ear, nose, and throat disorders
Septal Deviation and Perforation
Introduction
Deviations of the nasal septumdue 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. Severity of 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 ( Reference ). Septoplasty in patients with obstructive sleep apnea may make treatment with continuous positive airway pressure (CPAP) more successful. Septal ulcers and perforationsmay result from nasal surgery; repeated trauma, such as chronic nose picking; cosmetic piercing; toxic exposures (eg, to acids,chromium, phosphorus, orcoppervapor); chroniccocaineuse; chronic nasal spray use (including corticosteroids and over-the-counterphenylephrineoroxymetazolinesprays); 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. Topicalmupirocinointment 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. 