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Common Causes of Nasal Septum Perforation

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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.

What Dr. Khosh's Patients Say


Based on 55 reviews

Meredith G.
Saw Dr. Khosh for a fractured nose. He reset my nose beautifully (and with little discomfort to me) and then discussed some of my sinus issues with me upon my follow up visit. Never felt like he was rushing me out and felt very confident in his abilities. I would highly recommend to anyone needing plastic or reconstructive options!
Jackie C.
Great front office, really good experience after what was a terrible accident. I was made to feel comfortable. Dr. Khosh is very good at what he does. I'm still healing but I'm confident of the results
Kaitlin M.
Dr. Khosh takes exceptional care of his patients. He has operated on me twice, each time making me feel extremely comfortable and satisfied with the results. His staff is also very kind and knowledgeable.
Diana G.
Dr. Khosh & his staff Susan & Christine are absolutely amazing! They were so supportive & helpful from beginning to end & they are just wonderful people. Thank you guys I truly appreciate everything you guys have done for me. I would recommend them to anyone & everyone!
Joann M.
After visiting and being evaluated by several doctors, I kept going back to Dr. Khosh. His tranquil spirit and professionalism were captivating. Thank you for a job well done and keeping me calm throughout the entire process. A special thanks to your staff Susan and Christine for all of their support as well. Hi highly recommend Dr. Khosh.
Leah G.
Upon hearing of the overwhelmingly positive experience a friend of mine had in choosing Dr. Khosh as her surgeon, I decided to make an appointment for my own septoplasty/rhinoplasty/turbinate reduction. Although I was slightly skeptical as the praise I had heard seemed a bit hyperbolic, all uncertainty dissipated after meeting the Doctor and his staff. My pre- and post-operative experience was excellent in terms of concerns adequately addressed prior to the surgery and mitigation of any bruising in the convalescent period. Despite my apparent predisposition to rather slower healing, a year after the surgery, my nose looks really pretty and my breathing entirely unobstructed! I highly recommend Dr. Khosh!
Courtney G.
AMAZING!!!!!! I had Dr Khosh perform lipo on my chin/neck and my result is unbelievable! Better than I could have expected! I met with a couple of surgeons and the second I met with Dr Khosh I knew he was the one I was going with. He was compassionate and explained every detail of what would take place during the surgery and what to expect during recovery. I even emailed a few times during recovery with various questions and he got right back to me asap which was really comforting! I honestly fully recommend Dr Khosh, he did an amazing job and is an amazing person.
Frieda S.
i can finally breathe!! Dr. Khosh made the entire experience a breeze, it was truly a pleasure to be under his care. I am forever thankful and highly recommend him. Not only does his work speak for himself, but he has excellent bedside manner. His kindness and patience is above and beyond. He takes the time to answer to every question you have to help you understand the process while at the same time making you feel so comfortable. From the first consultation i knew i was in good hands. I am so pleased with the result and forever thankful.
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(212) 339-9945
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