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26 THE NOSE AND PARANASAL SINUSES
anterior naris. The tube is withdrawn sufficiently to allow a cut to be made in
one side, so that when it is drawn back again the cut lies in the nasopharynx,
thus creating two nasal tubes joined over the posterior end of the nasal
septum. The tubes are fixed across the columella, and are left in position for at
least 2 months. Thereafter dilatation of the choanae by bougies is carried out
at increasing intervals to ensure that the openings do not reclose.
Treatment of a unilateral atresia may be similarly dealt with if it is diagnosed
in infancy. If it is not recognized until later in life the operative approach is
through an incision at the junction of the hard and soft palates. The soft
palate is retracted, and the occlusion is removed together with part of the
posterior edge of the septum and the border of the hard palate. A plastic tube
is again inserted and anchored to prevent it from slipping.
DERMATITIS AND FURUNCULOSIS OF THE NASAL VESTIBULE
This skin infection involving the hair-bearing area of the nasal vestibule calls
for a careful investigation of the nasal cavity and sinuses. There is redness,
excoriation and fissuring of the skin around the nostril, leading to crusting
which may cause obstruction. A nasal swab should be taken to determine the
infecting organisms, which are usually staphylococcal, and to discover their
Treatment consists of the application of an ointment containing an
antibiotic with or without hydrocortisone, e.g. a mixture of framycetin and
gramicidin (Soframycin) or of oxytetracycline, nystatin and hydrocortisone
(Terra-Cortril). The ointment should be applied twice daily, and should be
continued for some days after the apparent cure, as the condition is prone to
early recurrence. A course of the appropriate antibiotic by mouth may be
given in addition.
If the infection is in a hair follicle a furuncle occurs. This gives rise to pain
in addition to the irritation of the dermatitis. The furuncle is easily seen in the
anterior naris and the temptation to squeeze it must be resisted because the
infection may be spread by this means to involve the cavernous sinus by a
spreading thrombosis. Hot fomentations, or the local application of 10 per
cent ichthyol in glycerin on ribbon gauze will relieve the pain, while a full
course of the appropriate antibiotic should cure the infection. The most
useful antibiotics are ampicillin, erythromycin or flucloxacillin.
DEVIATIONS OF THE NASAL SEPTUM *
A perfectly straight septum is rarely found, and, even when it is basically
straight, it frequently shows a ridge or spur to one side or the other. Deviations
and spurs of the septum may be very slight, causing no trouble, or very
marked so as tojblock one cavity to a greater or lesser degree. In some
deviations both sides may be obstructed. Individuals vary greatly in the degree
in which they suffer from apparent blocking of the nose from septal deviation.
In some in whom the obstruction appears slight there may be pronounced
symptoms, while others make no complaint although one nostril is almost
completely blocked. It is accordingly necessary to be guided largely by
subjective symptoms in deciding the advisability of operative interference.
Deviations may be developmental in origin or they may arise from trauma.