foreign body causing pressure necrisis .
- Chronic granulomatous conditions .Lupus, tuberculosis and leprosy cause perforation in the cartilaginous part while syphilis involves the bony part Evidence of the causative disease,in these cases , may also be seen in other systems of the body .
In many cases, there is no history of trauma or previous disease and the patient may even be unaware of the existence of a perforation.
Small anterior perforations cause whistling sound during inspiration or expiration . Larger perforations develop crusts which obstruct the nose or cause severe epistaxis when removed.
An attempt always be made to find out and treat the cause of perforation. This may require biopsy from the granulations or edge of the perforations .Inactive smaller perforations can be surgically closed by plastic flaps .Larger perforations are difficult to close .Their treatment is aimed to keep the nose crust – free by alkaline nasal douches and application of a blind ointment.Sometimes a thinsilastic button can be worn to relive the symptoms .
It is collection of blood under the perichondrium or periosteum of the nasal septum .It often results from nasal trauma or septal surgery .In bleeding disorders it may occur spontaneously.
Bilateral nasal obstruction is the commonest presenting symptom.This may be associated with frontal headache and a sense of pressure over the nasal bridge .
Examination reveals smooth rounded swelling of the septum in both the nasal Fossae .Palpation may show the mass to be soft and fluctuant.
Small haematomas can be aspirated with a wide bore sterile needle .Larger haematomas are incised and drained by a small anteroposterior incision parallel to the nasal floor .Excision of a small piece of mucosa from the edge of incision gives better drainage .Following drainage ,nose is packed on both sides to prevent re accumulation .Systemic antiboitics should be given to prevent septal abscess.
Septal haematoma ,if not drained ,may organise into fibrous tissue leading to a permanently thinkened septum . If secondary infection supervenes, ,it result in septal abscess with necrosis of cartilage and depression of nasal dorsum.