Diseases of external nose and vestibule

1. DISEASES OF EXTERNAL DISEASES OF EXTERNAL
NOSE AND VESTIBULENOSE AND VESTIBULE
DEPT OF OTORHINOLARYNGOLOGYDEPT OF OTORHINOLARYNGOLOGY
J J M M CJ J M M C
DAVANAGEREDAVANAGERE

2. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Nasal deformitiesNasal deformities::
1.1.Saddle noseSaddle nose: depressed nasal dorsum may involve bony, cartilagenous : depressed nasal dorsum may involve bony, cartilagenous
or both components of nasal dorsum.or both components of nasal dorsum.
EtiologyEtiology: a} nasal trauma causing depressed fractures(most common): a} nasal trauma causing depressed fractures(most common)
b} excessive removal of septum in SMR.b} excessive removal of septum in SMR.
c} destruction of septal cartilage by haematoma or abscess, or c} destruction of septal cartilage by haematoma or abscess, or
syphilis, tuberculosis or leprosy.syphilis, tuberculosis or leprosy.
TreatmentTreatment: augmentation rhinoplasty by filling the dorsum with cartilage : augmentation rhinoplasty by filling the dorsum with cartilage
,bone or synthetic implant.,bone or synthetic implant.
- if destruction is only cartilagenous cartilage is taken from nasal - if destruction is only cartilagenous cartilage is taken from nasal
septum or auricle and laid in single or multiple layers.septum or auricle and laid in single or multiple layers.
-if involves both bone and cartilage cancellous bone from iliac -if involves both bone and cartilage cancellous bone from iliac
crest is taken.crest is taken.
-autografts are preferred over allografts.-autografts are preferred over allografts.
-synthetic implants used are silicone or teflon (likely to be -synthetic implants used are silicone or teflon (likely to be
extruded)extruded)

3. Diseases of external nose and Diseases of external nose and
vestibulevestibule
2.2.Hump nose-this may involve the boneHump nose-this may involve the bone
or cartilage or both. corrected by reduction or cartilage or both. corrected by reduction
rhinoplastyrhinoplasty
3.3.Crooked nose-midline of dorsum from Crooked nose-midline of dorsum from
frontonasal angle to tip is curved in a C or S frontonasal angle to tip is curved in a C or S
shape.shape.
Deviated nose-midline is straight but deviated Deviated nose-midline is straight but deviated
to one side.to one side.
-usually these deformities are traumatic in -usually these deformities are traumatic in
origin (birth, neonatal or childhood) .With origin (birth, neonatal or childhood) .With
growth of nose these are identified.growth of nose these are identified.
- corrected by rhinoplasty or septorhinoplasty.- corrected by rhinoplasty or septorhinoplasty.

4. Nasal deformitiesNasal deformities

5. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Meningoencephalocele or encephalocoele:Meningoencephalocele or encephalocoele:
It is the herniation of brain tissue with meninges through It is the herniation of brain tissue with meninges through
a congenital bony defect.a congenital bony defect.
types: a} nasofrontal-subcutaneous pulsatile swelling in types: a} nasofrontal-subcutaneous pulsatile swelling in
the midline at the root of nose.the midline at the root of nose.
b} nasoethmoid - swelling at side of nose.b} nasoethmoid - swelling at side of nose.
c} naso-orbital-on the antero medial aspect of c} naso-orbital-on the antero medial aspect of
orbit.orbit.
Swellings show cough impulse and may be reducible.Swellings show cough impulse and may be reducible.
TreatmentTreatment: neurosurgical-severing the stalk from brain : neurosurgical-severing the stalk from brain
and repairing the bony defect.and repairing the bony defect.

6. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Glioma:Glioma:
It is a nipped off portion of encephalocele It is a nipped off portion of encephalocele
during embryonic development.during embryonic development.
60%-extranasal-firm subcutaneous swelling 60%-extranasal-firm subcutaneous swelling
on the bridge, side of nose or inner canthus.on the bridge, side of nose or inner canthus.
30%-intranasal,10%-both30%-intranasal,10%-both
extranasal gliomas are encapsulated and can extranasal gliomas are encapsulated and can
be easily removed by external nasal approach.be easily removed by external nasal approach.

7. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Benign tumors:Benign tumors:
Rhinophyma Rhinophyma (potato tumour(potato tumour)-it is a slow growing benign tumour )-it is a slow growing benign tumour
due to hypertrophy of the sebaceous glands of the tip of nose.due to hypertrophy of the sebaceous glands of the tip of nose.
-seen in long standing cases of acne rosacea.-seen in long standing cases of acne rosacea.
-patient comes for unsightly appearance of tumour, -patient comes for unsightly appearance of tumour,
obstruction in breathing and vision due to large of tumour.obstruction in breathing and vision due to large of tumour.
-presents as pink, lobulated mass over the nose with -presents as pink, lobulated mass over the nose with
superficial vascular dilations.superficial vascular dilations.
-mostly affect men past middle age.-mostly affect men past middle age.
-treatment consists of paring the bulk of the tumour with -treatment consists of paring the bulk of the tumour with
sharp knife or CO2 laser and the area allowed to re-sharp knife or CO2 laser and the area allowed to re-
epithelialise. sometimes completely excised and skin grafting is epithelialise. sometimes completely excised and skin grafting is
done.done.
-other benign tumours are Papilloma (warts), haemangioma, -other benign tumours are Papilloma (warts), haemangioma,
pimented naevus, seborrhoeic keratosis, neurofibroma.pimented naevus, seborrhoeic keratosis, neurofibroma.

8. RhinophymaRhinophyma

9. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Malignant tumours:Malignant tumours:Basal cell carcinoma (rodent ulcer)Basal cell carcinoma (rodent ulcer)::
-Most common malignant tumour of the skin of nose(87%).-Most common malignant tumour of the skin of nose(87%).
-affects males and females equally in the age group of 40-60.-affects males and females equally in the age group of 40-60.
-common sites: tip and the ala.-common sites: tip and the ala.
-may present as a cyst or papulo-pearly nodule or an ulcer with -may present as a cyst or papulo-pearly nodule or an ulcer with
rolled edges.rolled edges.
-very slow growing and remains confined to skin for a long time. -very slow growing and remains confined to skin for a long time.
underlying bone and cartilage may get invaded. nodal underlying bone and cartilage may get invaded. nodal
metastasis extremely rare.metastasis extremely rare.
-treatment-depends on size,location and depth .early lesions -treatment-depends on size,location and depth .early lesions
can be cured with cryosurgery, irradiation or surgical excision can be cured with cryosurgery, irradiation or surgical excision
with 3-5mm margin. Recurrent lesions, extensive or with with 3-5mm margin. Recurrent lesions, extensive or with
involvement of bone or cartilage are excised and surgical defect involvement of bone or cartilage are excised and surgical defect
closed by local or distant flaps or prosthesis.closed by local or distant flaps or prosthesis.
-Other malignant tumors are-squamous cell carcinoma, -Other malignant tumors are-squamous cell carcinoma,
melanoma.melanoma.

10. Diseases of external nose and Diseases of external nose and
vestibulevestibule
Furuncle (boil)Furuncle (boil): -acute infection of hair follicle by staphylococcus : -acute infection of hair follicle by staphylococcus
aureus.aureus.
-trauma from nose picking, plucking nasal vibrissae are -trauma from nose picking, plucking nasal vibrissae are
predisposing factors.predisposing factors.
-lesion is small but extremely painful and tender. inflammation -lesion is small but extremely painful and tender. inflammation
may spread to skin of nasal tip and dorsum which may become may spread to skin of nasal tip and dorsum which may become
red and swollen. Fever, malaise and head ache may be red and swollen. Fever, malaise and head ache may be
present. furuncle may rupture spontaneously in vestibule.present. furuncle may rupture spontaneously in vestibule.
-special significance as it lies in the dangerous area of face -special significance as it lies in the dangerous area of face
which drains into inferior orbital veins and cavernous sinuses.which drains into inferior orbital veins and cavernous sinuses.
-treatment-warm compress, analgesics, topical and systemic -treatment-warm compress, analgesics, topical and systemic
antibiotics. if fluctuation is seen incision and drainage is done. antibiotics. if fluctuation is seen incision and drainage is done.
furuncle should not be squeezed or prematurely incised furuncle should not be squeezed or prematurely incised
because of danger of cavernous sinus Thrombophlebitis.because of danger of cavernous sinus Thrombophlebitis.
-complications- cellulitis of face and upper lip, septal abscess, -complications- cellulitis of face and upper lip, septal abscess,
cavernous sinus Thrombophlebitis.cavernous sinus Thrombophlebitis.

11. Diseases of external nose and Diseases of external nose and
vestibulevestibule
VestibulitisVestibulitis: it is a diffuse dermatitis of nasal vestibule.: it is a diffuse dermatitis of nasal vestibule.
-causative organism- staph aureus-causative organism- staph aureus
-predisposing factors-nose picking, plucking of nasal -predisposing factors-nose picking, plucking of nasal
vibrissae, nasal discharge due to any cause coupled vibrissae, nasal discharge due to any cause coupled
with trauma due to handkerchief.with trauma due to handkerchief.
-acute form-vestibular skin is red, swollen and tender, -acute form-vestibular skin is red, swollen and tender,
crusts and scales cover an area of skin erosion or crusts and scales cover an area of skin erosion or
excoriation. upper lip may also be involved.excoriation. upper lip may also be involved.
-chronic form- induration of vestibular skin with painful -chronic form- induration of vestibular skin with painful
fissures and crusting.fissures and crusting.
-treatment-removal of crusts with hydrogen peroxide -treatment-removal of crusts with hydrogen peroxide
and application of antibiotic steroid cream. chronic and application of antibiotic steroid cream. chronic
fissure can be cauterized with silver nitrate.fissure can be cauterized with silver nitrate.