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Related Experiment Videos

Self-induced nasal ulceration.

Travis T Tollefson1, J David Kriet, Tom D Wang

  • 1Department of Otolaryngology- Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.

Archives of Facial Plastic Surgery
|May 19, 2004
PubMed
Summary

Self-induced nasal ulcerations, often due to trigeminal trophic syndrome (TTS) or factitious disorder (FD), are challenging to treat. Surgical repair for TTS has high recurrence rates, while nasal prosthetics are preferred for FD.

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Area of Science:

  • Otolaryngology
  • Dermatology
  • Psychiatry

Background:

  • Self-induced nasal ulcerations present diagnostic and therapeutic challenges.
  • Two rare causes include trigeminal trophic syndrome (TTS) and factitious disorder (FD).
  • TTS involves trigeminal anesthesia and nasal alar ulceration, while FD is characterized by normal trigeminal function and denial of manipulation.

Purpose of the Study:

  • To enhance physician awareness of conditions causing self-induced nasal ulceration.
  • To discuss management strategies for these complex cases.

Main Methods:

  • Retrospective review of 7 patients with self-induced nasal ulcerations.
  • Patients presented for reconstructive consultation between March 1985 and October 1997.
  • Tertiary university medical center setting.

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Main Results:

  • Five patients had TTS; 4 experienced ulcer recurrence after reconstruction.
  • Two patients had FD; one experienced recurrence shortly after nasal reconstruction.
  • Ocular findings in TTS patients necessitated ophthalmologic referral.

Conclusions:

  • Self-induced nasal ulceration requires excluding treatable causes via biopsy and lab studies.
  • Surgical reconstruction for TTS has common recurrences; nasal prosthetics are recommended for FD.
  • FD patients require psychiatric referral and local wound care; surgical repair is discouraged.