CARCINOMA seldom develops in the na-al cavities. It resembles sarcoma in it= development, though hmmorrhage is apt to occur later. Removal, when the diagnosis has been proved bv microscop- • ical examination, is useless.
Septum, Diseases of the.
Abscess.—Abscess of the septum is by no means rare. It is usuallv due to a blow on the nose, but mav thou,h seldom, be idiopathic or associated with perichondritis or erysipelas. The trau matic abscess is usually a suppurating lumnatoma, the formation of pus having been antedated by the extravasation of blood from the effects of the blow.
Occasionally' abscess of the septum is a complication of nasal diphtheria and scarlet fever. It has been noted in chil dren as a result of foreign bodies, and it may be caused by sepsis through any abrasion, occasioned, for example, by uncleanly methods of treatment. It oc casionally follows the use of the galvano cautery on the nasal partition, but it very seldom cornplicates a wound pro duced by the saw or any cutting instru ment.
The most frequent seat of septal ab scess is the anterior, inferior part of the septum, and when of traumatic origin is generally bilateral. The majority of cases occur in children.
Symptoms.—The abscess does not ap pear, as a rule, until a considerable time after the blow or fall. After the period of incubation the pus forms rapidly and the tumefaction quickly obstructs the nose.
In the acute cases the nose is painful and swelled and the congestion may even extend to the cutaneous surface. Ex amination with the nasal speculum shows the nasal openings closed, usually on both sides, by red swellings, which can be easily retracted by the pressure of the probe. Sometimes it requires the use of cocaine to determine that the swellings are a part of the septum and not attached to the turbinated wall. It is important to remember that cocaine does not reduce abscess-swellings of the septum as it does turbinal congestions.
Perforation of the septum rarely re sults front an abscess unless long neg lected or treated unscientifically. But there is danger of weakening the terior support sufficiently to occasion some depression at the tip of the nose.
Treatment.—The abscess should be punctured with a narrow-bladed knife after cocaine has been applied. The nostrils should be irrigated with a 1 to 4000 mercuric bichloride or a 25-per cent. solution of boroformalin. Re covery, as a rule, is very rapid.
Fourteen cases of acute abscess of nasal septum personally observed. In 5 eases the etiology was obscure; in the others it was either typhus, trauma, or erysipelas. Subjective signs—marked stoppage of the nose, and nasal speech; objective signs—a circumscribed, round, fluctuating red swelling, filling almost the whole lumen of the nose, and pos sible in some cases to confuse with a polypus. Treatment was free incision, followed by iodoform-gauze tampons. No perforations of the septum observed, as a result. But nasal deformity followed, due to luxation of the nasal bones. W. Wroblewski (Inter. Centralb. Laryn., etc., Apr., '95).
HIEMATOMA.—Ill most cases of trau matic abscess an extravasation of blood occurs directly after the injury, and forms a nidus for the development of the future abscess; but we may have abscesses without previous limmatoma, while hiematoma does not always sup purate.
Deviations of the Septum.—Anom alies of the septum, while almost uni versal in frequency, are able to cause such serious inconvenience and harm in many eases that it is best to regard them as pathological, especially as their recti fication is followed by decided improve ment.
The departures from the normal are of two kinds, viz.: local thickenings, which are spoken of as spurs or crests according to their extent, and deviations, in which the septum is simply bent in one of many possible ways.
Symptoms.-111any of the minor de grees are quite free from active symp toms, and even in severe forms the ex ternal deformity may be the chief sign of abnormality. -When symptoms are present they assume the form of nasal obstruction and catarrh; as already stated under the head of chronic rhi nitis, that condition appears, in the ma jority of cases, to depend almost entirely for its chronicity upon septal anomalies.