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[Nasal septal perforation and systemic disease]
S Vignes1, M Chaillet, J Cabane
1Service de médecine interne, hôpital de la Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
La Revue De Medecine Interne
|December 17, 2002
Summary
Systemic diseases can cause nasal septal perforations, even without obvious symptoms. Intranasal examination is crucial for diagnosis in these cases, aiding in the identification of underlying conditions.
Area of Science:
- Otolaryngology
- Rheumatology
- Pathology
Context:
- Nasal septal perforations are often attributed to trauma.
- Systemic diseases represent a less recognized etiology for nasal septal perforations.
- Limited data exists on the prevalence of nasal septal perforation in specific systemic diseases.
Purpose:
- To review systemic diseases associated with nasal septal perforation.
- To highlight the diverse clinical manifestations, including asymptomatic presentations.
- To discuss the diagnostic challenges and pathophysiological mechanisms.
Summary:
- Systemic conditions such as Wegener's granulomatosis, lupus erythematosus, antiphospholipid syndrome, sarcoidosis, and cryoglobulinemia can lead to nasal septal perforation.
- Clinical signs are nonspecific, including obstruction, epistaxis, and crusting; asymptomatic cases are common.
- Pathophysiology involves ischemic, infectious, or inflammatory processes; nasal septal biopsy is often unrevealing unless granuloma or vasculitis is present.
Impact:
- Suggests a systemic disease etiology for unexplained nasal septal perforations.
- Emphasizes the importance of intranasal examination, even in asymptomatic patients with systemic diseases.
- Underscores the need for a high index of suspicion for systemic involvement in septal perforation cases.