This document discusses various congenital malformations and abnormalities of the nose, including choanal atresia, dermoid cysts, gliomas, and bifid nose. It provides details on symptoms, diagnosis, and treatment options for these conditions. Choanal atresia involves closure of the posterior nares and can cause respiratory distress in bilateral cases. Dermoid cysts are congenital midline cysts on the nose dorsum that may require excision. Gliomas are intra-nasal tumors that do not increase in size with coughing. Treatment options discussed include surgical procedures like excision or reconstruction with grafts.

1. And
Congenital Malformations of Nose

2.  Choanal Atresia
 Dermoid Cyst
 Glioma
 Meningoencephalocele
 Bifid Nose
 Occlusion of anterior nares
 Sinus and Fistula

3.  Closure of posterior nares
 Failure of bucconasal/buccopharyngeal membrane to
rupture at 7th – 8th week of gestation
 Right side mc
 F:M = 2:1
 Rare 1 in 7000 births
 Types – Bony (90%), Membranous or both
 Complete/Incomplete (mc)
 U/L (mc) or B/L
 CHARGE Syndrome – Coloboma (eyes), TOF, PDA (heart),
Atresia (choana), retarded growth, genital anomalies, Ear
anomalies – external ear, ossicles, scc, SNHL/MHL
 Other anomalies – cleft lip and palate, tracheo esophageal
fistula

5.  C/F
 U/L
 Asymptomatic, only during URTI
 U/L Nasal obstruction, Nasal discharge
 Cant blow nose through affected side
 Mouth breathers (adults)
 B/L
 At birth – asphyxia, cyanosis, respiratory distress, failure
to thrive - life threatening (Obligatory nasal breathers),
mouth breathing only after 4-6 weeks of age
 Cyclic asphyxia – becomes better on crying
 Aggravated on feeding, suckling
 Persistant nasal obstruction not responding to
decongestants

6.  Diagnosis
 Probing with catheter – cant pass
 Cold spatula test
 Posterior rhinoscopy
 Diagnostic nasal endoscopy
 Drop of methylene blue in nose – don’t come
out into pharynx
 Contrast X ray lateral view – radio opaque
choana
 CT Scan axial cuts – to know the extent, type

7.  Treatment
 Excision – transpalatal approach (18 months
age), transnasal endoscopic approach (10
weeks age) – rupture the membrane
 Relieve distress (B/L) - endotracheal
intubation, tracheostomy, Mc Govern’s nipple
– rubber tube with holes for breathing and
feeding

8.  Congenital midline cystic swelling on the dorsum of
nose in the line of fusion b/w nasal tip to glabella
 Contains epithelial lining and dermal structures
 Simple/with sinus opening
 C/F
 Fluctuating cystic swelling +/- sinus opening with
hair protrusion in sinus in infants and children
 Compressible
 Extranasal (dorsum), Intranasal (nasal obstruction)
 Diagnosis – CT Scan (rule out intracranial extension)
 Treatment - Excision

10.  Congenital malformation
 Extra nasal – solid tumour with swelling over
bridge of nose (mc)
 Intra nasal – nasal polyp, doesn’t increase in
size on coughing (cough impulse negative)
 Lost their intracranial connection
 Furstenberg sign - negative
 Treatment - Excision

11.  Herniation of brain tissue through a
congenital bony defect
 Swelling increase in size on straining and
coughing (cough impulse positive)
 Intracranial connection – present
 Furstenberg sign – positive – increase in size
on compression of IJV

12.  Saddle nose
 Hump nose
 Crooked nose
 Nasal tip deformities (bulbous tip, narrow tip,
bifid tip, rotated tip, over projected tip,
underprojected tip)

13.  Depressed dorsum of nose
 Trauma – RTA, assault, sports injury, fall,
iatrogenic ( septal surgery)
 Infective – Syphilis, TB, Leprosy
 Septal haematoma/ abscess
 Bony/cartilaginous/both
 Treatment – Augmentation rhinoplasty – where
the defect is augmented by cartilage (septal,
concha, tragus) bone (iliac crest), synthetic
material (silicone, teflon)
 Preferred - autografts

15.  Excess bone or cartilage over dorsum
 Racial ( North India)
 Treatment – Reduction rhinoplasty – excess
bone and cartilage are resected along with
osteotomy – to narrow the nasal bridge

16.  Midline of dorsum is deviated to either side
 C shaped/ S shaped/ undefined
 Cartilage/ bony
 Associated with DNS
 Treatment
 Septorhinoplasty with osteotomy – medial
and lateral

17.  INFECTIONS
 Vestibulitis
 Furunculosis
 Erysipelas
 TUMOURS
 Rhinophyma
 Basal cell carcinoma

18.  Diffuse dermatitis of nasal vestibule
 Etiology
 Staph aureus
 Persistent infected nasal discharge due to
rhinitis or sinusitis
 Nose picking
 Rubbing the nose
 Irritation and maceration of vestibular skin
 Traumatic ulcer
 Types – acute/chronic

19.  C/F
 Acute
 Red, swollen, tender skin with itching and
pain, irritation, headache
 Crusts, scales, painful fissures, erosion or
excoriation
 Chronic
 Induration of vestibular skin with painful
fissures and swelling
 Leucocyte count – leucocytosis and
neutrophilia

20.  Treatment
 Clean the vestibule of crusts and scales of
cotton soaked in H2O2.
 Suctioning of nasal discharge
 Local application of soframycin/ mupirocin/
chlorhexidine ointment, petroleum jelly,
steroid preparations
 Cauterization with Silver nitrate (chronic)

21.  Localised acute inflammation of nasal
vestibule due to infection of hair follicles
caused by Staph aureus
 Etiology
 Trauma
 Nose picking/plucking of hair
 Immunocompromised – diabetes, steroids,
immunodeficiency

22.  C/F
 Pain at the site, swelling, rupture of swelling
 Tenderness, redness
 Can extend to lip and dorsum of nose
 Treatment
 Broad spectrum antibiotics – cloxacillin,
cefaclor, oral or IV, topical
 Aceclofenac and serratiopeptidase
 Warm compresses
 Incision and drainage (if fluctuation appears)

23.  Complications
 Thrombophlebitis of cavernous sinus and inf
orbital vein leading to edema and chemosis
of conjuctiva – as veins of nose have no
valves, so retrograde blood flow
 Septal abscess
 Cellulitis of upper lip, nose and face

24.  Acute spreading dermatitis of vestibule and face
caused by streptococci (mc), staph aureus,
haemophilus influenzae
 C/F
 Red swollen area of vestibular skin with well
defined margins
 Nasal mucosa – congested
 Fever
 Lymphadenopathy
 Spreads to face and eyes
 Sinuses - normal

25.  Complications - CST (immunocompromised)
 Treatment
 Systemic Pencillin (oral or IV)
 Anti inflammatory
 Analgesics

26.  Elephantiasis nose/ Cystadenofibroma nose
 Slow growing benign nodular enlargement of
tip of nose due to hypertrophy of sebaceous
glands
 Associated with lesions of ear (otophyma) and
chin (mentophyma)
 Middle/old age men (mc)
 Etiology – Acne Rosacea (last stage of acne)
 C/F – pink and lobulated swelling in lower ½
of nose with thickened skin associated with
nasal obstruction and obstructed vision

28.  Pathology
 Blood vessels are dilated , vascular
engorgement – blue or red coarse skin
 Treatment
 Decortication of skin with sharp knife/CO2
LASER/Radiofrequency knife

29.  Most common slow growing malignant
tumour of nasal skin
 M=F
 40-60 years
 Site – skin of ala of nose/tip of nose
 Later stages – invades cartilage and bone
 C/F
 Nodule/cyst/papule -> ulcerates and refuses
to heal
 Rare nodal or distant metastasis

30.  Diagnosis – Biopsy
 Prognosis – good
 Treatment
 Excision
 Irradiation (RT)
 Cryosurgery
 Reconstruction with flaps