Diseases Of The Nose Throat And Ear

28 THE NOSE AND PARANASAL SINUSES

following morning. Steam inhalations may be comforting, and the patient
should be discouragedLfrom nose blowing for a few_days. Postoperative
swelling of the nasal mucosa will occur, and will take some weeks to resolve
fully, so that the patient must not expect immediate relief. He should be
warned about further nasal injury until the tissues have soundly healed, and
for this reason he should not indulge in boxing or football for some months
after the operation.

COMPLICATIONS. These are not frequent. Septal_haematoma has been
mentioned, and is treated by reopening the incision to allow the blood to
drain, and repacking the nasal cavities. Adhesions between the nasal septum
and the inferior concha may occur if the mucosa EaTbeen lacerated, and if the
inferior concha has been trimmed to ease the airway in that side. The adhesion
takes place between the two raw surfaces. If seen early, it may be broken down,
and a splint inserted, but if it is not found until some time after surgery, it
may require a second slight operation to remove it completely. Perforation of
the septum may occur if both mucosal surfaces have been openedTancTthe
openings are opposite one another. It is usually permanent.

PERFORATION OF THE SEPTUM

The septum may become perforated as a result of septa]^surgery, from
syphilis or tuber.oylosis, or following the application of chemical caustics
such as chromic acid in the treatment^JLepistaxis. PerforatiorToOEe nasal
septum may cause no symptoms, and many people are unaware of it. If it is
associated with syphilis, it usually involves the bony septum and causes little
discomfort. If the perforation is situated anteriorly, it may cause an annoying
whistling noise during nasal respiration. If the perforation is large^crusting
may appear around its edges, and such crusts are uncomfortable, and may be
blown out by the patient.

Perfo™tingjulcer of the septum is idiopathic in origin, and affects the
cartUagJuocaiSLpaFt of the septum close'to the anterior naris. Before the ulcer
develops a small scab appears in this region, which is usually picked off by the
patient, only to be followed by another. The process is repeated until a small
sharply defined ulcer forms under the scab. This deepens gradually, and
erodes and perforates the septum. The edges of the perforation heal leaving a
small circular or oval perforation. The absence of inflammation distinguishes
it from^.jypMjs^ajidJuiajs. If the parent ~ls~seen at the stage oflsEallow
ulceratioii he must be enjoined not to pick the scab, and the ulcerated area is
treated by the application of an ointment containing hydrocortisone and an
antibiotic (Terra-Cortril or Soframycin) twice daily. The established perfora-
tion may be kept clean by similar treatment, but if there is much discomfort
and crusting a grafting operation may be advised.

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