A nasal septum is the structure that divides the nasal cavity in half, creating the nostrils, or nares, of the nose. The septum is comprised of a fleshy external surface – sometimes referred to as the columella – an anterior septal cartilage, and a posterior bony portion. The bony septum is actually a composite of four bones of the skull: the crest of the maxillary bone, the crest of the palatine bone, the perpendicular plate of the ethmoid bone, and the vomer bone.
The cartilaginous septum continues to grow after birth, but the belief that growth continues throughout a person's lifetime is usually inaccurate. It normally grows rather rapidly up to the age of two, at which time growth slows markedly and ceases altogether at maturity. The ossification of the cartilaginous septum, however, continues in most individuals until around the age of 36. It is believed that it is this continued growth into adulthood that accounts for septal deviations often being diagnosed in adult patients with no prior history of difficulties.
Deviation of the nasal septum is most frequently associated with facial injuries but can also occur as a result of birth trauma or due to certain rare genetic disorders such as Marfan syndrome. A deviated nasal septum involves the cartilaginous ridge being displaced to one side, sometimes obstructing airflow and sinus drainage. While not always symptomatic, a deviated septum can lead to chronic sinusitis, sleep apnea, headaches, snoring, and nosebleeds. In general, a deviated septum is only considered a medical issue if it causes one or more of these problems for the patient, in which case it can be corrected surgically by a fairly routine procedure known as septoplasty.
Chronic nosebleeds, prolonged cocaine use, or habitual manipulation of the nose can occasionally lead to a perforated nasal septum, in which a hole or fissure forms in the cartilaginous septum. Less commonly, the condition can be caused by nasal carcinoma, chronic infections, syphilis, tuberculosis, or any of several other rare disorders. Normally a minor condition, a perforated septum can sometimes lead to audible breathing noises and can be treated using nasal decongestants and topical moisturizers. In severe or complicated cases, surgery may be necessary.
Piercing of the nasal septum historically was common among warrior cultures around the world, and the act persists today among traditional people. In Western societies, septum piercing is seen as a form of body modification in the same vein as tattooing or scarification. Because of the proliferation of nerve endings in the area, this can be one of the most painful piercing sites, but is nevertheless an increasingly common choice.