Deviations of the nasal septum due 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. 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).

Septal ulcers and perforations may result from nasal surgery; repeated trauma, such as chronic nose picking; cosmetic piercing; toxic exposures (eg, to acids, chromium, phosphorus, or copper vapor); chronic cocaine use; chronic nasal spray use (including corticosteroids and OTC phenylephrineSome Trade Names
NEO-SYNEPHRINE
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or oxymetazolineSome Trade Names
AFRIN
DURATION
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sprays); transnasal O₂ use; or diseases such as TB, syphilis, leprosy, 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. Topical bacitracinSome Trade Names
AK-TRACIN
BACIGUENT
BACIIM
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or mupirocinSome Trade Names
BACTROBAN
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ointment 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.

Last full review/revision September 2012 by Marvin P. Fried, MD

Content last modified November 2012