=Killian, Prof. Gustav.—Case of Acute Perichondritis and Periostitis of
the Nasal Septum of Dental Origin.=—_Münch. med. Wochen._, No. 5, 1900.
There have been recorded two cases of perichondritis of the septum due
to alveolar periostitis. Suppuration of dental cyst was cause in the
following case.
A young man had pain in second left upper incisor; two days after
obstruction of nose supervened, with pain in forehead and high fever.
There was a sudden copious discharge of fetid pus from right nostril
seven days later. The entire mucosa of the septum was raised from the
cartilages, etc. It is considerably swollen over right side of the
triangular cartilage, but less so posteriorly. Severe headache in
forehead and frontal eminence, and still little fever. The pus was
escaping through a small hole into the left nostril. It was freely
incised. The triangular cartilage was disintegrated, and the pus had
burrowed between the soft tissues and vomer and vertical plate of the
ethmoid. The choanæ were constricted by thickening of the septal mucous
membrane. The wound healed in a fortnight without sequestrum, while the
toothache lasted but two days.
Six months later the patient had recurrence of pain in the same tooth of
two months’ duration; it was extracted and pus continued to exude from
the socket. A probe, passed 2½ centimeters to the floor of the nose and
septum, showed a cavity covered with membrane in the anterior parts of
upper jaw, which was a cyst at the root of the tooth. The anterior cyst
walls were removed with bone forceps, and the remainder scraped. The
cavity gradually healed.
The cyst probably broke through under the septal mucous membrane. In
exceedingly few cases of perichondritis does the process extend to the
osseous septum. Only once has the author seen record of a case which was
as extensive as this. The offensive odor also points to a dental origin.