Ext nose


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This presentation discusses various disorders involving external nose

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Ext nose

  1. 1. Conditions involving external nose Dr T Balasubramanian
  2. 2. Importance of nose <ul><li>Nose is the most prominent portion of face </li></ul><ul><li>More prone for injuries </li></ul><ul><li>Disorders of external nose could be a indicator of a systemic disorder </li></ul>
  3. 3. Introduction <ul><li>Disorders of external nose commonly involves skin </li></ul><ul><li>Whole of dorsum of nose is skin lined </li></ul><ul><li>The vestibule of the nose is skin lined </li></ul><ul><li>Since the common problems involve the skin in this area a recap of dermatological terms is a must </li></ul>
  4. 4. Dermatological terms <ul><li>Macule – This is a flat lesion within the skin </li></ul><ul><li>Papule – Circumscribed raised lesion of dermis / epidermis less than 1 cm in diameter </li></ul><ul><li>Nodule – This is a papule greater than 1cm in diameter </li></ul><ul><li>Plaque – Is a large superficial lesion whose surface area is greater than that of its height and its margins are irregular </li></ul>
  5. 5. Acute nasal infections <ul><li>Bacterial – Vestibulitis, Erysepelas, and impetigo </li></ul><ul><li>Viral – Herpes, Warts, Molluscum contagiosum, Measles </li></ul>
  6. 6. Acute vestibulitis <ul><li>Infection of nasal vestibular skin </li></ul><ul><li>Commonly arises from hair bearing region of vestibule </li></ul><ul><li>Staph aureus is the commonly involved organism </li></ul><ul><li>Common in children due to nose picking </li></ul>
  7. 7. Acute vestibulitis symptoms <ul><li>Severe pain </li></ul><ul><li>Fever </li></ul><ul><li>Swelling </li></ul><ul><li>Tenderness </li></ul><ul><li>In recurrent vestibulitis diabetes to be ruled out </li></ul>
  8. 8. Vestibulitis treatment <ul><li>Broad spectrum antibiotics </li></ul><ul><li>Antiinflammatory drugs </li></ul><ul><li>Local application of antibiotic cream </li></ul><ul><li>Squeezing to be avoided – could cause cavernous sinus thrombosis </li></ul>
  9. 9. Dangerous area of face <ul><li>Infection can traverse via the valveless facial vein </li></ul><ul><li>Via its supraorbital and superior ophthalmic branches spread to cavernous sinus </li></ul>
  10. 10. Impetigo <ul><li>Superficial contageous infection involving the skin of the vestibule </li></ul><ul><li>Group A streptococcus is involved </li></ul><ul><li>Two forms bullous and non bullous forms </li></ul><ul><li>Staphylococcal infection leads to widespread shedding of epidermis (scalded skin syndrome / Lyell's disease) </li></ul>
  11. 11. Erysipelas <ul><li>Acute infection of skin lined vestibule </li></ul><ul><li>Streptococcus implicated </li></ul><ul><li>It enters via fissures in the skin </li></ul><ul><li>Pain, heat, swelling and vesiculation </li></ul><ul><li>Peau d ' orange appearance </li></ul>
  12. 12. Herpes simplex lesions <ul><li>Type I Herpes virus is involved </li></ul><ul><li>Lips, perioral region and cheek involved </li></ul><ul><li>Infections from this area spreads to involve the vestibule of the nose </li></ul><ul><li>Antibiotics help in preventing secondary infections </li></ul>
  13. 13. Herpes zoster lesions <ul><li>This virus is responsible for chicken pox lesion </li></ul><ul><li>Involvement of maxillary division of V nerve causes vesicles over cheek and nasal vestibule areas </li></ul><ul><li>Infection gets transmitted via fluid present in the vesicles </li></ul>
  14. 14. HPV infections <ul><li>Warts </li></ul><ul><li>Localised neoplastic growth of epidermis </li></ul><ul><li>Self limiting </li></ul><ul><li>Cryotherapy / cauterization </li></ul>
  15. 15. Lesions formed by HPV <ul><li>Warts </li></ul><ul><li>Three types of lesions are possible </li></ul><ul><li>Hyperkeratotic lesions, verruca vulgaris, common wart </li></ul><ul><li>All these lesions appear raised </li></ul><ul><li>Usually self limiting </li></ul>
  16. 16. Wart Verruca vulgaris
  17. 17. Molluscum contagiosum <ul><li>DNA virus of Pox group is involved </li></ul><ul><li>Appears as small papules white and waxy with a dome </li></ul><ul><li>Not contagious </li></ul><ul><li>Self limiting </li></ul><ul><li>Can be cauerized </li></ul>
  18. 18. Chronic infections <ul><li>Vestibulitis </li></ul><ul><li>Lupus vulgaris </li></ul><ul><li>Syphilis </li></ul><ul><li>Lupus erythematosis </li></ul><ul><li>Acne rosacea </li></ul>
  19. 19. Chronic vestibulitis <ul><li>Repeated fissuring of vestibule </li></ul><ul><li>Crust formation </li></ul><ul><li>Epistaxis is possible when the pt rubs the nose </li></ul><ul><li>Diabetes to be excluded </li></ul>
  20. 20. Lupus vulgaris <ul><li>This is a type of cutaneous tuberculosis involving the skin of the vestibule </li></ul><ul><li>Direct inoculation of skin causes scrofuloderma </li></ul><ul><li>Post primary tuberculosis </li></ul><ul><li>Initially lesions are nodular resembling apple jelly hence the term apple jelly nodules </li></ul><ul><li>Extensive tissue destruction is seen causing nasal deformities. </li></ul><ul><li>Nasal cartilages are predominantly destroyed </li></ul>
  21. 21. Syphilis <ul><li>Primary syphilis involving the vestibule is common </li></ul><ul><li>Firm painless nodule </li></ul><ul><li>Rubbery cervical adenopathy </li></ul><ul><li>Rhinitis ”syphlitic snuffles” </li></ul><ul><li>Secondary syphilis causes vestibular skin fissuring </li></ul><ul><li>Tertiary syphilis in the form of gumma is common in the nose. There is extensive bony destruction. </li></ul><ul><li>Tenderness over bridge of nose & nocturnal pain </li></ul>
  22. 22. Congenital syphilis <ul><li>Presents within few weeks after birth </li></ul><ul><li>Purulent rhinorrhoea ”Snuffles” </li></ul><ul><li>Fissuring around vestibule </li></ul><ul><li>Saddling of nose is seen at the age of 3-4 </li></ul>
  23. 23. Yaws <ul><li>Extragenital infection of T Pertenue </li></ul><ul><li>Common in children of Africa </li></ul><ul><li>Extensive disease can lead to midfacial destruction </li></ul><ul><li>Gondou type of yaws causing bilateral rounded swelling of nasal process of maxilla </li></ul>
  24. 24. Lupus erythematosis <ul><li>Autoimmune disorder </li></ul><ul><li>Multi organ disorder </li></ul><ul><li>Involves skin in the vestibule </li></ul><ul><li>Photosensitivity </li></ul>
  25. 25. Acne rosacea <ul><li>Involves the skin over the face </li></ul><ul><li>Skin lining of the nasal vestibule is also involved </li></ul><ul><li>Skin shows reddish patches with ruptured subcutaneous blood vessels </li></ul><ul><li>Nose becomes red and bulbous </li></ul><ul><li>Burning / stinging sensation over face + </li></ul><ul><li>Avoid exposure to sun </li></ul>
  26. 26. Neoplasms <ul><li>Benign – Papilloma, Kerata acanthoma </li></ul><ul><li>Malignant – Rodent ulcer, sq cell carcinoma </li></ul>
  27. 27. Keratoacanthoma <ul><li>Benign tumor arising from hair follicles of skin over the nose </li></ul><ul><li>Skin exposed to sun causes more problems </li></ul><ul><li>Presents are firm, round, reddish / flesh colored lesion </li></ul><ul><li>Lesion may turn globular and may present with a horny central keratotic plug </li></ul><ul><li>Shedding of this plug signals recovery </li></ul>
  28. 28. Traumatic conditions <ul><li>Fracture nose </li></ul><ul><li>Septal hematoma </li></ul><ul><li>Saddle nose </li></ul>
  29. 29. Fracture nose <ul><li>May be with or without displacement </li></ul><ul><li>Deformity of dorsum of nose </li></ul><ul><li>Tenderness / Swelling over nasal bone area / crepitus </li></ul><ul><li>X-ray nasal bones may reveal # </li></ul><ul><li>Closed reduction is preferred </li></ul>
  30. 30. Septal hematoma / abscess <ul><li>May be caused by injuries / surgery in the nasal septal area </li></ul><ul><li>Bilateral swelling of nasal septum with nasal block </li></ul><ul><li>Perichondrium stripped away from the cartilage </li></ul><ul><li>Cartilage necrosis occur within 36 hours if not drained </li></ul><ul><li>Hematoma may give rise to septal abscess </li></ul>
  31. 31. Saddle nose <ul><li>Occurs due to destruction of the bridge of nose </li></ul><ul><li>Destruction of osseous / cartilagenous portion of the bridge of nose </li></ul><ul><li>Septal abscess / syphilis involving the nose may cause this problem </li></ul>
  32. 32. Foreign bodies <ul><li>Inanimate </li></ul><ul><li>Animate </li></ul><ul><li>Rhinolith </li></ul>
  33. 33. Conditions involving nasal septum <ul><li>Deviated nasal septum </li></ul><ul><li>Dislocation of anterior portion of nasal septum </li></ul><ul><li>Septal perforatrion </li></ul>
  34. 34. Congenital conditions <ul><li>Nasal dermoid </li></ul><ul><li>Gliomas </li></ul><ul><li>Choanal atresia </li></ul>
  35. 35. Thankyou