Infections
Acute Chronic
➢ Furunculosis ➢ Lupus vulgaris
➢ Impetigo ➢ Syphilis
➢ Herpes simplex ➢ Vestibulitis
➢Herpes zoster
➢ Erysipelas
❖Neoplasms
➢Basal cell carcinoma
➢Squamous cell carcinoma
➢Papilloma
❖Injuries
➢Cut injuries and lacerations
➢Fractures
❖Congenital Anomalies
Congenital nasal masses
▪ Nasal dermoid cyst
▪ Meningocoele
▪ Nasal glioma
▪ Congenital nasal deformities
❖Others
▪ Rhinophyma
▪ Nasal deformities
❖Vestibulitis
➢ Diffuse inflammation of nasal vestibule.
➢ Organism - staphylococcus aurous.
➢ Acute - superficial cracks and ulceration, red swollen and
tender, scales cover the area of skin erosion.
➢ Chronic - induration of vestibular skin with painful fissures and
crusting.
Treatment-
• Cleaning of crusts and scales.
• Steroid mixed antibiotic
• Advised to avoid nose picking and rubbing
❖Furunculosis
❖Acute infection of hair follicle by staphylococcus aureus
❖Predisposing factor:
➢ Nose picking
➢ Pulling out hair
➢ Cleaning with dirty handkerchief.
❖Clinical features:
➢ small painful and tender swelling.
➢ spontaneously rupture in the nasal vestibule.
➢ spread to skin of nasal tip and dorsum.
Danger of spread of infection to
cavernous sinus
The nose drain to anterior
facial vein, which in turn
drain into the cavernous
sinus via superior and
inferior ophthalmic vein
Treatment
▪ No case of furuncle should be squeezed or incised
prematurely – danger of spread of infection to
cavernous sinus.
▪ Topical antibiotics.
▪ Systemic antibiotic(cloxacillin)- oral/ i.v.
▪ Anti-inflammatory drugs.
▪ Cavernous sinus thrombophlebitis –
➢ hospitalization,
➢ high dose IV broad spectrum antibiotic.
❖Impetigo
Contagious skin infection involving the superficial layer
Organism - staphylococcus aureus
-streptococcus
Clinical features
➢ face,
➢ scalp and
➢ nasal vestibule
➢ pustules formation which break to form scabs
Treatment- antibiotic ointment and/or oral cloxacillin
❖Herpes simplex
▪ associated with rhinitis vesicles appear near the
nostrils and upper lip
▪ Organism- herpes simplex virus
▪ Clinical features:
painful vesicles appear which breakdown and
coalesce to form ulcer (cold sore)
▪ Treatment-
➢small vesicles-no treatment
➢painful-topical acyclovir ointment
❖Herpes zoster
▪ Cheek ,external nose , nasal vestibule, nasal mucosa , and palate
Clinical features:
▪ Pain followed by skin eruption and vesicles.
▪ Secondary infection
▪ Diagnosis: segmental distribution of
eruption along the nerve
limited at the midline
Treatment:
➢ Topical &/ or oral acyclovir and
➢ Anti-inflammatory drugs
❖Erysipelas
▪ Acute streptococcal infection of skin and
subcutaneous tissue.
Clinical features:
▪ Skin becomes red with sharp margins with
vesicles
▪ Painful condition associated with headache,
malaise and fever
Treatment:
▪ Oral or IV penicillin is treatment of choice
Lupus vulgaris:
➢ rare infection.
➢ mycobacterium tuberculosis.
➢ skin of the nose and adjacent
structures are commonly
involved.
➢ reddish-brown papules appear
which change to shallow
indolent.
➢ ulcer leading to scarring and
deformity and nasal obstruction.
➢ Treatment- anti-tubercular
drugs
Syphilis
▪ Rare, snuffles or congenital rhinitis early sign
▪ Tertiary syphilis (gumma) found in the nose
▪ Painless gumma ulcerates and heals with scarring and
tissue destruction.
▪ Destruction of bony and cartilaginous nasal septum
producing septal perforation.
Basal cell carcinoma (rodent ulcer)
▪ Common site-nasal tip and ala.
▪ Common-skin of nose (87%).
▪ Equally affects male and female.
▪ Small nodule appear which break down to form
painless ulcer with rolled margin
▪ Slow growing and destroys the
surrounding structures
▪ No metastasis to lymph nodes
▪ No systemic spread by blood
Treatment
Early lesion -surgical excision or radiotherapy.
Extensive and recurrent -surgical excision with
closure of the defect by local or distant flap
Squamous cell carcinoma
➢Skin of the vestibule and external nose rapidly growing
ulcer with everted margin
➢Destroys skin , bone and cartilage
➢Lymphatic spread to neck node is early.
Treatment
Early case -radiotherapy with wide excision.
Advance case- wide excision with/without
reconstruction and radical neck dissection
Melanoma
➢ Malignant proliferation of melanocytes
➢ Superficially spreading type (slow growing)
➢ Nodular invasive
➢ Treatment- excision
Papillomata
➢Papilloma virus
➢Nodular mass in and around the vestibule
➢Treatment – excision
Nasal dermoid cyst
Simple dermoid:
Midline swelling under
the skin but in front of nasal
bone
Dermoid with sinus
➢seen in infants and children
➢sinus pit opens in midline of dorsum of nose
➢sinus track lead to dermoid cyst under the nasal
bone.
Dermoid with intracranial dural
connection
➢in case of intracranial extension sinus tract
passes through cribriform plate or foramen
caecum and is attached to dura, may cause
meningitis.
Diagnosis- CT scan
Treatment
➢excision by splitting the nasal bone
➢combined neurosurgical and otolaryngologic
approach (intracranial extension)
Meningoencephalocele or Encephalocele
➢Herniation of brain tissue with meninges through
congenital bony defect (floor of anterior cranial fossa).
➢Presents as a subcutaneous pulsatile swelling in the
midline at the roof of nose, side of nose or
anteriomedial aspect of orbit.
Clinical features-
➢soft mass on external nose.
➢polyp like mass in nasal cavity.
➢pulsatile, reducible with cough impulse.
Treatment- excision with repair of bony defect.
(neurosurgical)
Nasal glioma
Entrapment of glial tissue outside the skull
which lies as a solid mass on dorsum of nose
➢ 60% - extra-nasal
➢ 30%-intranasal
➢ 10%-both intra and extra-nasal.
Treatment –excision
Rhinophyma (potato Tumour)
➢Lobulated or bulbous
swelling of nasal tip with
irregular margin
➢Due to hyperplasia of
sebaceous gland.
➢Slow growing benign tumor.
➢Mostly affects men past
middle age.
Clinical features:
➢obstruction of nose
➢difficulty in vision (size),
➢difficulty during eating
➢cosmetic
Treatment
➢shaving either by surgical blade or CO2 laser and
the area is allowed to re-epithealise
➢complete excision followed by skin grafting
Nasal deformities
Saddle nose:
Depressed nasal septum (bony, cartilaginous or both)
➢ Causes-Trauma, SMR, septal haematoma or abscess
➢ Treatment-Augmented rhinoplasty (cartilage, bone, synthetic implants)
Hump nose:
➢May involve bone, cartilage or both
➢ Treatment-Reduction rhinoplasty
Crooked or Deviated nose:
➢ Trauma, injuries during birth
➢ Treatment -Rhinoplasty or
-Septorhinoplasty
Stenosis and atresia of the nares:
Acquired due to
➢accidental,
➢surgical trauma (Young’s operation)
➢destructive inflammatory lesions,
➢small pox
➢Congenital atresia.
Treatment: reconstructive plastic surgery procedure.
Tumours:
Nasoalveolar cyst:
➢Smooth bulge in the lateral wall and floor of nasal
vestibule.
Treatment-Excision by sub-labial approach
Papilloma or wart:
➢ Single or multiple pedunculated or sessile.
Treatment- Excision
Squamous cell carcinoma:
➢Arises from lateral wall and spread to the floor, columella
and upper lip,
➢Metastasis to parotid and submandibular nodes .
Treatment- Excision / irradiation
Thank you
