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Tuberculosis of the nose

Tuberculosis of the nose, according to the clinical classification of tuberculosis (1973), is included in the group of tuberculosis of the respiratory system and a subgroup of tuberculosis of the upper respiratory tract. It usually develops in the presence of a tuberculous focus (most often in the lungs). Mycobacterium tuberculosis (Koch's bacillus) penetrate the nasal cavity and its external integument endogenously through the blood and lymph vessels. The pathomorphological element specific to tuberculosis is the tuberculous tubercle (tuberculoma) - one of the typical varieties of infectious granulomas. In appearance, it resembles a millet grain of whitish-gray or yellow. Microscopic examination reveals lymphoid, epithelioid, and giant multinucleated cells in various combinations. The accumulation in the submucosal layer of such tubercles forms tuberculous infiltrate, which in its development acquires the character of a productive and exudative process. The cell composition of the tubercle undergoes cheesy necrosis, which leads to the formation of ulcers.

There are two forms of nasal tuberculosis: tuberculosis of the nasal cavity and tuberculosis of the skin of the external nose - lupus (Fig. 2.10.3).

In case of tuberculosis of the nasal cavity, the most characteristic site of development of tuberculous changes is the anterior (cartilaginous) part of the nasal septum, less commonly, the front ends of the lower or middle conch (Likhachev A.G., 1963). In the initial stage of the disease, there is abundant discharge from the nose, drying of the crusts that make nasal breathing difficult. With rhinoscopy, an inflammatory infiltrate of a pale reddish color is found that does not have clear boundaries. After the breakdown of the infiltrate, an ulcer of irregular shape with scalloped edges forms, covered with purulent discharge with an admixture of blood. A prolonged course of the necrotic process leads to the formation of a through defect in the nasal septum. In distinguishes from syphilis, which affects the cartilage and bone tissue, tuberculous ulcer is localized only in the cartilage.

Lupus erythematosus is a particular variant of skin tuberculosis (tuberculosis cutis luposa or lupus vulgaris). Tuberculous infiltrates in this case affect mainly the vestibule and wings of the nose. The primary element of skin tuberculosis is a tubercle (lupoma) - a limited, initially flat, pin-sized head or slightly larger reddish or yellowish-red, soft, painless mass, prone to peripheral growth and fusion with neighboring elements (Mashkillayson A.
L. et al., 1986). Two simple methods are used in diagnostics: dioscopy and probe probe. With dioscopy (pressure on a lupus with a usual glass slide), hyperemia caused by reactive inflammation is eliminated, and primary elements (lupomas) resembling the color of apple jelly (a symptom of apple jelly) become clearly visible on a bloodless background. If you press on the backlash with a button probe, then the latter easily bends (falls), which is explained by the death of collagen and elastic fibers (Pospelov's symptom). At the same time, when pressing with a probe, increased bleeding is noted and painful sensations appear. Decaying and ulcerative tubercles on the skin of the external nose are replaced by scar tissue. The result is an atrophic scar. In addition to the nose, tuberculous lupus also affects other parts of the face - the upper lip, cheeks, forehead, and auricle, which leads to a significant disfigurement of the external appearance. The diagnosis of tuberculous lesions of the nasal cavity and its external surface does not present particular difficulties in the presence of a tuberculous process in other organs. In all cases, for the purpose of differential diagnosis, serological reactions are performed, as well as Pirke and Mantoux reactions.

Treatment. As in the treatment of tuberculosis of any localization, etiotropic therapy is the basis of the treatment of tuberculous lesions of the nose. Leading drugs are streptomycin, PACK, phthivazide and other similar drugs. For local cauterization of tuberculous infiltrates, various acids are used (trichloroacetic, lactic, parachlorophenol). Of these, parachlorophenol, which was first introduced into clinical practice by N. P. Simanovsky (1894) for the treatment of tuberculosis of the upper respiratory tract, including the larynx, is most effective. Limited tuberculosis foci (tuberculomas) can be removed surgically (excision), or eliminated by electrocoagulation. Cosmetic defects of the external nose and face caused by lupus can be eliminated by plastic surgery after treatment for tuberculosis.
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Tuberculosis of the nose

  1. Tuberculosis of the nose
    Mycobacterium tuberculosis, spreading along the lymphatic and circulatory pathways, enter the nose from the focus, which may be in the lungs, joints or larynx. In rare cases, the infection enters the nasal mucosa by contact. The pathomorphological substrate of the disease is infiltration - an accumulation of specific tubercles in the submucosal layer. Tuberculous tubercle
  2. Deformations of the nasal septum, synechia and atresia of the nasal cavity
    The etiologic deformation of the nasal septum may be due to physiological, traumatic, and compensatory factors. Physiological curvature occurs when there is a mismatch in the growth of the nasal septum and the bone frame into which it is inserted. The growth of the septum is slightly ahead of the growth of the facial skeleton, so its curvature occurs. In childhood, physiological
  3. Tuberculosis
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  4. Tuberculosis
    The leadership of the Institutions ensures the organization and implementation of a set of anti-tuberculosis measures, including health education on prevention, early detection of tuberculosis and the controlled treatment of patients with tuberculosis. Tuberculosis hospitals are the organizational and methodological centers for tuberculosis work in Institutions.
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    Motivational characteristic of the topic. Knowledge of the topic materials is necessary for the study of tuberculosis in clinical departments. In the practical work of the doctor, this knowledge is necessary for the clinical anatomical analysis of this pathology. The general purpose of the lesson. According to the knowledge of the morphological manifestations of tuberculosis, learn to determine the clinical and anatomical variants of different forms of this severe infectious disease. Specific
    TUBERCULOSIS is an infectious disease of humans and animals caused by mycobacterium tuberculosis, characterized by a chronic relapsing course. Tuberculosis is based on specific granulomatous inflammation. In humans, the disease most often causes 2 strains of mycobacterium tuberculosis: human and bovine. Infection with the human type occurs by airborne droplets, bovine -
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  10. Lupus
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  12. Tuberculosis
    Tuberculosis is an infectious disease that affects mainly the human lungs, but it is also possible damage to the bones, joints, skin, kidneys, and nervous system. Tuberculosis is a bacterial disease. Its causative agent is the so-called tubercle bacilli or Koch bacteria. They are quite stable in the environment, tolerate prolonged drying (about three months). IN
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  15. Tuberculosis
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