Diseases of external nose


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Diseases of external nose

  2. 2. CELLULITIS <ul><li>The nasal skin may be invaded by streptococci or staphylococci </li></ul><ul><li>leading to red, swollen and tender nose. </li></ul><ul><li>infection from the nasal septum. </li></ul><ul><li>T/t:-Systemic anti-bacterial’s, hot fomentation and analgesics. </li></ul>
  3. 3. NASAL DEFORMITIES:- <ul><li>SADDLE NOSE </li></ul><ul><li>HUMP NOSE </li></ul><ul><li>CROOKED NOSE OR DEVIATED NOSE </li></ul>
  4. 4. SADDLE NOSE:- <ul><li>Depressed nasal dorsum may involve bony, cartilaginous or both. </li></ul><ul><li>Nasal trauma causing depressed fractures is the common cause. Also results from excessive removal of in S.M.R, haematoma or abscess. </li></ul><ul><li>T/t:-Augmentation rhinoplasty (Autograft or synthetic implant). </li></ul>
  5. 5. HUMP NOSE :- <ul><li>This may also involve the bone or cartilage or both bone and cartilage. </li></ul><ul><li>T/t:-Reduction rhinoplasty. </li></ul>
  6. 6. CROOKED NOSE OR DEVIATED NOSE:- <ul><li>In Crooked nose the midline of dorsum from fronto-nasal angle to the tip, is curved in a C or S shaped manner. </li></ul><ul><li>In Deviated nose, the midline is straight but deviated to one side. </li></ul><ul><li>These deformities are usually traumatic in origin. </li></ul><ul><li>T/t:-Septorhinoplasty or Rhinoplasty </li></ul>
  7. 7. TUMOURS <ul><li>1. Congenital </li></ul><ul><li>2. Benign </li></ul><ul><li>3. Malignant </li></ul>
  8. 8. 1. Congenital Tumour <ul><li>DERMOID CYST. </li></ul><ul><li>ENCEPHALOCELE or MENINGOENCEPHALOCELE. </li></ul><ul><li>GLIOMA </li></ul>
  9. 9. DERMOID CYST:- <ul><li>a. Simple dermoid cyst: - It occurs as a midline swelling under the skin but in front of the nasal bones. </li></ul><ul><li>b. Associated with sinus: - It is seen in infants and children and is represented by pit or sinus. </li></ul>
  10. 10. Encephalocele or meningoencephalocele :- <ul><li>It is hernition of brain tissue with meninges through a congenital bony defect.swellings show cough impulse and may be reducible. </li></ul><ul><li>T/t:-Neurosurgical(severing the tumour stalk from the brain and repairing the bony defect though which herniation has taken place). </li></ul>
  11. 11. GLIOMA:- <ul><li>It is a nipped off portion of encephalocele during embryonic development. Most of them are extranasal and present as firm subcutaneous swellings on the,side of the nose or near the inner canthus. </li></ul>
  12. 12. 2.BENIGN TUMOURS <ul><li>They arise from the nasal skin and include papilloma, hemangioma, pigmented naevus, seborrhoeic keratosis, neurofib </li></ul><ul><li>T/t:-Excision and Skin grafting. </li></ul>
  13. 13. 3. Malignant tumours :- <ul><li>Basal cell carcinoma (rodent ulcer). </li></ul><ul><li>Squamous cell carcinoma (epithelioma). </li></ul><ul><li>Melanoma. </li></ul>
  14. 14. Basal cell carcinoma <ul><li>Most common malignant tumour involving skin of nose (87%) </li></ul><ul><li>Equally in males and females of age group 40-60. </li></ul><ul><li>Common sites on nose are tip and the ala. </li></ul><ul><li>It may present as a cyst or papulo-pearly nodule or an ulcer with rolled edges. </li></ul><ul><li>It grows slowly and is confined to skin, underlying bone or cartilage may get invaded. </li></ul><ul><li>Nodal metastases is rare. </li></ul>
  15. 15. <ul><li>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. </li></ul><ul><li>If lesions which are recurrent , extensive or with involvement of cartilage or bone are excised and closed with local or distant flaps or prosthesis. </li></ul>
  16. 16. Squamous cell carcinoma (epithelioma). <ul><li>It’s the second most common malignant tumour (11%). </li></ul><ul><li>Equally affecting both sexes (40-60yrs). </li></ul><ul><li>Occurs as an infiltrating nodule or an ulcer with rolled out edges affecting side of nose or columella. </li></ul><ul><li>Nodal metastases are seen in 205 of cases. </li></ul><ul><li>Early lesions respond to radiotherapy, advanced lesions exposed to bone or cartilage require surgical and plastic repair of the defect. </li></ul><ul><li>Enlarged regional lymph nodes will require block dissection. </li></ul>
  17. 17. Melanoma. <ul><li>It’s the least common variety. </li></ul><ul><li>Clinically it is superficially spreading type or nodular invasive type. </li></ul><ul><li>Treatment is surgical excision. </li></ul>
  18. 18. Diseases of nasal vestibule <ul><li>Furuncle or boil. </li></ul><ul><li>Vestibulitis. </li></ul><ul><li>Stenosis and atresia of the nares. </li></ul><ul><li>Tumours. </li></ul>
  19. 19. Furuncle or boil :- <ul><li>It is an acute infection of the hair follicle by staphylococcus aureus. </li></ul><ul><li>Trauma from picking of the nose or plucking the nasal vibrissae, is the usual predisposing factor. </li></ul><ul><li>The lesion is small,painful and tender. </li></ul><ul><li>Inflammation may spread to skin of nasal tip and dorsum which becomes red and swollen. </li></ul><ul><li>The furuncle may rupture in nasal vestibule. </li></ul>
  20. 20. <ul><li>Treatment consist of warm compresses, analgesics to relieve pain, and topical and systemic antibiotics directed against staphylococcus. </li></ul><ul><li>In case of fluctuant area incision and drainage can be done. </li></ul><ul><li>The furuncle should not be squeezed or prematurely incised because of the danger of spread of infection to cavernous sinus through venous thrombophlebitis. </li></ul><ul><li>A furuncle of nose may complicate into cellulitis of the upper lip or septal abscess. </li></ul>
  21. 21. Vestibulitis :- <ul><li>It is a diffuse dermatitis of nasal vestibule. </li></ul><ul><li>Nasal discharge due to any cause such as rhinitis, sinusitis or nasal allergy, coupled with trauma of handkerchief, is the usual predisposing factor. </li></ul><ul><li>Causative organism is staphylococcus aureus. </li></ul><ul><li>It may be acute or chronic. </li></ul><ul><li>In acute form, skin is red, swollen and tender, crust and scales cover an area of skin erosion. Upper lip may be involved. </li></ul>
  22. 22. <ul><li>In chronic there is a in-duration of vestibular skin with painful fissures and crusting. </li></ul><ul><li>Treatment consists of cleaning nasal vestibule of all crusts and scales with cotton applicator soaked in hydrogen peroxide and application of antibiotic-steroid ointment. </li></ul><ul><li>Chronic fissure can be cauterized with silver nitrate. </li></ul>
  23. 23. Stenosis And Atresia Of The Nares. <ul><li>Accidental or surgical trauma to the nasal tip or vestibule can lead to web formation and stenosis of anterior nares. </li></ul><ul><li>Destructive inflammatory lesions of nose also cause stenosis. </li></ul><ul><li>Earlier vestibular stenosis resulted from smallpox. </li></ul><ul><li>Congenital atresia of anterior nares due to non canalization of epithelial plug is a rare condition. </li></ul>
  24. 24. Stenosis of nares corrected by reconstructive plastic procedures. <ul><ul><li>Naso-alveolar cyst presents a smooth bulge in the lateral wall and floor or nasal vestibule. The cyst can be excised by sublabial approach preserving the integrity of vestibular skin. </li></ul></ul><ul><ul><li>Papiloma or wart may be single or multiple, pedunculated or sessile. Treatment is surgical excision under local anaesthesia. </li></ul></ul><ul><ul><li>Squamous cell carcinoma arises from the lateral wall of the vestibule and may extend into nasal floor, columella and upper lip. Treatment is surgical excision or irradiation. </li></ul></ul>
  25. 25. Trauma of nose: fractures of nose <ul><li>Types of nasal fractures: </li></ul><ul><li>Depressed </li></ul><ul><li>Due to frontal blow </li></ul><ul><li>Collapse of nasal septum </li></ul><ul><li>Widening of nasal dorsum </li></ul><ul><li>Angulated </li></ul><ul><li>Lateral blow </li></ul><ul><li>Fracture of nasal bone and septum with deviation of nasal bridge. </li></ul>Nasal fractures- often accompanied by injuries of nasal septum. Septal hematoma may form.
  26. 26. Clinical features <ul><li>Swelling of nose </li></ul><ul><li>Periorbital ecchymosis </li></ul><ul><li>Tenderness </li></ul><ul><li>Nasal deformity </li></ul><ul><li>Crepitation and mobility of fractured fragments. </li></ul><ul><li>Epitaxis </li></ul><ul><li>Nasal obstruction due to septal injury or hematoma. </li></ul><ul><li>Lacerations of nasal skin, exposure of nasal bones and cartilage. </li></ul>
  27. 27. Diagnosis <ul><li>Treatments </li></ul><ul><li>Treatment should be started during the 1 st hrs following injury. </li></ul><ul><li>Arrest bleeding from injuried tissues </li></ul><ul><li>Tetarus antitoxin should be administered to prevent infection. </li></ul><ul><li>If there is concussion of brain => neurogical treatments should be given. </li></ul><ul><li>Primary surgical treatment of wound: wound margins are not excised, and only non-viable tissues should be removed. Face wounds usually heal quickly due to intensive blood supply. </li></ul><ul><li>Treat with H2O2 and dry the wound </li></ul><ul><li>Join margins of the wound with shortly spaced sutures using fine synthetic ligatures. </li></ul><ul><li>Primary suturing should be done during the course of 24 hrs following the injury. </li></ul><ul><li>Repositioning of displaced bone ragments. </li></ul><ul><li>Laterally displaced – using digital finger, thumb, no anaesthesia, only Novocain can be injected. </li></ul><ul><li>Posteriorly displaced – using nasal elevators. (volkov) </li></ul><ul><li>Fixing by anterior tamponade. </li></ul><ul><li>Paraffin tampon. </li></ul>Physical exam and x-ray
  28. 28. Injuries to paranasal sinuses <ul><li>Frontal sinuses injuries are nore common, next maxillary sinuses and ethmoidal labyrinth. </li></ul><ul><li>Sphenoidal sinuses are rarely injuried. </li></ul>Clinical features: concussion syndrome, nasal syndrome. Injuries to paranasal sinuses with penetration into skull: loss of the consciousness, dizziness, psychic disturbance, vomiting, congestive changes in funds of eye and cardio vascular disfunction.
  29. 29. <ul><li>Changes of sinus </li></ul><ul><li>Accumulation of blood in injuried sinus. </li></ul><ul><li>Subcutaneous emphysema of orbit cyclid, cheek, forehead (bone fracture) during fracture of ethmoid bone. </li></ul><ul><li>Injury to ethmodial labyrinth : hypoosmia / asnomis. </li></ul>
  30. 30. <ul><li>Treatment: </li></ul><ul><li>Arrest bleeding and eliminate shock. </li></ul><ul><li>Complete primary treatment including reposition of bone fracture </li></ul><ul><li>Suturing wound </li></ul><ul><li>Administering antiteranic serum. </li></ul>
  31. 31. <ul><li>Nasal bleeding </li></ul><ul><li>(EPISATAXIS) </li></ul><ul><li>Causes of episataxis : </li></ul><ul><li>local (trauma, infections-viral, foreign body, neoplasm etc.) </li></ul><ul><li>General- (hypertension, arteriosclerosis, disorder of the blood and blood vessels, liver diseases etc) </li></ul><ul><li>idiopathic </li></ul>
  32. 32. <ul><li>Sites of episataxis </li></ul><ul><li>Liltle’s area- anterior inferior part of nasal septum- kiesserbach’s plexus </li></ul><ul><li>Above level of middle turbinate – from anterior and posterior ethmoidal vessels </li></ul><ul><li>Below level of middle turbinate – from artery sphenopalatina. </li></ul><ul><li>Posterior part of nasal cavity – blood flows directly into pharynx. </li></ul><ul><li>Diffuse – both from septum and lateral nasal wall. </li></ul><ul><li>Nasopharynx. </li></ul>
  33. 33. Classifications <ul><li>Anterior episataxis </li></ul><ul><li>More common </li></ul><ul><li>Mostly from liltles area or anterior part of lateral wall </li></ul><ul><li>In childrens/ youngs </li></ul><ul><li>Mostly trauma </li></ul><ul><li>Mild bleeding </li></ul><ul><li>Blood flows out from front of nose in sitting position. </li></ul><ul><li>posterior episataxis </li></ul><ul><li>Less common </li></ul><ul><li>From posterior superior parts of nasal cavity </li></ul><ul><li>40 years </li></ul><ul><li>Spontaneous, hypertension </li></ul><ul><li>Severe bleeding </li></ul><ul><li>Blood flows back into throat. </li></ul>
  34. 34. <ul><li>Clinical features: </li></ul><ul><li>Prodormal disorder : headache, noise in ears, dizziness, itching </li></ul><ul><li>Blood can enter pharynx and is swallowed : profuse haematemesis : decrease in B.P and increase heart rate. </li></ul>Diagnosis : rhinoscopy, pharyngoscopy and inspection of other organs.
  35. 35. <ul><li>Treatment: </li></ul><ul><li>Arrest nasal bleeding – for ex- bleeding at liltle’s area, pinch the nose with thumb and index for 5 min. and cold compress. </li></ul><ul><li>Transfusion of erythrocytes, correction of protein, electrolyte and acid base balance of body. </li></ul><ul><li>Antibiotics to prevent sinusitis. </li></ul><ul><li>Maintain hemodynamics . </li></ul>