Common Causes of Nasal Septum Perforation

Perforation of the nasal septum is one of the main causes of a saddle nose deformity. The nasal septum is the wall of cartilage that separates the two nasal passages. It provides support for the middle and lower nasal bridge and tip. If the cartilage is perforated or wears thin, the support for the nasal bridge is weakened. This can lead to a bridge collapse, the main manifestation of a saddle nose deformity. Here are the common causes of deterioration or perforation of the nasal septum.

Trauma and Septum Hematoma

Blunt trauma to the nose can damage the nasal septum as can punctures to the septum from objects that enter the nasal passages (this includes fingers). Most injuries to the septum will heal and form scar tissue, but sometimes septum hematomas can form. If left untreated, the hematoma can cause deterioration of the cartilage in the septum, leaving a permanent hole or perforation.

Inhaling Drugs, Chemicals or Nasal Sprays

Purposely sniffing or snorting cocaine or other illicit drugs can cause inflammation and damage to the nasal septum. Continued intranasal drug use causes permanent septum perforations. Over or misuse of steroid or OTC nasal sprays can create cartilage damage in the septum. Inhaling certain chemicals, powders or fumes in the workplace without nasal protection can also damage the septum cartilage and cause a perforation.

Infections and Diseases

Certain bacterial infections can attack cartilage and deteriorate the nasal septum. Syphilis and Hansen’s disease (leprosy) are examples of infections that weaken and destroy the cartilage in the septum. Autoimmune and inflammatory diseases can also cause nasal cartilage damage, including:

• Granulomatosis Polyangiitis
• Relapsing Polychondritis
• Sarcoidosis
• Wegener’s Granulomatosis

These diseases slowly degrade the cartilage and can result in perforations in the septum. If the septum structure is too weak, the nasal bridge will collapse, creating the saddle nose deformity.

Repairing a Saddle Nose Deformity Caused by Septum Perforations

When a septum perforation is severe and the nasal bridge collapses, a repair is needed to restore the shape of the nose. Minor saddle nose deformities only involve the nasal bridge, and repairing the septum perforation can restore support to the bridge. If there is extensive damage to the septum and other nasal cartilage, multiple cartilage grafts may be needed to fix the damage and reform the shape and structure of the nose.

If a septal perforation occurred and you are living with a saddle nose deformity, contact the office of Dr. Maurice Khosh to schedule a consultation. Dr. Khosh can repair septum perforations and reshape your nose to restore a pleasing shape and normal breathing function.