Diseases Of Nasal Septum Flashcards
(28 cards)
Septal perforation
Perforation on the nasal septum
Most common cause of nasal septal perforation
Trauma
Forms of traumatic septal perforation
1) Injury to mucosal flaps during SMR
2) cauterisation of septum with chemicals
3) galvanocautery for epistaxis
4) habitual nose picking
5) perforated voluntarily for putting ornaments
Forms of pathological septal perforations
1) septal abscess
2) nasal myiasis
3) rhinolith
4) chronic granulomatous conditions like TB, lupus, leprosy»_space;> affects cartilage
Syphilis affects»_space;> bony cartilage
5)wegeners granuloma
Aetiology of nasal septal perforation
1) traumatic
2) pathological
3) drugs and chemicals
4) idiopathic
Forms of Pharmacological septal perforation
1) prolonged use of steroids
2) cocaine addicts
3) workers eg 1- chromium plating
2- dichromate
3-soda ash
4- arsenic and it’s compounds
Form of idiopathic septal perforation
Unknown cause.
Patient is unaware of its existence
Small anterior perforation causes what
Causes whistling sound during inspiration or expiration
Large perforation develop what
Develop crust which obstruct the nose or cause severe epistaxis when removed
Treatment of small septal perforation
Septal button
How to detect cause of perforation
Biopsy from the granulations or from the edges of the perforation
Symptoms associated with perforation
Crusting, epistaxis, whistling— main
Other symptoms- feeling of dryness, emptiness in the nose, feeling of discomfort
Symptoms of nasal perforation depends on
Size and position of perforation
Pick ulcer
Aggressive nasal self toilet with digital trauma or tissues will convert an inflamed mucous membrane into ischemia crusty area.
Patients often deny this.
Pick ulcer» cartilage exposure»_space;cartilage necrosis»_space; cartilage perforation
Which is the best method to assess the margins and state of the nasal septum
Endoscopy
Investigations needed in septal perforation
Full blood count, ESR, urine and electrolytes, C -ANCA, treponemal investigation, ACE titres, chest X ray, nasal swab
Why is biopsy not diagnostic in septal perforation
1) it reveals nothing other than chronic inflammation
2) May convert an inactive state to an active state»> enlargement of the perforation
Biopsy are indicated only in
Idiopathic cause
Septum with irregular margin
Neoplasticism septal perforation
1) melanoma
2) adenocarcinoma
3) squamous cell carcinoma
4) metastatic carcinoma
5) lymphoma
Nasal steroid sprays causes septal perforation. How to reduce the incidence of septal perforation?
Patients should use the spray with the opposite hand to the nostril being treated
An nasal septal ulcer appeared after steroidal therapy.what would u do?
Withdraw the medication
Management of septal perforation
1) prevention
2) obturation
3) surgical
Prevention of septal perforation after septal surgeries
Use of mucosal protectant
antiseptic silicon barrier creams
Avoidance of aggressive cleaning
Non surgical management of septal perforation
Alkaline nasal douches, saline sprays, petroleum based ointment
