“DISEASES OF EXTERNAL NOSE & NASAL VESTIBULE”.

CELLULITIS• The nasal skin may be invaded

by streptococci or staphylococci

• leading to red, swollen and tender nose.

• Infection is mostly extending from the nasal vestibule.

• Treatment:-Systemic anti-bacterial’s, hot fomentation and analgesics.

NASAL DEFORMITIES:-

• SADDLE NOSE

• HUMP NOSE

• CROOKED NOSE OR DEVIATED NOSE

SADDLE NOSE:-• Depressed nasal dorsum may

involve bony, cartilaginous or both.

• Aetiology :- Nasal trauma causing depressed fractures, excessive removal of septum in S.M.R, destruction of septal cartilage by haematoma/abscess, syphilis, leprosy& tuberculosis

TREATMENT:

:Augmentation rhinoplasty

: Cartilge deformity is corrected by taking implant from nasal septum or auricle

: Bony deformity is corrected by taking implant from iliac crest

: Autografts are preferred over allografts

: Silicone or teflon implants can be used

HUMP NOSE:-

• This may also involve the bone or cartilage or both bone and cartilage.

• TREAMENT :-Reduction rhinoplasty.

• Raising of nasal skin by vestibuar incision,removal of hump & narrowing of lateral wall by osteotomies to reduce the widening left by hump removal

CROOKED NOSE OR DEVIATED NOSE:-

• In Crooked nose the midline of dorsum from fronto-nasal angle to the tip, is curved in a C or S shaped manner.

• In Deviated nose, the midline is straight but deviated to one side.

• These deformities are usually traumatic in origin.

• TREATMENT :- Septorhinoplasty or Rhinoplasty

TUMOURS

• 1. Congenital

• 2. Benign

• 3. Malignant

1.Congenital Tumour

• DERMOID CYST.

• ENCEPHALOCELE or MENINGOENCEPHALOCELE.

• GLIOMA

DERMOID CYST:-

• a. Simple dermoid cyst: - It occurs as a midline swelling under the skin but in front of the nasal bones without any external opening

• b. Associated with sinus: - It is seen in infants and children and is represented by pit or sinus.

Encephalocele or meningoencephalocele :-

• It is hernition of brain tissue with meninges through a congenital bony defect.

• swellings are pulsatile ,show cough impulse and may be reducible.

• Presenting at root of nose ( nasofrontal), side of nose (nasoethmoid),or anteromedial aspect of orbit(naso-orbital)

• TREATMENT:-Neurosurgical severing of the tumour stalk from the brain and repairing the bony defect though which herniation has taken place.

GLIOMA:-

• It is a nipped off portion of encephalocele during embryonic development.

• Most of them(60%) are extranasal and present as firm subcutaneous swellings on the, side of the nose or near the inner canthus or the bridge. They are encapsulated & can be easily removed by external nasal approach

• 30% are purely intra nasal while 10% are both extranasal & intra nasal.

BABY WITH

GLIOMA

2.BENIGN TUMOURS

• They arise from the nasal skin and include

• A) PAPILLOMA• B) HAEMANGIOMA• C) SEBORRHOEIC KERATOSIS• D) NEUROFIBROMA• E) TUMOUR OF SWEAT GLAND

RHINOPHYMA

• Also known as potato tumour, is a slow growing benign tumour due to hypertrophy of sebaceous glands of the tip of nose as a complication of long standing acne rosacea

• Mostly effects middle aged men & presents as a pink lobulated mass over the nose with superficial vascular dilation, causing obstruction in breathing & vision

• TREATMENT:- Excision of bulk of tumour with sharp knife or carbon dioxide laser

MALE WITH RHINOPHYMA

3. Malignant tumours :-

• Basal cell carcinoma (rodent ulcer).

• Squamous cell carcinoma (epithelioma).

• Melanoma.

Basal cell carcinoma• Most common malignant

tumour involving skin of nose (87%)

• Equally in males and females of age group 40-60.

• Common sites on nose are tip and the ala.

• It may present as a cyst or papulo-pearly nodule or an ulcer with rolled edges.

• It grows slowly and is confined to skin, underlying bone or cartilage may get invaded.

• Nodal metastases is rare.

• TREATMENT:-

• Depends on the size, location and depth of the tumour.

• Early lesions can be cured by cryosurgery, irradiation or surgical excision with 3-5mm of skin around palpable borders of the tumour.

• If lesions which are recurrent, extensive or with involvement of cartilage or bone are excised and closed with local or distant flaps or prosthesis.

Squamous cell carcinoma (epithelioma).

• It’s the second most common malignant tumour (11%).

• Equally affecting both sexes (40-60yrs).• Occurs as an infiltrating nodule or an ulcer with

rolled out edges affecting side of nose or columella.

• Nodal metastases are seen in 20% of cases.

• TREATMENT :-Early lesions respond to radiotherapy, advanced lesions with exposureto bone or cartilage require wide surgical excision and plastic repair of the defect.

• Enlarged regional lymph nodes will require block dissection.

Melanoma.

• It’s the least common variety.

• Clinically it is superficially spreading type or nodular invasive type.

• Treatment is surgical excision.

Diseases of nasal vestibule

• Furuncle or boil.

• Vestibulitis.

• Stenosis and atresia of the nares.

• Tumours.

Furuncle or boil :-• It is an acute infection of the hair

follicle by staphylococcus aureus.• Trauma from picking of the nose

or plucking the nasal vibrissae, is the usual predisposing factor.

• The lesion is small,painful and tender.

• Inflammation may spread to skin of nasal tip and dorsum which becomes red and swollen.

• The furuncle may rupture in nasal vestibule.

TREATMENT:- consist of warm compresses, analgesics to relieve

pain, and topical and systemic antibiotics directed against staphylococcus.

• In case of fluctuant area incision and drainage can be done.

• The furuncle should not be squeezed or prematurely incised because of the danger of spread of infection to cavernous sinus through venous thrombophlebitis.

• A furuncle of nose may complicate into cellulitis of the upper lip or septal abscess.

Vestibulitis :-• It is a diffuse dermatitis of nasal vestibule.• Nasal discharge due to any cause such as rhinitis,

sinusitis or nasal allergy, coupled with trauma of handkerchief, is the usual predisposing factor.

• Causative organism is staphylococcus aureus.• It may be acute or chronic.• In acute form, skin is red, swollen and tender, crust

and scales cover an area of skin erosion. Upper lip may be involved.

PATIENT WITH VESTIBULITIS

In chronic there is a in-duration of vestibular skin with painful fissures and crusting.

• TREATMENT:-

• Consists of cleaning nasal vestibule of all crusts and scales with cotton applicator soaked in hydrogen peroxide and application of antibiotic-steroid ointment.

• Chronic fissure can be cauterized with silver nitrate.

Stenosis & atresiaof the Nares.• Accidental or surgical

trauma to the nasal tip or vestibule can lead to web formation and stenosis of anterior nares.

• Destructive inflammatory lesions of nose also cause stenosis.

• Earlier vestibular stenosis resulted from several cases of smallpox.

• Congenital atresia of anterior nares due to non canalization of epithelial plug is a rare condition.

• TREATMENT:- It is corrected by reconstructive plastic procedures

NASAL VESTIBULAR TUMOURS

– NASOALVEOLAR CYST:- It presents a smooth bulge in the lateral wall and floor oF nasal vestibule. The cyst can be excised by sublabial approach preserving the integrity of vestibular skin.

– PAPILLOMA OR WART:- It may be single or multiple, pedunculated or sessile. Treatment is surgical excision under local anaesthesia.

– SQUAMOUS CELL CARCINOMA:- It arises from the lateral wall of the vestibule and may extend into nasal floor, columella and upper lip. Treatment is surgical excision or irradiation.

THANK YOU

Dr. SYED REHMATHULLAH