Large septal perforations often produce a sensation of nasal stuffiness which is probably due to airflow disturbance. The drying effect of the inspired air on the posterior margin of the perforation frequently causes crust formation, and epistaxis as the crusts separate. The mucosa of the margins of the perforation frequently undergo squamous metaplasia and thus appear to be hyperkeratotic. Courtesy of Professor Heinz Stammberger, University of Graz, Austria.
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