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  • 1. “ DISEASES OF EXTERNAL NOSE & NASAL VESTIBULE”.
  • 2. CELLULITIS
    • The nasal skin may be invaded by streptococci or staphylococci
    • leading to red, swollen and tender nose.
    • infection from the nasal septum.
    • T/t:-Systemic anti-bacterial’s, hot fomentation and analgesics.
  • 3. NASAL DEFORMITIES:-
    • SADDLE NOSE
    • HUMP NOSE
    • CROOKED NOSE OR DEVIATED NOSE
  • 4. SADDLE NOSE:-
    • Depressed nasal dorsum may involve bony, cartilaginous or both.
    • Nasal trauma causing depressed fractures is the common cause. Also results from excessive removal of in S.M.R, haematoma or abscess.
    • T/t:-Augmentation rhinoplasty (Autograft or synthetic implant).
  • 5. HUMP NOSE :-
    • This may also involve the bone or cartilage or both bone and cartilage.
    • T/t:-Reduction rhinoplasty.
  • 6. 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.
    • T/t:-Septorhinoplasty or Rhinoplasty
  • 7. TUMOURS
    • 1. Congenital
    • 2. Benign
    • 3. Malignant
  • 8. 1. Congenital Tumour
    • DERMOID CYST.
    • ENCEPHALOCELE or MENINGOENCEPHALOCELE.
    • GLIOMA
  • 9. DERMOID CYST:-
    • a. Simple dermoid cyst: - It occurs as a midline swelling under the skin but in front of the nasal bones.
    • b. Associated with sinus: - It is seen in infants and children and is represented by pit or sinus.
  • 10. Encephalocele or meningoencephalocele :-
    • It is hernition of brain tissue with meninges through a congenital bony defect.swellings show cough impulse and may be reducible.
    • T/t:-Neurosurgical(severing the tumour stalk from the brain and repairing the bony defect though which herniation has taken place).
  • 11. GLIOMA:-
    • 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.
  • 12. 2.BENIGN TUMOURS
    • They arise from the nasal skin and include papilloma, hemangioma, pigmented naevus, seborrhoeic keratosis, neurofib
    • T/t:-Excision and Skin grafting.
  • 13. 3. Malignant tumours :-
    • Basal cell carcinoma (rodent ulcer).
    • Squamous cell carcinoma (epithelioma).
    • Melanoma.
  • 14. 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.
  • 15.
    • 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.
  • 16. 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 205 of cases.
    • Early lesions respond to radiotherapy, advanced lesions exposed to bone or cartilage require surgical and plastic repair of the defect.
    • Enlarged regional lymph nodes will require block dissection.
  • 17. Melanoma.
    • It’s the least common variety.
    • Clinically it is superficially spreading type or nodular invasive type.
    • Treatment is surgical excision.
  • 18. Diseases of nasal vestibule
    • Furuncle or boil.
    • Vestibulitis.
    • Stenosis and atresia of the nares.
    • Tumours.
  • 19. 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.
  • 20.
    • 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.
  • 21. 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.
  • 22.
    • 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.
  • 23. Stenosis And Atresia Of 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 smallpox.
    • Congenital atresia of anterior nares due to non canalization of epithelial plug is a rare condition.
  • 24. Stenosis of nares corrected by reconstructive plastic procedures.
      • 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.
      • Papiloma or wart may be single or multiple, pedunculated or sessile. Treatment is surgical excision under local anaesthesia.
      • 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.
  • 25. Trauma of nose: fractures of nose
    • Types of nasal fractures:
    • Depressed
    • Due to frontal blow
    • Collapse of nasal septum
    • Widening of nasal dorsum
    • Angulated
    • Lateral blow
    • Fracture of nasal bone and septum with deviation of nasal bridge.
    Nasal fractures- often accompanied by injuries of nasal septum. Septal hematoma may form.
  • 26. Clinical features
    • Swelling of nose
    • Periorbital ecchymosis
    • Tenderness
    • Nasal deformity
    • Crepitation and mobility of fractured fragments.
    • Epitaxis
    • Nasal obstruction due to septal injury or hematoma.
    • Lacerations of nasal skin, exposure of nasal bones and cartilage.
  • 27. Diagnosis
    • Treatments
    • Treatment should be started during the 1 st hrs following injury.
    • Arrest bleeding from injuried tissues
    • Tetarus antitoxin should be administered to prevent infection.
    • If there is concussion of brain => neurogical treatments should be given.
    • 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.
    • Treat with H2O2 and dry the wound
    • Join margins of the wound with shortly spaced sutures using fine synthetic ligatures.
    • Primary suturing should be done during the course of 24 hrs following the injury.
    • Repositioning of displaced bone ragments.
    • Laterally displaced – using digital finger, thumb, no anaesthesia, only Novocain can be injected.
    • Posteriorly displaced – using nasal elevators. (volkov)
    • Fixing by anterior tamponade.
    • Paraffin tampon.
    Physical exam and x-ray
  • 28. Injuries to paranasal sinuses
    • Frontal sinuses injuries are nore common, next maxillary sinuses and ethmoidal labyrinth.
    • Sphenoidal sinuses are rarely injuried.
    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.
    • Changes of sinus
    • Accumulation of blood in injuried sinus.
    • Subcutaneous emphysema of orbit cyclid, cheek, forehead (bone fracture) during fracture of ethmoid bone.
    • Injury to ethmodial labyrinth : hypoosmia / asnomis.
  • 30.
    • Treatment:
    • Arrest bleeding and eliminate shock.
    • Complete primary treatment including reposition of bone fracture
    • Suturing wound
    • Administering antiteranic serum.
  • 31.
    • Nasal bleeding
    • (EPISATAXIS)
    • Causes of episataxis :
    • local (trauma, infections-viral, foreign body, neoplasm etc.)
    • General- (hypertension, arteriosclerosis, disorder of the blood and blood vessels, liver diseases etc)
    • idiopathic
  • 32.
    • Sites of episataxis
    • Liltle’s area- anterior inferior part of nasal septum- kiesserbach’s plexus
    • Above level of middle turbinate – from anterior and posterior ethmoidal vessels
    • Below level of middle turbinate – from artery sphenopalatina.
    • Posterior part of nasal cavity – blood flows directly into pharynx.
    • Diffuse – both from septum and lateral nasal wall.
    • Nasopharynx.
  • 33. Classifications
    • Anterior episataxis
    • More common
    • Mostly from liltles area or anterior part of lateral wall
    • In childrens/ youngs
    • Mostly trauma
    • Mild bleeding
    • Blood flows out from front of nose in sitting position.
    • posterior episataxis
    • Less common
    • From posterior superior parts of nasal cavity
    • 40 years
    • Spontaneous, hypertension
    • Severe bleeding
    • Blood flows back into throat.
  • 34.
    • Clinical features:
    • Prodormal disorder : headache, noise in ears, dizziness, itching
    • Blood can enter pharynx and is swallowed : profuse haematemesis : decrease in B.P and increase heart rate.
    Diagnosis : rhinoscopy, pharyngoscopy and inspection of other organs.
  • 35.
    • Treatment:
    • Arrest nasal bleeding – for ex- bleeding at liltle’s area, pinch the nose with thumb and index for 5 min. and cold compress.
    • Transfusion of erythrocytes, correction of protein, electrolyte and acid base balance of body.
    • Antibiotics to prevent sinusitis.
    • Maintain hemodynamics .