External Nose Diseases PDF

EXTERNAL CONDITIONS OF THENOSE DR.SHORASH SINDI FIBMS (ENT) Otorhinolaryngologesit H Diseases of External Nose and Nasal Cavity CLASSIFICATION CW 1. Infective conditions: a) Acute: Furunculosis Impetigo E...

EXTERNAL CONDITIONS OF THENOSE DR.SHORASH SINDI FIBMS (ENT) Otorhinolaryngologesit H Diseases of External Nose and Nasal Cavity CLASSIFICATION CW 1. Infective conditions: a) Acute: Furunculosis Impetigo Erysipelas I Herpes simplex and zoster b) Chronic: Vestibulitis Lupus vulgaris Syphilis Lupus erythematosis Acne rosacea 2. Neoplastic conditions: Papilloma Rodent ulcer Keratoacanthoma Squamous cell carcinoma 3. Traumatic conditions: Fracture nose Septal haematoma Saddle nose 4. Foreign bodies in the nose: Rhinolithiasis Myiasis Rhinosporidiosis 5. Congenital conditions: Posterior choanal atresia Nasal dermoid Gliomas 6. Bleeding from the nose Epistaxis 7. Affections of septum of nose: Deviated nasal septum (DNS) Anterior dislocation Septal perforation Bleeding polypus of septum  Acute Vestibulitis Nose n Also called furunculosis of nose, it is caused by staphylococcal infection and patient presents with redness, excoriation and fissuring of skin of the vestibule which results from infection of hair follicles. 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. Chronic Vestibulitis Nose There is repeated incidence of fissuring of vestibule with crust formation. The patient rubs his nose and bleeding may occur. Treatment is by antibiotics and steroid cream. Diabetes should be excluded CONGENITAL ANOMALIES OF THE NOSE: I.COANAL ATRESIA: which is closed non-patent posterior nares. I.CHOANAL ATRESIA Incidence: 1/7000 live birth, + family tendency. female : male = 2:1 Aetiology: embryological failure of the primitive bucconasal membrane to rupture before birth. Types: Bony (90)% Membranous (10)% or mixed. unilateral (most commonly) or bilateral. Clinical features: A unilateral obstruction may be asymptomatic at birth but will later cause unilateral nasal discharge and obstruction. O/E: thick gelatinous secretion on the affected side, and no airway can be demonstrated by holding a cold plated spatula below the nares. Bilateral :emergency at birth. The newborn is a near-obligate nasal breather pallor and cyanosis until the mouth is opened bowing of the lateral nasal wall, facial asymmetry, high arched palate and deformed or absent teeth. CHARGE association C, colobamatous Blindness H, heart disease; A, atresia choanae; R, retarded growth and development; G, genital anomalies; E, ear abnormalities and deafness. In addition, half exhibit facial nerve palsies and one third of cases have laryngotracheal anomalies.  The diagnosis ¨ Mirror test: ¨ Plastic catheter: ¨ Cotton wool ¨ Fibreoptic endoscopy. ¨ Contrast radiography: ¨ CT scan Bilateral/Urgent  Treatment: Unilateral atresia can initially be observed without Urgent treatment. Bilateral :maintain an oral airway, Definitive treatment which is Surgical, the removal of the atretic plate. prevent granulation tissue formation and subsequent stenosis. Two approaches are in common use. 1. Transnasal: perforation with a probe. ,electrocautery or laser. ,a burr or potassium titanyl phosphate (KTP) Stent/fequent diletation. 2. Transpalatal. Follow-up and aftercare ¨ Maintenance of the opening following corrective surgery with regular bouginage is now mostly preferred to the use of indwelling tubes. ¨ Dilation will probably be necessary every 2 months initially, but this period can be extended as the child grows. Congemital nasal swellings: dermoid, glioma & meningoencephalocele. just know communicated to CSF or not via MRI.  II.Congenital Nasal Masses: ¨ 1.Nasal Dermoid: sequestration of epithelial elements during the fusion of median nasal process. ¨ solid /cystic masses anywhere in the midline. ¨ as sinuses recognised by minute opening sometimes containing single hair. ¨ Treatment is surgical. Dermoid cyst of nose Types: It is of two types—simple and with sinus. Simple dermoid: It presents as a midline swelling over the nasal bones and does not have any external opening. 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. – Intracranial connection: The sinus track communicate intracranially. Dermoid cyst lies between nasal bones and upper part of septum. Treatment: Surgery consists of splitting of the nasal bones and removal of cyst along with its extension in the upper part of the nasal septum. Intracranial extension needs associated neurosurgical approach  O Nasal dermoid. (A) Simple dermoid lies superficial to nasal bones; (B) Dermoid with sinus. Dermoid situated deep to nasal bones and sinus tract has an external pit in the midline of dorsum of nose; (C) Dermoid with intracranial connection 2.Nasal glioma: ¨ usually seen after birth.  0 Most of the gliomas, which are nipped off portions of encephalocele (during embryonic development), are extranasal (60%). Other types include intranasal (30%) and both intra and extranasal (10%). Extranasal gliomas are encapsulated. Clinical feature: Firm subcutaneous swellings may be seen on nasal bridge, side of nose or near the inner canthus. Treatment: Glioma is removed by external nasal approach. Nasal glioma 3.Nasal Meningoencephaloceles: local herniation of the glial tissue and meninges through a defect in the skull. They contain CSF They are connected to intracranial cavity, sothey enlarge in size during crying. cystic massover the root of the nose or intranasal,. Treatment by surgical excision Any associated anomalies of the orbit and facial skeleton should also be corrected. 3.Nasal Meningoencephaloceles ¨ III. Agenesis of the nose: total or partial. Treatment is reconstruction ¨ IV. Cleft Nose: range from minor notching of the nasal tip to total midline devision of the nose into separated nasal cavities, ususlly associated with cleft lip and palate. ¨ Treatment is reconstruction.