Download ext_nose - Dr. George Zgheib

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