Intracranial Suppuration Secondary to Disease of the Nasal Septum: A Survey of the Literature; A Report of Cases and Animal Experiments

Abstract

There are many causes of secondary intracranial suppurations, not a few being of primary nasal origin. Of the latter group those infections having their origin within the structure of the nasal septum will be considered in this study. During the past several decades a number of excellent reports of cases of this type have appeared in the literature, but an extensive search fails to uncover a survey in which any great number of these reports have been collected and their findings correlated. It is the purpose of this contribution to attempt to organize the data in these various reports so that definite conclusions as to incidence, causes, pathogenesis and other considerations may be drawn. The compilations of Loeb 1 were an excellent start in this direction.As a basis for this thesis, reports of 52 fatal and 4 nonfatal cases of intracranial suppuration associated with septal infection were collected from the literature and studied.2 It is evident that not all of these could be proved to be in¬ stances of primary septal origin and in certain instances even the actual presence of intracranial infection must be doubted. Two fatalities follow¬ ing submucous resection of the nasal septum were studied from the records of the White Me¬ morial Hospital. In the case of one of these an intranasal ethmoidectomy was also done. I was privileged to see the third patient whose case I report, with Drs. T. T. Cunningham and Cyril . Courville, who have permitted me to report it. PRIMARY SEPTAL LESIONSOf the primary conditions that result in intra¬ cranial extension of infection, abscess of the nasal septum and submucous resection of the septum are probably the most common. With these con¬ ditions must be considered certain intermediate associated lesions that result in intracranial suppuration. Other rare primary conditions will also be mentioned.Abscess of the Nasal Septum.-Hirschfeld 3 studied 3,489 cases of septal abscess and found that in about 75 per cent it was secondary to trauma. A blow on the nose results in fracture of the cartilage or of the bone, usually with lac¬ eration of the septal mucosa. If a subperichondrial or a subperiosteal hematoma forms, or¬ ganisms may invade the hematoma via the lacer¬ ated areas, and an abscess may then result.Septal abscess may follow submucous resec¬ tion.4 However, in many cases this type of ab¬ scess is hardly comparable to those not associated with surgical trauma ; it might better be described merely as a suppurative process between the sep¬ tal flaps or in the operative wound which some¬ times becomes walled off as a localized abscess.Septal abscesses of dental origin may be the result of infection of a root cyst5 or may result from alveolar caries.6 Septal abscess following in¬ fluenza has been reported by Rudakoff7 and others. A more rare primary cause of septal ab-