DISEASES OF EXTERNAL NOSE AND NASAL CAVITY

1. DISEASES OF EXTERNAL NOSE
AND
NASAL CAVITY
DR HARJITPAL SINGH
ASSISTANT PROFESSOR (ENT)
Dr RKGMC, HAMIRPUR

2. EXTERNAL NOSE

4. DANGEROUS TRIANGLE OF FACE

5. DANGEROUS TRIANGLE OF FACE

6. FURUNCULOSIS OF NOSE
• Nasal furunculosis: It is a minor Staphylococcus aureus
infection involving the follicles of the vibrissae of the
nares and patient presents with redness, excoriation
and fissuring of skin of the vestibule.
• Symptoms and Signs: Severe pain, fever, swelling and
tenderness to touch. In recurrent cases, diabetes
should be ruled out.
• Treatment: Broad-spectrum antibiotics, anti-inflammatory
drugs and local application of antibiotic cream.
Squeezing and surgery should be avoided, as it may
lead to the fatal complication such as cavernous sinus
thrombosis.

7. FURUNCULOSIS OF NOSE
• An acute red,
exquisitely painful
swelling spreading
to the tip and
dorsum of nose

8. FURUNCULOSIS OF NOSE
Complications:
• Cellulitis of the upper lip
• Septal abscess
• Cavernous sinus thrombosis

9. NASAL VESTIBULITIS
• Etiology: This diffuse dermatitis is caused by S. aureus. „
• Predisposing factors:
Nasal discharge due to rhinitis or sinusitis or nasal allergy.
Frequent picking or wiping of nose with handkerchief. „
• Clinical features: Can be of two types—
1.acute
2.chronic.
 Red, painful and tender swelling.
 Crusts and scales.
 Painful Fissure/erosion/excoriation
 The infection may involve upper lip

10. NASAL VESTIBULITIS
When nasal discharge and skin
involvement affect both
nostrils, a vestibulitis (an
eczema of the vestibular
skin) is the probable
diagnosis.

11. NASAL VESTIBULITIS
Treatment:
• Treat the cause of nasal discharge.
• Clean all the crusts and scales with cotton soaked
in hydrogen peroxide and apply antibiotic-
steroid ointment.
• A chronic fissure is cauterized with silver nitrate.

12. DEFORMITIES OF EXTERNAL NOSE
Saddle Nose:
It may be bony, cartilaginous or both. „
Etiology:
1. Depressed nasal fracture is the most common cause.
2. Excessive removal of septum in submucous resection.
3. Septal hematoma.
4. Septal abscess.
5. Granulomatous lesions of nose: Leprosy, tuberculosis
and syphilis.

13. Normal Nose Saddle Nose
DEFORMITIES OF EXTERNAL NOSE

14. DEFORMITIES OF EXTERNAL NOSE
Saddle Nose:
Treatment:
• Augmentation rhinoplasty,
• Cartilage, bone or a synthetic implant.
• Autografts are usually preferred over allografts.
• Septal or auricle cartilage
• Cancellous bone from the iliac crest

15. DEFORMITIES OF EXTERNAL NOSE
Hump Nose:
Hump may involve bone/cartilage/both. „
Treatment:
Reduction rhinoplasty which consists of
exposure of nasal framework by careful
raising of the nasal skin by a vestibular
incision.
Removal of hump and narrowing of
the lateral walls by osteotomies to reduce
the widening left by hump removal.

16. Supratip Depression Humped Nose

17. DEFORMITIES OF EXTERNAL NOSE
Crooked/Deviated Nose:
In crooked nose, nose is curved in either C or S shape
In deviated nose, nose deviated to one side. „
Etiology: Trauma is the most common causes. „
Treatment: Rhinoplasty or septorhinoplasty

18. CROOKED/DEVIATED NOSE

19. CROOKED NOSE

20. DEFORMITIES OF EXTERNAL NOSE
Stenosis and Atresia of Nares:
Etiology
1. Web formation and stenosis may occur after trauma
or surgery of nasal tip or vestibule. In Young’s
operation, which is done in atrophic rhinitis, nares
are deliberately closed with vestibular skin flaps.
2. Destructive inflammatory lesions of nose.
3. Congenital atresia due to non canalization of
epithelial plug. It is rare. „
Treatment: Reconstructive plastic surgery.

21. Classification of Swellings of External
Nose and Vestibule

22. CONGENITAL TUMOURS
Dermoid Cyst Of Nose: Its of two types
1. Simple Dermoid
2. Dermoid cyst with sinus
Simple Dermoid -It occurs as a midline
swelling under the skin but in front of the
nasal bones. It does not have any
external opening.

23. CONGENITAL TUMOURS
Dermoid cyst with sinus
• External pit: Infants and children present with a pit or a
sinus over the dorsum of nose. Hair may be protruding
out from the sinus.
• Dermoid cyst lies between nasal bones and upper part of
septum.
• Intracranial connection: The sinus track communicate
intracranially.
Treatment:
• May necessitate splitting of the nasal bones.
• Combined neurosurgical–otolaryngologic
approach

24. DERMOID CYST OF NOSE

25. DERMOID CYST OF NOSE

26. CONGENITAL TUMOURS
Encephalocele or Meningoencephalocele.
• It is herniation of brain tissue along with its
meninges through a congenital bony
defect.
• An extranasal meningoencephalocele
presents as a subcutaneous pulsatile
swelling in the midline at the root of
nose, side of nose or on the
anteromedial aspect of the orbit.
Swellings show cough impulse and may
be reducible.
• Treatment is neurosurgical.

27. ENCEPHALOCELE OR
MENINGOENCEPHALOCELE.

28. CONGENITAL TUMOURS
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 bridge, side of nose or near the
inner canthus.
• Purely intranasal (30%), while 10% are both
intra and extranasal.
• Extranasal gliomas are encapsulated and can be
easily removed by external nasal approach.

29. GLIOMA

30. NASOLABIAL/ KLESTADT/NASOALVEOLAR CYST
• It is a soft tissue mass with epithelial lining filled with
fluidIt lies on the bone and causes an excavation.
• It is closely attached to the floor of the nose.
• It originates from non odontogenic epithelium
• It presents as a smooth and soft bulge in the lateral
wall and floor of nasal vestibule anterior to
inferior turbinate.
• Large cyst obliterates the alar facial fold .
• The fluctuation and fluid thrill is best felt with one
finger in vestibule and second under the lip. „

31. NASOLABIAL CYST
Theory I :Arises from
entrapped nasolacrimal
tissue.
Klestadt theory: Arise form
entrapped tissue within
naso labial fissures.
Hence he coined the term
fissural cyst

32. NASOLABIAL CYST
Treatment:
• The cyst is excised
through sublabial
approach from
gingivobuccal sulcus
near the midline.
• A portion of nasal
mucosa may be
removed because
cyst is adherent to it.

33. RHINOPHYMA OR POTATO TUMOR
This slow growing benign
tumor occurs due to the hypertrophy of sebaceous
glands in the region of nasal tip. „
Clinical features:
• Most of the patients are men past middle age.
• It is usually seen in long-standing cases of acne
rosacea.
• Patient presents with pink and lobulated mass
over the nose with superficial vascular dilation,
which gives unsightly appearance to the face.

34. RHINOPHYMA OR POTATO TUMOR

35. RHINOPHYMA OR POTATO TUMOR
Treatment:
• Paring down of the bulk of tumor may be done
with sharp knife or carbon dioxide laser.
• The raw area may be allowed to re-epithelialize.
• The complete excision of tumor is usually
followed by skin grafting.

36. PAPILLOMA OR WART OF NOSE
• Clinical features: This may be single or multiple
and pedunculated or sessile. „
• Treatment: It consists of surgical excision, which
is usually done under local anesthesia.

37. BASAL CELL CA (RODENT ULCER)
This most common malignant
tumor of nose skin (87%) equally affects either sex and age
group involve is 40–60 years. „
• Clinical features:
1. Common sites are tip and ala of nose.
2. This slow growing lesion may present as a cyst,
pearly papule, nodule or an ulcer with rolled
edges.
3. The lesion, which remains confined to the skin for a
long time, may invade underlying cartilage or
bone.
4. Lymph node metastasis is extremely rare. „

38. BASAL CELL CA (RODENT ULCER)

39. BASAL CELL CA (RODENT ULCER)
Treatment:
•The extent of surgery depends on the size, location
and depth of the tumor.
•Early lesion: Surgical excision, cryosurgery, or
irradiation. Excision includes 3–5 mm of normal
skin around the tumor mass.
• Recurrent and extensive lesions: The wide
resection of recurrent and extensive lesions
involve cartilage and bone. The large surgical
defect is closed by local or distant flaps or a
prosthesis.

40. SQUAMOUS CELL CA (EPITHELIOMA)
This second most common malignant
tumor of nose skin (11%) equally affects either sexes
and occurs in the age group of 40–60 years. „
Clinical features:
1. It presents as an infiltrating nodule or an ulcer
with rolled out edges.
2. The common sites are lateral wall of the vestibule
and columella. It which may extend into
nasal floor and upper lip.
3. Nodal metastases to parotid/ submandibular
nodes are seen in 20% cases.

41. SQUAMOUS CELL CA (EPITHELIOMA)

42. SQUAMOUS CELL CA (EPITHELIOMA)
Treatment:
1. Early lesion: It responds well to radiotherapy.
2. Advanced lesions: Advanced lesions, which
involve bone or cartilage, need wide surgical
excision and plastic repair of the defect.
3. Metastatic cervical lymph nodes: They require
block dissection.

43. MELANOMA NOSE
• Clinical features: This slow growing, rare lesion
may present as superficially spreading type
or nodular invasive type. „
• Treatment: It is treated with surgical excision.

44. HAEMANGIOMA NOSE

45. HAEMANGIOMA NOSE
• Hemangiomas are the most common soft tissue tumors of
infancy.
• Almost 60% of these tumors develop in the head and neck
region.
• Intralesional corticosteroids, laser may accelerate
involution.
• The first line of treatment for large nasal hemangiomas is
intralesional corticosteroids.
• Excision is indicated for small hemangiomas.
• While subtotal excision is preferable for large nasal
hemangiomas.

46. FOREIGN BODIES IN THE NOSE
• Foreign bodies may be organic such as wood,
paper, cotton foam or rubber and inorganic
such as metal, button, beads, plastic.
• Unilateral foul-smelling discharge in a child is
pathognomonic of a foreign body.
• Treatment is removal under LA/GA

47. FOREIGN BODIES IN THE NOSE
Rhinolithiasis:
• In rhinolithiasis calcareous masses result due to
deposition of salts such as calcium and
magnesium carbonates and phosphates
around the nucleus of a foreign body.
• Treatment is removal under GA or LA and most
of the time by breaking these into small
pieces

48. RHINOLITH

49. FOREIGN BODIES IN THE NOSE
Myiasis:
• It results from the presence of ova of flies in the
nose, which produce ulceration and destruction
of nasal structure mostly seen in atrophic
rhinitis, when the mucosa becomes insensitive
to the flies laying eggs inside.
• Treatment consists of putting chloroform or
turpentine oil or maggot oil in the nose and
plugging the nasal cavities, which makes the
maggots to crawl out of the nose

50. CONGENITAL CONDITIONS
Posterior Choanal Atresia:
• Posterior choanal atresia results from failure of
absorption of buccopharyngeal membrane
during fetal life.
•Incidence is 1 in 60,000 live births. Atresia may be
bony (90%) or membranous (10%), unilateral
or bilateral.
•If bilateral, the child presents as an emergency
and child may have cyanosis.

51. CONGENITAL CONDITIONS
Posterior Choanal Atresia:
•Malformations of anterior nares are also seen alone
or with some other malformations.
•Undetected unilateral choanal atresia is an unusual
anomaly that can result from bony or
membranous obstruction of the posterior nose.
•The diagnosis can be made readily in the office by
attempting to pass a soft catheter through the
nose or by instilling a small amount of
methylene blue in the nostril being examined.