Endocrine Abstracts

Introduction: Necrosis of the nasal pyramid is mainly of traumatic origin, among the other possible causes, those induced by systemic diseases, in particular Wegener’s granulomatosis…We report a case of necrosis of the nasal pyramid secondary to prolonged intubation in a type 1 diabetic.

Observation: Patient T.T, 28 years old, followed for a poorly balanced type 1 diabetes, admitted to a blood clot in a table of diabetic ketoacidosis. The patient was sedated and intubated endo-tracheally. The course was marked by CRP elevation at 68 mg/l, pancytopenia, persistence of acidosis state and rapidly nasal ischemia of the nasal pyramid, facial CT was realized objectifying the filling of the nasal fossae with a hematic material, without any other notable anomaly.

Discussion: Nasal necrosis is one of the maxillofacial complications of prolonged endotracheal intubation. It can also be secondary to many systemic diseases, in particular Wegener’s granulomatosis, systemic lupus erythematosus and/or antiphospholipid syndrome, sarcoidosis or cryglobulinemia. Clinical manifestations are polymorphic and nonspecific, but asymptomatic forms of fortuitous discoveries are common. The various pathophysiological mechanisms evoked are ischemic, infectious and inflammatory.

Conclusion: The maxillofacial complications of prolonged intubation are fortunately rare, but especially if they occur on a precarious vascular site. The treatment of these complications is essentially preventative.