Diseases of external nose and nasal vestibule

Cellulitis. The nasal skin can be invaded by Streptococcus or Staphylococcus bacteria, resulting in redness, swelling, and tenderness of the nose. Occasionally, this condition arises as an extension of infection from the nasal vestibule.
Treatment:

• Systemic antibacterials

• Hot fomentation

• Analgesics

Cellulitis

Acute infection of the hair follicle of nasal vestibule

Furuncle or boil

Staphylococcus aureus

Most common organism causing boil

Nose picking

Plucking the nasal vibrissae

pulling out nasal hair

Predisposing factor of furuncle

Very painful

Fever, malaise,

Headache

Swelling of the cheeks

Swelling and redness of the conjunctiva

signs:

Hard, tender, red nodule present over nasal vestibule

Pyrexia

Swelling of face

Tenderness along the course of facial vein, Edema and chemosis of conjunctiva, proptosis, papilloedema and restricted eye movements in later cases

Clinical feature of furuncle

Never squeeze or premature incision

Warm fomentation

Antibiotics;flucoxacillin, cloxacillin mupirocin oinment

analgesucs

abscess-incision and drainage

In case of cavernous sinus thrombophlebiits-iv antibiotics

treat underlying cause

Management of furuncle

Frequent trauma to the nose by dirty fingers

Immunocompromised state

DIabetes

Recurrent furunculosis causes

Facial cellulitis

Upper lid abscess

Septal abscess

Cavernous sinus thrombophlebitis

Vestibular stenosis

Complications of furuncle

Diffuse dermatitis of the nasal vestibule caused due to nasal discharge as a resul of rhinitis, sinusitis, nasal allergy coupled with the trauma of hankerchief.

causative organism -staphylococcus aureus

Vestibulitis

• Acute Form: Redness, swelling, and crusting.

• Chronic Form: Induration, painful fissures, and crusting.

Form of vestibulitis

• Cleaning with hydrogen peroxide

• Application of antibiotic-steroid ointment

• Cauterization of chronic fissures with silver nitrate

Treatment of vestibulitis

Dermoid cyst

Encephalocele or Meningoencephalocele

GLioma

Congenital tumors of the nose include

2 types-

a. Simple dermoid

b. Dermoid associated with a snius-pit or sinus seen in the midline of the dorsum of the nose and hair is seen protruding from the sinus.

Sinus track has intracranial connection hence meningitis may occur if infection travels along this route

Dermoid cyst

Herniation of the brain tissue with the meninges along the congenital bony defect.

Meningoencephalocele

Orbital followed by frontal

most common location of meningoencephalocele

Nasofrontal

Nasoehtmoidal

Nasoorbital

Types of meningoencephalocele

Nipped off portion of the encephalocele during embryonic development.

Glioma

Extranasal

Intranasal

Both extranasal and intranasal

Types of glioma

Rhinophyma

Most common benign tumor of the external nose

Papilloma

Rhinophyma, Haemangioma, Pigmented naevus, Seborrheic keratosis, Neurofibroma, Sweat gland tumor

Benign tumors of the nose

Rhinophyma

most common benign tumor of the external nose is

Inverted papilloma

Most common benign tumor of the nasal cavity is

Hypertrophy of the sebaceous lads at the tip of the nose in

Long standing cases of acne rosaceas

Rhinophyma cause

Bulking down the tumor using sharp knife or Co2 laser

Excision of tumor and regrafting of the epithelium.

Treatment of rhinophyma

Schneiderian or Rigertz tumor

Inverted paipilloma is also known as

Basal cell carcinoma

Squamous cell carcinoma

Melanoma

Malignant tumors of the nose

Basal cell carcinoma-least dangerous

Most common malignant tumor of external nose

Squamous cell carcinoma

MOst common malignant tumor of nasal cavity and paranasal sinuses

Early lesions respond to radiotherapy. Advanced cases require wide surgical excision and lymph node dissection.

Options include cryosurgery, irradiation, or surgical excision with margins

Treatmen of scc and bcc

Saddle nose

Humped nose

Crooked nose

Deviated nose

Nasal deformities

involves the dorsum of the nose. cartilage or bone or both

causes; HOT SALT
Haematoma, operative,trauma, syphilis, abscess,leprosy , tuberculosis

Correction-augmentation rhinoplasty

Saddle nose

Bony hump on the dorsum of nose

treatment-reduction rhinoplasty

Humped nose

Crooked nose-midline of the dorsum from the frontonasal angle to the tip of the nose is curved in a C or S shaped manner.corrective rhinoplasty is done

Deviated-midline is straight but it is deviated to one side

Crooked nose and deviated nose

Infestation of the nasal cavity by maggots. maggots are the larval form of the blue bottle fly( Chrysomyia).

Attracted by foul smelling discharge in- atrophic rhinitis, nasal syphilias and leprosy, purulent sinusitis, post radiotherapy carcinoma of maxilla.

Nasal myiasis(scholeiasis)

Formation of stones in the nasal cavity

Formed around the nucleus of a small exogenous foreign body, blood clot ot inspissated secretion by slow deposition of calcium and magnesium salts.

Rhinolith

UL obstruction with blood stained foul snelling discharge

Common repesentaiton of foreign body insertion especially in children is

Leakage of CSF from the nasal cavity which denotes the presence of fistulous connection between the subarachnoid space and nasal cavity.

CSF rhinorrhoea

Leakage of CSF into the nasal cavit but here the defect is present in the mastoid/ middle ear roof and CSF enters via the eustachian tube into the nasal cavity

Paradoxical CSF rhinorrhea

1. Traumatic (96%)

   accidental(80%)-2%of head injuries

   surgical (20%)-endoscopic sinus surgery, acoustic neuroma surgery,trans-sphenoidal hypophysectomy, surgery for meningocele

2. Non-traumatic\Normal ICP-congenital anomaly, focal atrophy, osteitis/osteomyelitis,idiopathic, cough/strain

   High ICP-Tumor(85%), Hydrocephalus (15%)

Etiology of CSF rhinorrhea

From anterior cranial fossa-

cribriform plate, roof of ethmoidal air cells, frontal sinus

From middle and posterior cranial fossa- mastoid/middle ear and sphenoid sinus

Pathway of CSF rhinorrhea

1.Teapot sign/ Reservoir sign-watery nasal discharge increases on bending forward

2.Halo sign./ double target sign/ double ring sign-csf mixed with blood on filter paper/ pillow cover produces peripheral csf galo around the central blood

3. HAnkerchief sign-nasal discharge since containing mucin causes stiffening of the handkerchie. not so in csf

Signs seen in CSF rhinorrhea

Difference between CSF rhinorrhea and Allergic rhinitis

COnservative treatment

Surgery-

NEurological intracranial approach

Extradural approach-Anterior ethmoidectomy for cribriform plate and ethmoid area

trans septal sphenoidal approach for sphenoid

Osteoplastic flap approach for frontal leak

Transnasal endoscopic approach

Treatment for CSF rhinorrhea

Persistence of bucconasal membrane

Choanal atresia

CHARGE Syndrome

Coloboma/cranial nerve defects

Hear defects(ASD)

Atresia of choana

Retarded growth

GEnitourinary anomaly

Ear defects

Choanal atresia is associated with

DNE with 2.7mm scope-atretic plate is seen

Flexible nasopharyngoscopy-atretic plate is seen

Rhinogram(choanogram)-dye instilled in nasal cavity collects in the choanal level

CT scan-posterior choanae<0.34cm or posterior vomer>0.55cm

Investigations

Emergency-Endoracheal intubation/tracheostomy

Mc Govern’s feeding nipple

Definitive-perforation of atretic plate

transnasal-for membranous and thin bony atresia

transpalatal-for thick bony atresia

Excision+mitomycin c

Tretament

Meningitis vs glioma