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Septal Haematoma, Abscess, Perforation

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					SEPTAL HAEMATOMA,
SEPTAL ABSCESS,
SEPTAL PERFORATION,
BOIL NOSE &
NASAL MAGGOTS/MYIASIS.
SEPTAL HAEMATOMA
         SEPTAL HAEMATOMA
   DEFINITION
       Collection of blood under the mucoperichondrium
        or mucoperiosteum of nasal septum
   AETIOLOGY
     Nasal Trauma
     Septal Surgery

     Bleeding Disorders ( Spontaneous)
Normal Inferior Turbinate




                  IT        Septum
        SEPTAL HAEMATOMA
   CLINICAL FEATURES
     Bilateral nasal obstruction
     Frontal headache

     Smooth rounded swelling on the nasal septum in
      both nasal fossae
     Soft and fluctuant on palpation
        SEPTAL HAEMATOMA
   Managemant
     ASPIRATION -for small haematomas
     INCISION AND DRAINAGE - for large
      haematomas
         Incision is given along the floor of the nose
         Small piece of mucosa excised to facilitate drainage

         Nasal Cavity packed with BIPP to prevent
          reaccumulation.
         Systemic antiobiotic cover to prevent septal abscess.
SEPTAL HAEMATOMA
        SEPTAL HAEMATOMA
   COMPLICATIONS

     FIBROUS THICKINING OF SEPTUM
     SEPTAL ABSCESS

     NECROSIS OF CARTILAGE
           DEPRESSION NASAL BRIDGE
              SEPTAL ABSCESS
   DEFINITION
       Collection of pus under the perichondrium and
        periosteum
   AETIOLOGY
     Infected Septal Haematoma
     Furuncle of Nose

     Rarely occurs following typhoid or measles
                 SEPTAL ABSCESS
   CLINICAL FEATURES
     Bilateral Nasal Obstruction
     Fever
     Frontal headache
     Red and warm skin over the nose
     Tenderness over nasal bridge
     Bilateral nasal swelling
            Soft and fluctuant
       Submandibular Lymphadenopathy
SEPTAL ABSCESS RT
     NOSTRIL
            SEPTAL ABSCESS

   TREATMENT
     Incision and drainage
     Piece of mucosa and necrotic cartilage removed

     Systemic antibiotics for 10 days
            SEPTAL ABSCESS
   COMPLICATIONS
     Necrosis of Septal Cartilage
     Depresion of Nasal tip

     Meningitis

     Cavernous sinus thrombosis
SEPTAL PERFORATION
        SEPTAL PERFORATION
   AETIOLOGY
     Traumatic
        SMR
        Chemical/Electrical Cautery
        Ornaments placement
     Pathological Perforation
        Septal Abscess
        Nasal myiasis
        Rhinolith (neglected Foreign body)
 SEPTAL PERFORATION
 Chronic    Granulamatous Diseases
      TB, Lupus, Leprosy - cartilagenous perforation
      Syphilis - bony septal perforation

      Wegner’s Granulomatosis

 Idiopathic    Perforations
        SEPTAL PERFORATION
   CLINICAL FEATURES
       Small Anterior Perforations
            Whistling during inspiration and expiration
       Large Perforations
          Crusting
          Nasal Obstruction

          Epistaxis
SEPTAL PERFORATION
        SEPTAL PERFORATION
   MANAGEMENT
       Treat the cause

       Inactive small perforation
            Closed surgically with plastic flaps
       Large Perforations
          Clear Crusts alkaline nasal washing
          Use bland Ointments

       Silastic Buttons used to close the perforations
                BOIL NOSE
    Acute infection of the Hair follicle in the
     Vestibule of nose / Tip of nose / Alae
    Causes :
1.   Scratching -> skin breach  Staph. Infection
2.   Nose picking
3.   Trimming of hair from nasal vestibule
    Underlying causes of recurrent boils
    1.   Diabetes mellitus
    2.   Chronic nasal infections  sinusitis
    3.   Immunodeficiency
               Clinical Features
   Severe pain, as the skin is tight & mild cellulitis
     severe pain
   Red shiny , indurated swelling of nasal tip /
    vestibule
   Severe tenderness
   May be swelling of face due to spreading
    cellulitis
                   Treatment
   Analgesics
   Antibiotics  cover Staph aureus
   Do not pinch the nose
   Swab from vestibule for C/S
   Treat underlying cause e.g. Diabetes
   Boil when pointing may be incised
               Complications
    Cavernous sinus thrombosis 
1.   Proptosis
2.   Ophthalmoplegia
3.   Decreased vision
4.   High grade fever with rigors & shivering
5.   Coma
NASAL MAGGOTS/MYIASIS

   Infection with maggots of the fly
   Fly lays eggs in wound, or is inhaled
   Furuncular form is most common
   Pruritic furuncle develops where eggs laid
   This becomes a nonhealing papule, from
    which larvae emerge when hatched
   May also occur in nasopharynx.
   Diagnosis:
       Microscopic examination


   Treatment:
       Excision and curettage
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