Nasal septal perforation is a condition in which a hole or gap forms in the septum inside of the nose. This condition can affect nasal function and cause various symptoms. Nosebleeds, congestion and runny nose are some of the symptoms. The goal of repair is to alleviate these symptoms and restore intranasal structures.

Nasal septal perforation refers to a type of hole or opening in the septum inside the nasal cavity. The septum is made from bone and cartilage. It helps with airflow in the nasal passages and separates the two cavities of the nose. Nasal septal perforation occurs as a result of a hole, crack or tear in this structure.

What are the causes of nasal septal perforation?

Nasal septal perforation can occur for many different reasons associated with the complex anatomical structures within the nose. Some causes of a perforated septum include:

●       Trauma: One of the most common causes of nasal septal perforation is trauma to the nasal area. Trauma can occur for a number of reasons, such as blow injury to the bridge or sides of the nose, sports accidents or surgical procedures. These traumas lead to damage and perforation of the nasal septum.

●       Long-term use of nasal medications: Nasal medications are commonly used to relieve or treat symptoms in the nasal mucosa. However, prolonged and incorrect use can be a cause of nasal septal perforation. When applied to the nasal mucosa, these medicines can irritate and weaken the mucosa. Some medications can also constrict the nasal blood vessels, preventing healthy regrowth of the mucosa.

●       Nasal foreign bodies: Another factor that can perforate the nasal septum is nasal foreign bodies. Nasal foreign bodies can cause irritation and injury in the nose and weaken the nasal septum. Children in particular may have a tendency to insert small toys or other objects into their nose, which can perforate the septum by irritating and scratching the delicate mucous membrane inside the nose. This irritation can lead to thinning and weakening of the mucosa.

●       Systemic Diseases: Diseases affecting the immune system, such as autoimmune diseases and systemic lupus erythematosus, can weaken the nasal septum and increase the risk of a perforated septum. These diseases encourage the body to attack its own cells and can cause damage to the nasal mucosa. Inflammatory processes can cause permanent irritation of the mucosa and lead to weakening of the septum. Some medications used for systemic diseases can also damage the nasal mucosa.

●       Chemical Exposure: Chemical exposure can cause serious damage to the nasal septum. Perforations can be observed especially in people exposed to industrial chemicals or corrosive substances.

What are the symptoms of nasal septal perforation?

Symptoms of a perforated septum depend on the location, size and cause of the hole in your septum. Personal factors, the immune response and how long the perforation has been present can also influence symptoms. Large perforations usually lead to more pronounced symptoms, with the causes depending on various factors such as trauma, nasal foreign bodies, medications or systemic diseases. Symptoms of a perforated septum can vary from person to person, but generally include:

●       Nosebleeds: Perforation can irritate the nasal mucosa and lead to recurrent bleeding.

●       Nasal Congestion: A perforated septum can disrupt the intranasal structures, which can lead to nasal congestion. Restricted air flow may be the result, making breathing difficult.

●       Runny nose: Damage to the mucous membranes can cause a runny nose. Sometimes the discharge can be bloody or purulent.

●       Loss of Smell: Damage to intranasal structures can prevent the proper perception of odor particles.

●       Nasal Crusting and Dryness: Perforation of the nasal septum can cause intranasal crusting, dryness and discomfort.

●       Upper Respiratory Tract Infections: A perforated septum can weaken the nasal mucosa and increase the frequency of upper respiratory tract infections.

How is a perforated septum repaired?

Nasal septal perforation repair is a surgical procedure to treat damage to the partition inside the nose called the nasal septum. The procedure can be performed with different techniques depending on the size and location of the perforation and the symptoms. The first step is to assess the size and condition of the nasal septal perforation. An otolaryngologist will assess the size, location and effects of the perforation. If surgery is indicated, the patient's health status and history are evaluated before surgery, along with medications, allergies and other factors. Different surgical techniques may be used depending on the size and location of the perforation. If the patient is not suitable for nasal septum repair, some medications may be used to relieve the  symptoms. Nasal septum perforation repair options include:

●       Nasal septal suturing (traditional repair): In septal suturing, the perforation in the nasal septum is closed up with stitches. The doctor joins the intact tissues on both sides of the nasal septum so that the hole is closed. This method can be effective for small perforations. After the procedure, patients may experience symptoms such as nasal swelling and mild pain, which usually subside shortly.

●       Septal flap reconstruction: In this technique, a piece of intact septum is used to close the perforation. Septal flap reconstruction is commonly used to repair large or complex perforations. Tissue transfer is ideal when more tissue is needed to completely close the hole.

●       Grafting: Grafting is another method used to close perforations in the septum. To close the perforation, doctors usually use grafts harvested from other body parts, typically the patient’s ear cartilage, rib cartilage or other parts. Grafting restores nasal septal integrity by closing the perforation.

●       Endoscopic repair: Endoscopic techniques offer a less invasive option for the repair of a perforated septum. This technique can be used to repair certain nasal septal perforations and may offer faster recovery. The endoscope allows detailed observation and exploration of the nasal septum. Depending on the size and location of the perforation, the hole can be closed using intact tissue surrounding the septum. Sutures or adhesives may be used.

●       Surgical laser repair: In some cases, laser surgery can be used to repair a perforated septum. The use of a laser can speed up tissue repair and healing. Laser beams create heat that vaporizes the tissue surfaces. This vaporization helps to clean damaged tissue. Laser beams can also be used to stop bleeding. This cleaning of damaged tissue and control of bleeding promotes closure of the perforation.

The site of repair starts to heal after surgery. This process is usually painless and temporary symptoms such as nasal congestion and swelling may occur. Patients should regularly see their doctor after surgery. During these visits, the doctor will evaluate the recovery and adjust the treatment plan as necessary.

The size of the perforation, its cause and the patient’s overall health are key criteria in determining which repair method to use. The appropriate repair method needs to be evaluated by a specialist doctor on a case-to-case basis. Nasal septal perforation repair is a surgical procedure that aims at relieving symptoms, restoring nasal function and improving quality of life. Therefore, it is important for patients to contact a specialized healthcare professional.

References:

https://www.healthline.com/health/perforated-septum 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902156/ 

https://academic.oup.com/asj/article/25/5/524/196357 

https://www.healthdirect.gov.au/deviated-septum