The nasal septum is made up of cartilage anteriorly and bone posteriorly. It can be perforated as a result of trauma, including iatrogenic trauma, cocaine inhalation and certain diseases including granulomatous conditions (sarcoidosis, Wagner's granulomatosis), infections (syphilis, tuberculosis) and nasal malignancies. Inhalation of acidic fumes and phosphorus can also lead to this condition. Source: http://www.ghorayeb.com/septalperforation.html