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