Nasal septal ulcer: causes, symptoms, diagnosis, treatment

Perforated ulcer of the nasal septum is relatively rare (1.5-2.5% of all patients suffering from diseases of the nasal cavity), and is most often discovered accidentally either by the patient himself or during rhinoscopy. The disease was isolated as an independent form in 1890 by the famous otolaryngologist Hajek.

Pathological anatomy. The first stage is characterized by atrophy and ulceration of the mucous membrane with the formation of a crust, the periodic removal of which aggravates the process by destroying the submucosal layer and the vessels and nerve endings in it, which leads to trophic changes in the cartilage and its resorption; a small oval opening is formed (second stage), which gradually increases to 1 cm or more in diameter (third stage), scarring at the edges and remaining in this form permanently.

The clinical course is characterized by the virtual absence of any distinct symptoms, except for a feeling of dryness and crust growth in the anterior parts of the nose. Most often, patients are bothered by whistling, which occurs during nasal breathing due to turbulent air movements caused by perforation (whistle symptom). Removal of crusts by the patient with a fingernail leads to secondary infection and inflammation of the nasal septum, up to its abscess. Often, removal of crusts leads to nosebleeds.

Anterior rhinoscopy reveals a round or oval perforation in the anterior nasal sections, surrounded by pale, atrophic mucous membrane. Dry crusts or ulcers formed after forced removal of crusts are observed along the edges of the perforation. Cartilage of the nasal septum, deprived of perichondrium, is found at the sites of ulceration.

The diagnosis of a perforated ulcer of the nasal septum is not difficult, but in all cases of detection of "spontaneous" perforation of the nasal septum with ulcerations, it should be differentiated from tuberculosis and syphilis. A tuberculous ulcer is always surrounded by granulating edges and is extremely painful. Ulcers and perforations of tuberculous origin are accompanied by sequestration of the cartilage of the nasal septum and the nasal bones themselves. A syphilitic ulcer most often affects the bony part of the nasal septum and is completely painless, while the nasal pyramid can acquire certain shapes (saddle-shaped, "Socrates' nose", etc.). In lupus, perforation of the nasal septum can have the same appearance as in atrophic perforation, but the ulcers extend beyond the nasal septum, to its wings and tip. In Wegener's granulomatosis, bleeding granulomas are detected in the nasal cavity, spreading diffusely to all walls of the nasal cavity. The perforation of the nasal septum and surrounding tissues are covered with brown crusts that are removed in the form of casts. Posttraumatic perforations of the nasal septum may be a consequence of trauma with a fracture of the nasal septum, which occurred as a result of a gunshot wound or surgical intervention on the nasal septum (sentum operation).

Treatment of perforated ulcer of the nasal septum. Non-surgical treatment can be relatively effective at the very initial stage of the atrophic process in the nasal septum, the development of perforation can be stopped by intensive local and general treatment, which includes the exclusion of atmospheric industrial hazards, forced removal of crusts, general vitamin therapy (A, C, D, E), local application of antihypoxic and epithelializing ointments and pastes such as solcoseryl. In case of small perforation, an attempt at surgical treatment using autoplasty is possible, however, the results of this do not always give a positive effect.

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