A 25yo boy complaints of a whistling sound when he breathes. This is the naso-endoscopic picture of his nasal septum.
1. Describe the abnormalities seen.
2. What is your diagnosis?
3. What are the common risk factors underlying this problem?
4. How will you manage this case?
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6 comments:
Mr Yap,
I'm very bad at describing lesions and stuff..Maybe you can give a few pointers on how to do so?
:)
Awy,
Q1. The is a naso-endoscopic picture of a nasal spetum.
There is a perforation seen at the nasal septum.
There is crusting seen , and the mucosa surrounding the perforation is oedematous and rather angry-looking. Hyperemic vessels can be seen on the medial aspect of the spetum. There are mucoid discharge seen but thre is no bleeding seen.
Q2. Nasal Septum Perforation
Q3. Causes of Nasal septum perforation can be divided into traumatic, iatrogenic, inflammatory and inhalant related. Therefore, the common risk factors are. :
- nose-picking
- contact sports
- post nasal surgery
- Tuberculosis
- syphilis ( not very common in this antibiotic era )
- Chromium and sulfuric acid fumes
- Cocaine Abuse
Q4. AS septal perforations are impossible to repair, and if whistling is a problem for the patient, enlargement of the perforation can help relieve the embarrassment.
Nasal douching with saline and bicarbonate soloution reduces crusting around the edge of the defect and antiseptic cream will control the infection.
The nasal septal prosthesis (ie, button) is the most conservative approach.
Surgical repair techniques can range from prosthetic devices, local mucosal flaps, 2-stage procedures, and free-flap repair.
Well done, Jo.
Septal perforation is right.
In terms of causes, Wegener's could also be considered, and septal hematoma/abscess secondary to trauma should be mentioned. Otherwise that's a good list.
Treatment-wise you are spot-on. Googled answer?
Mr.Yap
My first impression was a black foreign body (FB) get stuck inside the nasal septum. Occur in motor vehicle accidents for example. Is this possible and how would the presentation be in sucha case?
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