BOIL OR FURUNCLE IN EXTERNAL NOSE
WHAT IS BOIL OR FURUNCLE IN EXTERNAL NOSE ?
BOIL is defined as an acute suppurative inflammation of a hair follicle.Boil is only seen on hairy skin so it is found only in the vestibule of the nose.
The vestibule of the nose has a lateral and medial walls lined by thick skin which contain hairs.The inflammation may occur either in the lateral or medial wall or at the junction of the two or at the floor.
WHAT IS THE CAUSATIVE ORGANISM ?
Boil is caused by the Staphyllococcus albus and aureus.
IS IT A DANGEROUS CONDITION ?
Yes, BOIL is a dangerous condition because of the following reasons :-
1) It can cause severe or ugly nasal deformities when healing takes place.The tip of the nose or lateral wall of the nose is badly deformed.
2) External nose has a peculiar venous drainage. It drain into a vein which is running by the side of the lateral walls of external nose.
WHAT IS THE IMPORTANCE OF THIS PARTICULAR DRAINAGE?
1) Through the ophthalmic veins, is communicated with a blood sinus situated on the body of sphenoid called Cavernous sinus.
2) Angular veins also communicates with the pterigoid plexus which in turn communicates with the cavernous sinus.
Infection from Boil can spread to the cavernous sinus by retrograde thrombophlebitis.Through cavernous sinus ophthalmic and retinal veins are involved and blindness occurs on the same side. Through inter cavernous sinus the eye of the opposite side may become blind also.
Through the cavernous sinus duramater is also involved leading to meningitis. It is more dangerous if the patient's resistance is low or he is diabetic. The complication can endanger life.
3) Angular vein is devoid of valves so the blood can flow in any direction. The Boil which is harmless to start with can cause Anterior Facial Vein Thrombosis.
WHAT ARE THE CAUSES OF BOIL IN THE NOSE ?
1) Trauma to the root of hair i.e.plucking of the hairs.
2) Low resistance of the patient.
WHAT ARE THE SEQUENCE OF EVENTS ?
1) When the hair is pulled and infection enters the root, a localized red swelling appears which can be anywhere in the vestibule.
2) As a result of this , there is lymphatic obstruction due to which swelling also appears outside on the tip, lip or side.
3) Suppuration starts in localised swelling.
4) Finally pus drains out and whole inflammatory process subsides.
WHAT ARE THE COMPLICATIONS OF BOIL IN THE NOSE ?
In some unfortunate cases ( very weak thin,low resistant and Diabetic patients ) the inflammatory process spreads and some complications occurs. Inflammatory process may extend to :-
1) The septum leading to septal abscess.
2) The cartilage leading to perichondritis.
3) Retrograde Thrombophlebitis.
4) Cavernous sinus thrombosis.
WHAT ARE THE SIGNS AND SYMPTOMS ?
a) Pain at the vestibule.
c) Swelling of tip and vestibule.
d) Constitutional symptoms ( temperature and patient is toxaemic ).
In complicated cases swelling as well as constitutional symptoms are much more marked. They may be :-
1) Enlarged regional lymph glands.
2) Cord like thickening of thrombosed angular veins.
3) In cavernous sinus thrombosis there is high temperature with rigour.
4) Oedema of the lids.
5) Redness of the eye.
6) Conjunctival ecchymosis.
7) Blurred vision.
8) Eyeball starts coming out. (proptosis ).
9) Complete loss of vision ( due to oedema of retinal veins ).
10) Eye ball can not move ( due to involvement of 3rd,4th and 6th cranial nerves.
12) Complete opthalomoplagia.
All these Symptoms are due to venous obstruction, collection of exudate inside and around the eye ball. The patient is highly toxic and is comatose. The cavernous sinus thrombosis is unilateral to start with but soon becomes bilateral because of inter sinus communications.
WHAT IS THE TREATMENT ?
1) Control the infection as soon as possible.
2) Give adequate doses of appropriate antibiotic. Start with Penicillin if fails then tetracycline.
3) Hot foamentation.
4) Relief of pain.
5) Leave the nose undisturbed, the infection will subside.
6) If complications are setting in they should be quickly treated and for this take the help of
Ophthalmologist and Neurologist.
7) Surgery should not be advised at any cost and should be avoided. In cases of Abscess formed it should be drained in early cases because the inflammation has not localised, incision will open other tissue pains and infection will spread. Un- ripe Boils should not be touched.
8) If there is history of repeated boil Diabetes should be excluded and general health should be improved.