GRANULOMATA OF NOSE Definition: IT IS A FOCAL AREA OF CH.INFLAMMATION PRODUCED BY CICULATING MONOCYTES, AS A PART OF AN IMMUNOLOGIC PROCESS. A GRANULOMATOUS REACTION IS CHARACTARISED BY TRANSFORMED MACROPHAGES SURROUNDED BY LYMPHOCYTES.

Autoimmune:1. Wegners granuloma 2. Relapsing polychondritis 3. Systemic lupus erythaematosis 4. Systemic lupus erythaematosis

Wegners granulomaA DISEASE THAT CONSISTS OF A TRIAD: 1-AIRWAY NECROTISInG GR. 2-SYSTEMIC VASCULITIS 3-FOCAL GLOMERULONEPHRITIS CLINICAL:-NASAL:INFL.FRIABLE MUCOS A,ULCERATIONS,SEPTAL PERF.,SADDLE NOSE DEFORMTY. -EARS:O.M. -LARYNX:WHEEZE,HAEMOPTSIS. TREATMENT:-STEROIDS FOR 4-6 WEEKS -6MONTHES,CHEMOTHERAPY CYCLOPHOSPHAMIDE . LASER FOR FIBROTIC AREAS.

Relapsing polychondritisIS A RARE DIS. AFFECTS CARTILAGES&TISSUES CONTINING GLYCOSAMINOGLYCONS. CLINICAL P.:-NASAL CHONDRITIS -AURICULAR CH. -RESP.TRACT CH. -POLYARTHRITIS PERICHONDRIUM IS INVADED BY INFL.CELLS CAUSING SADDLE NOSE DEF. TTT:-IMMUONOSUPPRESIVE AGENTS&STEROIDS.

Systemic lupus erythaematosisAN A.I. DIS. CAUSED BY DEPOSITION OF ANTIBODIES,IMMUNO COMPLEXES IN THE TISSUES. CLINICAL P.:-MILD ELEVATED ERYTHOMATOUS PLAQUES.MODERATE,PAPULOSQUAMOUOU S LEISIONS,SEVERE SYSTEMIC:MULTIPLE ORGANS IN NOSE :CRUSTS,DRYNESS&? SEPTAL PERF. TTT:STEROIDS,NASD

Allergic granulomatosis + vasculitisTRIAD:-BR.ASTHMA -SYSTEMIC VASCULITIS -EOSINOPHILIA IN BLOOD&TISSUES. CLINICAL P.:NASAL COMP.LIKE IN WEG.GRAN.

INFECTIOUS DISEASES1. RHINOSCLEROMA 2. LEPROSY 3. TUBERCULOSIS 4. SYPHILIS 5. LUPUS VULGARIS

RHINOSCLEROMAORGANISM:KLEBS.RHINO. 3 STAGES,START IN NOSE,EXTEND TO N.PH,O.PH,LARYNX,TRACHEA. -CATARRAL(ATROPHIC)AFFECTS MUCOSA,CRUSTS,FOUL DISCHARGE. -GRANULAR:RED,PALE THEN HARD NODULES,NON ULCERATIVE. -CICATRECIAL:DENSE FIBROSIS,ADHESIONS&STENOSIS. TTT:STREPTOMYCIN OR TETRACYCLINE SURGICAL REMOVAL OF ADHESIONS,STENOSIS,

LEPROSYMYCOB.LEPRAE -TUBERCULOID:PATCHES ON SKIN,VEST,OF NOSE -LEPROMATOUS:AFFECTS MUCOSA,NS.,N.OBST.BLOODY DISCHARGE,HYPOSMIA,CRUSTATIONS NODULES MAY LEAD 2 N.DEFORMITY,SEPTAL PERF. TTT:DAPSONE 4 2 MONTHES OR RIFAMPCIN FOR 10 DAYS

TUBERCULOSISMYCOBAC.TUBERC. V.RARE IN NOSE.MAY BE 1RY BUT MOSTLY 2RY.AFFECTS CARTILGES CLINICAL P.:-N.DISCHARGE,OBST. -RED NODULES ON SEPTUM,ULCER,PERF. TTT:STREPTOMYCIN,PAS,INSH,RIFAMPI CIN

SYPHILISTREPONEMA PLALLIDUM -1RY:CHANCRE V.RARE IN NOSE IRRITABBE SW,PAIN.ULCER OR FUNGATION.FIRM ;Y.NODES -2RY:PERSIST.CATARRAL RHINITIS,LEISIONS ON OTHER SITES. LY.NODES ENLARGMENT IN GROUPS. -TERTIARY(GUMMA) COMMON IN NOSE PAIN,HEADACHE BY NIGHT,DIFFUSE NODULAR MUCOSAL INFILTERATION. BLOODY FOUL DISCH.CRUSTS,HYPOSMIA. SEPTAL PERF.+ANY WALL,COLLAPSE TTT:PENICLLIN LOCAL CLEANING,MECURY CREAM,REMOVAL OF SEQUESTRAE PLASTIC SURG.4 DEFRMITY

LUPUS VULGARISLIKE T.B. SKIN,MUCOSA :T TTT:SAME AFFECTS

LEISHMANIASISLEISHMANIA DONOVANI IT AFFECTS SOFT TISSUES,N.MUCOSA+CARTILAGES TTT:CURRETAGE ANTIMONY

FUNGAL INFECTIONS1. RHINOSPRIDIOSIS 2. HISTOPLASMOSIS

3. BLASTOMYCOSIS

RHINOSPRIDIOSISRHINOSPORIDIUM SEEBRE CLINICAL P.:-STRAWBERRY POLIPOIDAL MASSES AFFECT MUCOSA OF NOSE, N.PH.,PALATE,O.PH.,&LARY.PH. -EPISTAXIS,VISCID DISCHARGE CONTAINING SPORES. -N.OBST.,DYSPHAGIA TTT :-MEDICAL:STEROIDS AMPHOTRICINE B SYSTEMIC -SURGICAL:EXCISION,BASE CAUTERISATION.

HISTOPLASMOSISHISTOPLASMA CAPSOLATUM RARE. MUCOSAL ULCERS TTT:AMPHOTRICINE B

BLASTOMYCOSISYEAST LIKE FUNGUS PAPILLARY SWELLINGS ON N.MUCOSA TTT:AMPH. B

UNKOWN DISEASES1. SARCOIDOSIS 2. IDIOPATHIC MIDLINE DESTRUCTIVE DISEASE

.

SARCOIDOSISIDIOPATHIC SYSTEMIC GR.DISEASE(?AUTOIMMU.) CLINICAL P.COUGH,DYSPNEA,HOARSENESS,APHONIA,,, N.OBST,EPIST.,CRUSTS, TINY NODULES,SYNAECHIA,MAY CAUSE DESTRUCTION:CART.,PN SINUSES. TTT: DEPOT OR LOCAL STEROID IN NOSE SURGERY IN OBST. LESIONS

IDIOPATHIC MIDLINE DESTRUCTIVE DISEASE (not gr. Dis.)LOCAISED 2 HEAD,NECK MAY DAUSE:PANSINUSITIS,ULCERATION OF N.FLOOR,SEPTAL PERF. IT STARTS AS A SMALL PAINLESS NODULE IN PALATE,PERFORATES 2 NOSE,SINUSES,ORBIT,WHOLE FACE DESTROYING BONES LEADING 2 SCARS(LIKE YAWS) IN BIOPSY NO GRAN. OR VASCULITIS TTT:-RADIOTHERAPY LOCALLY -PREDNISONE,CYCLOPHOSPHAMIDE

NEOPLASTIC1. HISTOCYTOSIS

2. EOSINOPHILIC GRANULOMA

3. FIBROUS HISTOCYTOSIS 4. LOBULARCAPILLARHAEMANGIOMA.

HISTOCYTOSIS.NON GRAN.DIS CLINICAL:N.MASS,EPISTAXIS,SEPT.PER .F BIOPSY:SHEETS OF POLYGONAL HISTOCYTES PROGNOSIS:POOR

EOSINOPHILIC GRANULOMA LOCAISED FORM OF HISTOCYTOSIS TTT:CURETTAGE OF BONE IRRADIATION

FIBROUS HISTOCYTOMAN.OBST,EPISTAXIS,DYSPNEA,DYSPHAGI A

LOBULAR CAPILLARY HAEMANGIOMAi.e: PYOGENIC GRAN. FRIABLE LEISION IN HEAD,NECK TTT:SURGERY

CONGENITAL DISEASISGRAN .DISEASE CAN OCCUR DUE TO HEREDTARY DEFECT IN IMMUNITY;DISORDER OF PHAGOCYTIC CELLS &PHAGOCYTOSIS RESULTING IN RECURRENT INFECTIONS&ABSCESSES.

DIAGNOSISHISTORY COUNTRY JOB SEXUAL REL. COTEXT OTHER SITES

.CLINICAL EXGENERAL:G.C ANAEMIA,PALLOR,DYSPNEA,DYSPHA GIA,HOARSENESS&FEVER BY NIGHT LOCAL: SHAPE OF NOSE NODULES OR PATCHES SWELLING IN VESTIBULE SW.CHARACTERS REC. BLEEDING CRUSTS,DISCHARGE EX.PNSP,ORAL

.BLOOD,SEROLOGICAL EXC.B.C SERUM ELECTROLYTES BLOOD CULTURE BLOOD FILM COMPL,FIXATION TESTS IMMUNOGLOBULINS VDRL,TPI

FILMS&CULTURESN .DISCHARGE:SWAB FOR FILMS,C/S&SMEARS

.RADIOLOGICAL EX .X-RAY PN SINUSES,BONE:MASS,SADDLING&DESTRUC TION. CHEST:TB,CYSTIC BONY CHANGES+THINNING IN SARCOIDOSIS,HILAR LYM.NODES. CT: PN SINUSES MASSES CH:SITE,SIZE,SHAPE,EXTENSION ,IN SYPHILIS POST . SEPAL PERF.,,BONY RAREFICATION.,,,, IN FUNGAL LEISIONS :MOTTLING

BIOPSY .IS THE MOST IMPORTANT DIAGNOSTIC INVESTIGATON. THE HISTOLOGIC PATTERN IS CHARACTERSTIC IN SOME LEISIONS. IT MY BE TAKEN FROM GR.MASS OR FROM LYMPH NODES.

D.D. BACTERIAL INFECTION FUNGAL PARASITIC AUTOIMMUNE SARCOIDOSIS LMPHOMA F.BODY HEAVY METALS IDIOPATHIC

MANAGEMENT MEDICAL TTT 1:PREDNISOLONE-4 LONG TERM THERAPY 2:ANTIBIOTICS-4 BACTERIAL,SECONDARY INFECTION 3:ANTISYPHILITIC :PENICILLINE 4:ANTITUBERCULUS:STREPTOMYCIN,REFA MPICINE,PAS. 5-AMPHOTRICINE-B:INJECTION,N.SPRAY OR WASH. 6:CHEMOTHERAPY:METHOTREXATE

SURGICALTTTEXCISION OF GRANULOMA-1 LASER,SPECIALLY IN SARCOIDOSIS-2 PLASTIC SURGERY,4-3 RECONSTRUCTION OF DESTROYED .NASAL OR FACIAL BONES

COBINATIONS.IN MOST OF THE CASES

PLEASE

NO QUESTIONS