Septal Perforation and Deviation

Septal perforation, a hole in the nasal septum between the two air passages, usually occurs in the anterior cartilaginous septum but may also occur in the bony septum. Septal deviation is a shift from the midline, which is common in adults, and may be severe enough to obstruct the passage of air through the nostrils. With surgical correction, the prognosis for either disorder is good.

Causes

The cause of the most common form of scoliosis that develops in childhood is unknown, hence its name - idiopathic scoliosis. Sometimes the child is born with an abnormality of a vertebral bone or spina bifida, which can lead to scoliosis. In a number of cases, scoliosis forms secondary to a different condition, particularly those that cause an imbalance in the muscles, such as muscular dystrophy or cerebral palsy. It may also follow problems with the bones or connective tissues, such as neurofibromatosis or Marfan's syndrome.

Signs and Symptoms

Although a small septal perforation usually produces no symptoms, the patient may complain of hearing a whistling noise on inspiration. A patient with a large perforation may report a history of rhinitis and epistaxis. The patient's history also may reveal a possible cause of the perforation, such as chronic sinusitis, tuberculosis, or inhalation of irritating chemicals. Inspection may reveal nasal crusting and a watery discharge. Inspection with a nasal speculum may also reveal the septal perforation.

The patient with a deviated septum may report a recent traumatic injury to the nose or a history of nasal obstruction. He may complain of a sensation of fullness in the face; shortness of breath; difficulty breathing through the nose; edema in the nasal mucosa; dry, cracked, or crusted nasal mucosa; swelling of the face and ecchymosis from recent trauma; nasal discharge; recurring epistaxis; infection; sinusitis; and headache. Inspection may disclose a crooked nose as the midline deflects to one side.

Diagnostic tests

No specific diagnostic tests exist. However, clinical inspection confirms septal perforation or deviation and X-rays of the skull reveal nasal and skull fractures.

Treatment

Based on the patient's symptoms, treatment for a perforated septum may include decongestants to reduce nasal congestion by local vasoconstriction, nasal steroid sprays to decrease edema, local application of lanolin or petroleum jelly to prevent ulceration and crusting, and antibiotics to combat infection. Surgery may be necessary to graft part of the perichondrial layer over the perforation. Also, a plastic or Silastic "button" prosthesis may be used to close the perforation.

Treatment of a deviated septum is also based on the patient's symptoms. It usually includes analgesics to relieve headache, decongestants to minimize secretions, and vasoconstrictors, nasal packing, or cauterization as needed to control hemorrhage. Manipulation of the nasal septum at birth can correct congenital deviated septum.

Corrective surgery may consist of reconstruction of the nasal septum by submucous membrane resection to reposition the nasal septal cartilage and relieve nasal obstruction. Other surgical procedures include rhinoplasty to correct nasal structure deformity by intranasal incisions and septoplasty to relieve nasal obstruction and enhance cosmetic appearance. Surgical complications include possible hemorrhage, infection, and deformity.

Prevention

Scoliosis is not preventable. At this time, we do not understand what causes the condition in the majority of children.