DISEASES OF

EXTERNAL NOSE AND

VESTIBULE
Infections • Stenosis and atresia of nares
• Cellulitis
• Furuncle
• Vestibulitis
Deformities
• Saddle nose
• Hump nose
• Crooked and Deviated nose
Tumors • Haemangioma
Congenital • Pigmented naevus
• Dermoid Cyst • Seborrheic keratosis
• Encephalocele or • Neurofibroma
meningoencephalocele • Sweat gland tumour
• Glioma Malignant
Benign • Basal Cell Carcinoma (Rodent Ulcer)
• Nasoalveolar Cyst • Squamous cell carcinoma
• Rhinophyma or Potato Tumor • Melanoma
• Papilloma
Infections
• Minor abrasions and hair follicles - common sites of both acute and
chronic infections.

• Coagulase-positive staphylococci are the most common pathogens.

Cellulitis of nose
• Etiology: The causative organisms are streptococci or staphylococci,
may be an extension from the nasal vestibule.

• Clinical features: A red, swollen and tender nose.

• Treatment : systemic antibacterial, hot fomentation and analgesics

Furuncle or Boil of nose
• Etiology: An acute infection of the hair follicle by Staphylococcus
aureus.

• Predisposing factors: These are:

o Picking of the nose
o Plucking the nasal vibxrissae
Furuncle of nose
Clinical features:
A small, red, exquisitely painful and tender swelling, which may
spread to the tip and dorsum of nose and rupture spontaneously in
the nasal vestibule
Treatment: warm compresses, analgesic and topical and systemic
antibiotics.
• The incision and drainage is done if fluctuation appears.
• Furuncle should not be squeezed or prematurely incised because
infection can spread to cavernous sinus through venous
thrombophlebitis.
Complications:
• Cellulitis of the upper lip
• Septal abscess
• Cavernous sinus thrombosis
Nasal Vestibulitis
• Etiology: This diffuse dermatitis is caused by S. aureus.

• Predisposing factors:
They are:
o Nasal discharge due to rhinitis or sinusitis or nasal allergy.
o Frequent picking
Clinical features: Nasal vestibulitis can be of two types—
• Acute and chronic.
• Patients present with red, painful and tender swelling.
• Crusts and scales and painful fissure, erosion or excoriation
• The infection may involve upper lip.
Treatment:
• Treat the cause of nasal discharge.
• Clean all the crusts and scales and apply antibiotic-steroid ointment
• A chronic fissure is cauterized with silver nitrate
Deformities of nose
• Nasal deformities can be either congenital or acquired.

• The acquired defects are usually due to injuries

Saddle nose (Depressed nasal Dorsum)

• It may be bony, cartilaginous or both.

Etiologies:
1. Depressed nasal fracture is the most common cause.
2. Excessive removal of septum in submucous resection.
3. Septal hematoma.
4. Septal abscess.
5. Granulomatous lesions of nose: Leprosy, tuberculosis and syphilis.
Treatment:
• Augmentation rhinoplasty, which fills the dorsum with cartilage, bone
or a synthetic implant.
• Autografts are usually preferred over allografts.
• The chances of extrusion are more with synthetic implants, (silicone
and teflon).
• In cases of cartilaginous depression, septal or auricle cartilage is laid
in a single or multiple layers.

• In case of both cartilaginous and bony deformity, cancellous bone

from the iliac crest is used as graft
Hump nose
• This may also involve the bone or cartilage or both bone and
cartilage.
• It can be corrected by reduction rhinoplasty
• Consists of exposure of nasal framework by careful raising of the nasal
skin by a vestibular incision and removal of hump,

• Narrowing of the lateral walls by osteotomies to reduce the widening

left by hump removal.
Crooked nose or deviated nose
• In crooked nose, the midline of dorsum from frontonasal angle to the
tip is curved in a C- or S-shaped manner.
• In a deviated nose, the midline is straight but deviated to one side

• Etiology: Trauma is the most common cause, which may be sustained

during birth, neonatal period or childhood.
• Treatment: Rhinoplasty or septorhinoplasty corrects deformity and
nasal obstruction.
Stenosis and atresia of nares
• May be congenital or acquired
• Secondary to trauma, surgeries or destructive inflammations

• Corrected by reconstructive plastic surgery

Tumors of nose
• Congenital

• Benign

• Malignant
Dermoid cyst of nose
• Types: simple and with sinus
• Simple dermoid: midline swelling over the nasal bones, no external
opening.
• Dermoid cyst with sinus:
– External pit: 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: removal of cyst along with its extension in the upper part
of the nasal septum.
• Intracranial extension needs associated neurosurgical approach
Extra nasal encephalocele or
meningoencephalocele
• Herniation of brain tissue with meninges occurs through a congenital
bony defect.

• May be intranasal or extra nasal

• Clinical features: with pulsatile swelling, reducible with impulse on

cough.
• Swelling may be present in the following sites:
1. Root of nose (nasofrontal variety).
2. Side of nose (nasoethmoidal variety).
3. Anteromedial aspect of the orbit (naso-orbital variety).
• Treatment:
It needs neurosurgery, which includes severing the stalk from the brain
and repairing the bony defect.
Extranasal glioma
• Nipped off portions of encephalocele
• Extranasal (60%), intranasal (30%) and both intra and extranasal
(10%).
• Extranasal gliomas are encapsulated.
• Clinical feature: Firm subcutaneous swelling on nasal bridge, side of
nose or near the inner canthus.
• Treatment: Glioma is removed by external nasal approach.
Nasolabial (nasoalveolar, Klestadt’s) cyst
• Squamous epithelium-lined cyst arises from the epithelial rests
situated at the junction of globular, lateral nasal and maxillary
processes.

• It lies on the bone and causes an excavation.

• It is closely attached to the floor of the nose
• Clinical features: smooth and soft bulge in the lateral wall and floor of
nasal vestibule anterior to inferior turbinate.
• Large cyst obliterates the alar facial fold.
• Treatment: The cyst is excised through sublabial approach from
gingivobuccal sulcus near the midline.
• A portion of nasal mucosa may be removed because cyst is adherent
to it.
Rhinophyma or potato tumour
• Benign tumor occurs due to the hypertrophy of sebaceous glands in
the region of nasal tip.
• Most of the patients are men past middle age
• Clinical features: usually in long-standing cases of acne rosacea.
• Patient presents with pink and lobulated mass over the nose with
superficial vascular dilation
• The big tumors can cause nasal obstruction and obstructed vision

• Treatment: debulking with knife or co2 laser, +/- skin grafting

Papilloma or Wart of nose
• Clinical features: This may be single or multiple and pedunculated or
sessile.

• Treatment: It consists of surgical excision, which is usually done under

local anesthesia.
Basal cell carcinoma
• This most common malignant tumor of nose skin (87%) equally affects
either sex and occurs in the age group of 40–60 years.
• Clinical features:
1. Common sites are tip and ala of nose.
2. This slow growing lesion may present as a cyst, pearly papule, nodule
or an ulcer with rolled edges.
3 . The lesion, which remains confined to the skin for a long time, may
invade underlying cartilage or bone.
4. Lymph node metastasis is extremely rare
• Early lesion: treated with cryosurgery, irradiation or surgical excision
with 3–5 mm of margin.
• Recurrent and extensive lesions: wide resection of recurrent and
extensive lesions involve cartilage and bone.
• The large surgical defect is closed by local or distant flaps or a
prosthesis
Squamous cell carcinoma
• Second most common malignant tumor of nose skin (11%) equally
affects either sexes and occurs in the age group of 40–60 years.
• Clinical features:
1. Infiltrating nodule or an ulcer with rolled out edges.
2. The common sites are lateral wall of the vestibule and columella,
may extend into nasal floor and upper lip.
3. Nodal metastases to the parotid and submandibular nodes are seen
in 20% cases.
• Treatment:
1. Early lesion: It responds well to radiotherapy.

2. Advanced lesions: Advanced lesions, which involve bone or cartilage,

need wide surgical excision and plastic repair of the defect.

3. Metastatic cervical lymph nodes: They require block dissection

Melanoma nose
• Clinical features: This slow growing, rare lesion may present as
superficially spreading type or nodular invasive type.

• Treatment: It is treated with surgical excision.

Thank you