Perforated ulcer of the nasal septum: causes, symptoms, diagnosis, treatment

The perforated ulcer of the septum of the nose is relatively rare (1.5-2.5% of all patients suffering from diseases of the nasal cavity), and is most often detected by chance either by the patient himself or by a rhinoscopy. The disease was isolated in 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 terminals contained therein, which leads to trophic changes in cartilage and its resorption; a small oval opening (the second stage) is formed, which gradually increases to 1 cm or more in diameter (the third stage), scarring along the edges and remaining in this form permanently.

The clinical course is characterized by virtually no any distinct symptoms except for the sensation of dryness and build-up of crusts in the fore parts of the nose. Most of the patients are disturbed by a whistle arising from nasal breathing due to turbulent air movements caused by perforation (whistle symptom). Removal of crusts with patients with the nail leads to the attachment of a secondary infection and inflammation of the septum of the nose, down to its abscess. Often the removal of crusts leads to nasal bleeding.

With anterior rhinoscopy, a circular or oval perforation surrounded by a pale atrophic mucosa is detected in the anterior nasal region. At the edges of the perforation, dry crusts or ulcers occur after the forcible removal of the crusts. On the sites of ulcers, a nasal septum of cartilage that is devoid of perichondrium is found.

Diagnosis of a perforated ulcer of the septum of the nose does not cause difficulties, however, in all cases of detecting a "spontaneous" perforation of the septum of the nose with ulceration, it should be differentiated from tuberculosis and syphilis. Tuberculosis ulcer is always surrounded by granulating edges, sharply painful. Ulcers and perforations of tuberculous origin are accompanied by sequesters of the cartilage of the septum of the nose and the own bones of the nose. The syphilitic ulcer most often affects the osseous part of the septum and is completely painless, while the nose pyramid can take definite forms (saddle, "nose of Socrates", etc.). In lupus, perforation of the septum of the nose can have the same appearance as with atrophic perforation, however ulcers extend beyond the septum of the nose, to its wings and tip. With Wegener's granulomatosis, bleeding granulomas are detected in the nasal cavity, which diffuse diffusely on all the walls of the nasal cavity. The perforation of the nasal septum and the surrounding tissues are covered with brown crusts, which are removed in the form of impressions. Post-traumatic perforations of the nasal septum may be the result of a trauma with a fracture of the septum of the nose that resulted from gunshot wounds or surgical intervention on the septum (soutum operation).

Treatment of perforated ulcer of septum of nose. Non-operative treatment can be relatively effective at the very beginning of the atrophic process in the nasal septum, the development of perforation can be suspended by intensive local and general treatment, including elimination of atmospheric production hazards, forced removal of crusts, general vitamin A (C, D, E) use of antihypoxic and epithelial ointments and solcoseryl type pastes. With a small perforation, an attempt at surgical treatment with autoplasty is possible, but the results of this do not always have a positive effect.

[1], [2], [3], [4], [5], [6], [7]