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Septal Deviation and Perforation


Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Reviewed/Revised Jul 2023
Topic Resources

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. 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 (1 Reference 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... read more Reference ). Septoplasty in patients with obstructive sleep apnea may make treatment with continuous positive airway pressure (CPAP) more successful.

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 over-the-counter phenylephrine or oxymetazoline sprays); 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.

Topical mupirocin 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.


Drugs Mentioned In This Article

Drug Name Select Trade
4-Way Nasal, Ah-Chew D, AK-Dilate, Anu-Med, Biorphen, Formulation R , Foster & Thrive Nasal Decongestion, Gilchew IR, Hemorrhoidal , IMMPHENTIV, Little Remedies for Noses, Lusonal, Mydfrin, Nasop, Nasop 12, Neofrin, Neo-Synephr, Neo-Synephrine, Neo-Synephrine Cold + Allergy, Neo-Synephrine Extra Strength, Neo-Synephrine Mild, Neo-Synephrine Non-Drowsy Cold + Allergy, Ocu-Phrin, PediaCare Children's Decongestant, PediaCare Decongestant, PediaCare Infants' Decongestant, Sinex Nasal, Sudafed PE, Sudafed PE Children's Nasal Decongestant , Sudafed PE Congestion, Sudafed PE Sinus Congestion, Sudogest PE, Vazculep
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus
Bactroban, Centany, Centany AT
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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