<prompt> Nasal perforation in bony part seen inSyphilisTuberculosisWegners granulomaAllergic rhinitis  <response>: A. Syphilis 144 - Dhingra 4th 189 - Maqbool 11thLupus, tuberculosis and leprosy - causes perforation in the cartilaginous part while syphilis involves the bony partPERFORATION OF NASAL SEPTUM1. Traumatic perforations - Trauma is the most common causea. Surgical during and after SMR or accidentalb. Constant habit of nose pickingc. Tight nasal packingd. Repeated cauterization with chemicals or galvanocautrye. Haematoma and abscess formation due to necrosis of the septal cartilage2. Pathologic perforationsa. Septal abscessb. Nasal myiasis, allergic rhinitisc. Rhinolith or neglected foreign body causing pressure necrosisd. Chronic granulomatous conditions like lupus, tuberculosis and leprosy, syphilise. Wegeners granuloma is a midline destructive lesion which may cause total septal destructionf. Irritants like tobacco or cocaine snuff and fumes such as those of chronic acid and mercuryg. Tumours of the septum eg chondrosarcoma, granuloma. Perforation of posterior septum is commonly seen in syphilisTreatment - Inactive small peforation can be surgically closed by plastic flaps - larger perforations are difficult to close. 