““DISEASES OF DISEASES OF EXTERNAL NOSE & EXTERNAL NOSE &

NASAL VESTIBULE”.NASAL VESTIBULE”.

““DISEASES OF DISEASES OF EXTERNAL NOSE & EXTERNAL NOSE &

NASAL VESTIBULE”.NASAL VESTIBULE”.

CELLULITIS• The nasal skin may be

invaded by streptococci or staphylococci

• leading to red, swollen and tender nose. Sometime it is an extention of

• infection from the nasal septum.

• T/t:-Systemic anti-bacterial’s, hot fomentation and analgesics.

NASAL DEFORMITIES:-• SADDLE NOSE

• HUMP NOSE

• CROOKED NOSE OR DEVIATED NOSE

SADDLE NOSE:-• Depressed nasal dorsum

may involve bony, cartilaginous or both.

• Nasal trauma causing depressed fractures is the common cause. Also results from excessive removal of in S.M.R, haematoma or abscess.

• T/t:-Augmentation rhinoplasty (Autograft or synthetic implant).

HUMP NOSE:-

• This may also involve the bone or cartilage or both bone and cartilage.

• T/t:-Reduction rhinoplasty.

CROOKED NOSE OR DEVIATED NOSE:-

• In Crooked nose the midline of dorsum from fronto-nasal angle to the tip, is curved in a C or S shaped manner.

• In Deviated nose, the midline is straight but deviated to one side.

• These deformities are usually traumatic in origin.

• T/t:-Septorhinoplasty or Rhinoplasty

TUMOURS

• 1. Congenital

• 2. Benign

• 3. Malignant

1.Congenital Tumour• DERMOID CYST.

• ENCEPHALOCELE or MENINGOENCEPHALOCELE.

• GLIOMA

DERMOID CYST:-

• a. Simple dermoid cyst: - It occurs as a midline swelling under the skin but in front of the nasal bones.

• b. Associated with sinus: - It is seen in infants and children and is represented by pit or sinus.

Encephalocele or meningoencephalocele :-

• It is hernition of brain tissue with meninges through a congenital bony defect.swellings show cough impulse and may be reducible.

• T/t:-Neurosurgical(severing the tumour stalk from the brain and repairing the bony defect though which herniation has taken place).

GLIOMA:-

• It is a nipped off portion of encephalocele during embryonic development. Most of them are extranasal and present as firm subcutaneous swellings on the,side of the nose or near the inner canthus.

2.BENIGN TUMOURS• They arise from the nasal skin and

include papilloma, hemangioma, pigmented naevus, seborrhoeic keratosis, neurofib

• T/t:-Excision and Skin grafting.• keratosis, neurofibroma or tumour

of sweat glands.

3. Malignant tumours :-• Basal cell carcinoma (rodent

ulcer).

• Squamous cell carcinoma (epithelioma).

• Melanoma.

Basal cell carcinoma (rodent ulcer).

• Most common malignant tumour involving skin of nose (87%)

• Equally in males and females of age group 40-60.

• Common sites on nose are tip and the ala.• It may present as a cyst or papulo-pearly

nodule or an ulcer with rolled edges.• It grows slowly and is confined to skin,

underlying bone or cartilage may get invaded.

• Nodal metastases is rare.

• Treatment depends on the size, location and depth of the tumour. Early lesions can be cured by cryosurgery, irradiation or surgical excision with 3-5mm of skin around palpable borders of the tumour.

• If lesions which are recurrent, extensive or with involvement of cartilage or bone are excised and closed with local or distant flaps or prosthesis.

Squamous cell carcinoma

(epithelioma).• It’s the second most common malignant tumour

(11%).• Equally affecting both sexes (40-60yrs).• Occurs as an infiltrating nodule or an ulcer with

rolled out edges affecting side of nose or columella.

• Nodal metastases are seen in 205 of cases.• Early lesions respond to radiotherapy, advanced

lesions exposed to bone or cartilage require surgical and plastic repair of the defect.

• Enlarged regional lymph nodes will require block dissection.

Melanoma.• It’s the least common variety.• Clinically it is superficially

spreading type or nodular invasive type.

• Treatment is surgical excision.

Diseases of nasal vestibule

• Furuncle or boil.

• Vestibulitis.

• Stenosis and atresia of the nares.

• Tumours.

Furuncle or boil :-• It is an cute infection of the hair

follicle by staphylococcus aureus.• Trauma from picking of the nose

or plucking the nasal vibrissae, is the usual predisposing factor.

• The lesion is small,painful and tender.

• Inflammation may spread to skin of nasal tip and dorsum which becomes red and swollen.

• The furuncle may rupture in nasal vestibule.

• Treatment consist of warm compresses, analgesics to relieve pain, and topical and systemic antibiotics directed against staphylococcus.

• In case of fluctuant area incision and drainage can be done.

• The furuncle should not be squeezed or prematurely incised because of the danger of spread of infection to cavernous sinus through venous thrombophlebitis.

• A furuncle of nose may complicate into cellulitis of the upper lip or septal abscess.

Vestibulitis :-• It is a diffuse dermatitis of nasal vestibule.• Nasal discharge due to any cause such as

rhinitis, sinusitis or nasal allergy, coupled with trauma of handkerchief, is the usual predisposing factor.

• Causative organism is staphylococcus aureus.• It may be acute or chronic.• In acute form, skin is red, swollen and tender,

crust and scales cover an area of skin erosion. Upper lip may be involved.

• In chronic there is a in-duration of vestibular skin with painful fissures and crusting.

• Treatment consists of cleaning nasal vestibule of all crusts and scales with cotton applicator soaked in hydrogen peroxide and application of antibiotic-steroid ointment.

• Chronic fissure can be cauterized with silver nitrate.

Stenosis And Atresia Of The Nares.

• Accidental or surgical trauma to the nasal tip or vestibule can lead to web formation and stenosis of anterior nares.

• Destructive inflammatory lesions of nose also cause stenosis.

• Earlier vestibular stenosis resulted from smallpox.

• Congenital atresia of anterior nares due to non canalization of epithelial plug is a rare condition.

Stenosis of nares corrected by reconstructive plastic

procedures.– Naso-alveolar cyst presents a smooth bulge

in the lateral wall and floor or nasal vestibule. The cyst can be excised by sublabial approach preserving the integrity of vestibular skin.

– Papiloma or wart may be single or multiple, pedunculated or sessile. Treatment is surgical excision under local anaesthesia.

– Squamous cell carcinoma arises from the lateral wall of the vestibule and may extend into nasal floor, columella and upper lip. Treatment is surgical excision or irradiation.

AYURVEDIC

• Common aetiology of nasal diseases:-• Suppressing the natural urges.• Indigestion • Exposure to dust• Seasonal changes• Trauma • Anger • Irrelevant talking• Allergic factors like dust,smoke,vapour

exposure or fumes.• Foreign bodies.

Nasa naha:- (DNS)• The udana vayu is get encircled(avrutha) with

kapha and causes vitiation in its own place(swa marga viigunya), leads to nasal obstruction and difficulty in respiration, is known as nasa naha.

• t/t:- Intake of oleus substances after meals.• Meal with mamsa rasa.• Ghrita pana.• Shiro vasti.• Nasya with anu taila.• Bruhana chikitsa.etc

NASA ARBUDA:- (Tumours)

• The rakta and mamsa are vitiated by vatadi doshas and produces a round hard and deep rooted growth is known as arbuda.

• Types:- 7• Vataj• Pittaj• Kaphaj• Raktaj• Mamsaj• Medoj• Sannipataj

• It produces obstructive inflammatory irritative symptoms in the nose.

• T/T:- Aushadh. Shastra, Kshara & Agnikarma.

NASA PAKA:- (Vestibulitis)

• Vitiated pitta dosha causes acute inflammatory changes by the eruption of small piticas(vesicles) in the nasal cavity, the piticas suppurates and discharges sticky secretion with atrophic changes associated with pain, burning sensation, redness and oedema.

• T/T:- Shatadhouta ghrita.Jalouka avacharan.Pittahara ahar vihar.Sneha, mrudu swedan, lepa, seka, sneha dhooma,

mruduVirechan and nasya.