The 5 possible causes of septal perforation (a hole in the common wall between the 2 nasal airways) are:
1) Traumatic-such as after surgery, a punch, gunshot or knife stab to the nose, nose picking, repeated cautery for nosebleeds
2) Infection-such as typhoid, syphilis, tuberculosis, leprosy, fungus
3) Irritants-such as cocaine(especially if the bone is involved), heroin, nasal sprays, or industrial chemical exposure
4) Cancer(especially if the bone is involved)-such as melanoma, adenocarcinoma, squamous cell carcinoma, lymphoma, cancer metastases
5) Inflammation-such as sarcoid, Crohn’s disease, Wegener’s granulomatosis, systemic lupus erythematosis, rheumatoid arthritis
A variety of laboratory tests must be performed for non-traumatic causes of septal perforation before treatment is begun. Only perforations causing problems or symptoms such as crusting, bleeding, obstruction to nasal air passage, or whistling noises when breathing need to be treated. Most do not cause any symptoms.
If cocaine or heroin is the cause the chemical addiction must be treated as well in order to have a successful outcome.
The repair technique chosen depends on the size of the perforation, the location of the perforation and the condition of the surrounding septal mucosa. Prior to attempted repair the condition of the mucosa or nasal lining should be optimized with the appropriate nasal sprays, antibiotics, nasal cleansing regimen and nasal lubrication. Dry crusting nasal mucosa will not hold a stitch & the hole may just get bigger in such situations.
Small holes near the nostrils with healthy surrounding mucosa can be repaired with advancement of the mucosa over the hole. The succcess rate of these procedures is improved if additional grafts of tissue from elswhere on the body are used to help plug the hole. Larger holes will require more tissue with a separate blood supply. This can be furnished by rotating a flap of tissue from inside the mouth via the floor of the nostril. Holes that are far back from the nostril may require temporary separation of a nostril from the cheek in order to get the necessary exposure to see the defect. The closer to the nostrils & larger the septal perforation/hole the greater the likelihood there will be symptoms or problems.
Plastic buttons have been used to plug the holes but they can cause problems such as increased mucus production, crusting and obstruction to airflow.