Etiology of nasal septal perforations can be classified into these 4 main categories: traumatic, iatrogenic, inflammatory/malignant, and cocaine use.
Most traumatic or iatrogenic perforations result from mucosal lacerations on corresponding sides of the septum with exposure of the underlying cartilage or from a fracture of the cartilaginous septum. Perforation occurs because the cartilage relies upon the overlying mucoperichondrium for its blood supply and nutrients.
Iatrogenic causes include nasal surgical procedures (prior septal surgery is the most common cause of septal perforations) and nasal intubation or nasogastric tube placement.
Septal hematoma, if not identified and treated early, also may result in perforation.
Infectious and inflammatory etiologies, including tuberculosis, syphilis, Wegener granulomatosis, and sarcoidosis, always should be considered in the differential diagnosis.
