June 24, 2019

Can a Deviated Septum Cause a Septal Perforation?

Over the years, I have been asked by a number of patients with deviated septums what problems may occur if un-corrected, especially if such patients are also suffering from recurrent nosebleeds. In particular, can a deviated septum be the underlying trigger that causes a septal perforation to occur (purple arrow below)?

Well, this blog article is to answer that very question. But first off, a little anatomy...

A nasal septum is a wall that separates the right nasal cavity from the left side. Normally, this septum should be perfectly straight.

However, in some people, the septum may be deviated causing not only nasal obstruction, but increases the risk of nosebleeds.

When the septum is straight, nasal breathing proceeds such that the air smoothly enters the nose without creation of any turbulence.

However, if the septum is deviated, turbulence is created when the air hits the "curve" of the septum. When this happens, the lining of the septum becomes dried out resulting in cracking and increased vascularity which increases the risk of a nosebleed.

The lining of the nose in this situation is much like when a person's lips become so dried out to the point that it cracks and bleeds. Over the years, the septal mucosa in this region may become so damaged that if not fixed, it may ultimately lead to a septal perforation right where the bend of the deviated septum is present.

What makes this situation worse is that such patients will often use nasal sprays to help alleviate symptoms, but nasal sprays like afrin on their own can also cause septal perforations if over-used. Nose-picking also is not unusual in these patients as boogers can get trapped where the septal deviation is located. Nose-picking also is a risk factor for septal perforation due to repetitive fingernail trauma against the septum.

Finally, nasal cauterization which is often employed to stop nosebleeds can cause septal perforations as it works by cauterizing the offending blood vessel. Although this would help stop a nosebleed, it would also risk devascularizing the septal mucosa... resulting in a septal perforation.

That said, deviated septums as a whole RARELY leads to septal perforations and patients as a general rule should not be overly concerned that this WILL happen if they have a deviated septum. Nose-picking, afrin over-use, and nasal cauterization also RARELY cause septal perforations as well.

But, it does happen.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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