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Nasal Granulomas

Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

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Page 1: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Nasal Granulomas

Page 2: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory process

Page 3: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

It may occurs locally as a mass,

an isolated process or

it may be local manifestation of a generalized disease.

Page 4: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Classification

Bacterial

Fungal

Non specific

Page 5: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Bacterial

Syphilis Tuberculous Leprosy Histiocytosis Lupus vulgaris Anthrax

Page 6: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Fungal

Rhinosporidiosis Aspergillosis Actinomycosis Candidiasis Histoplasmosis mucormycosis

Page 7: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Non Specified

Wegeners granuloma Stewarts midline granuloma Sarcoidosis

Page 8: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Fungal granulomas

Grow by budding Commonly affects males Immunocompromised,diabetics,leukemia,malign

ancies,AIDS,burns ,organ transplant ,malnutrition more susceptible

Biopsy,serology antifungal

Page 9: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Rhinosporidiosis

Rhinosporium Seeberi In mucosa of upper&lower rt Bleeding polyp Friable strawberrry like,white dots Biopsy Excision,diathermy,antifungal

Page 10: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Lupus Vulgaris

Indolent,localized and chronic form ofTB Common in females Mucocutaneous junctions Epitheloid and langhans giant cellsules Red ,firm nod,blanching leads to apple

jelly nodules ATT,Vit D

Page 11: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Leprosy

Chronic, laprae Bacillus Clinical types tuberculoid,borderline

&lepromatous Nasal involvement in lepromatous type Anosmia,crusts,atrophic rhinitis,bleed Dapsone,clofazimine,rifampicine

Page 12: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Tuberculosis

Usually secondary wit a rapid course Nodular,ulcerative or polypoidal Nasal septum,lateral wall No pain Mucosa bright red ulcerative AFB,Bacteriology,biopsy Alkaline douches,ATT

Page 13: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

sinonasal sarcoidosis

The clinical symptoms are usually nonspecific. Nasal obstruction, postnasal drainage, headache, and recurrent

sinus infections are common Sarcoidosis patients usually present with symptoms in other systems, particularly the lungs.

Other associated findings in the head and neck, such as xerostomia

(dry mouth), xeroophthalmia (dry eyes), or parotid gland enlargement increase the clinical suspicion for sarcoid

the diagnosis of sinonasal sarcoidosis is established only after appropriately directed biopsy and histopathologic examination.

Page 14: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Rhinoliths

They are calcareous concretions that are formed by the deposition of salts on an intranasal foreign body. 

The foreign body, which acts as the nucleus for encrustation, can be

either endogenous or exogenous. Dessicated blood clots, ectopic teeth, and bone fragments are examples of endogenous matter. Exogenous materials include fruit seeds, plant material, beads, cotton wool, and dental impression material.

Page 15: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Although the pathogenesis remains unclear; a number of factors are thought to be involved in the formation of rhinoliths. These include entry and impaction of a foreign body in the nasal cavity, acute and chronic inflammation, obstruction and stagnation of nasal secretions, and precipitation of mineral salts. Development and progression are believed to take a number of years.

Page 16: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Most patients complain of purulent rhinorrhea and/or ipsilateral nasal obstruction. Other symptoms include fetor, epistaxis, sinusitis, headache and, in rare cases, epiphora. In some patients, rhinoliths are discovered incidentally

Page 17: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Rhinoliths

Nasal obstruction and discharge Destruction of mucosa leading to

sequestra of bone and cartilage with unpleasant odour

Diagnosis is clinical Treatment surgical removal with pnasal

packs for 24 hours

Page 18: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Wegener’s granuloma

A systemic disorder Lungs,Kidneys, upper respiratory tract Necrotizing giant cell with vasculitis

Page 19: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Wegener’s ganuloma

Septal perforation unilateral discharge Raised ESR, multinodular and cavitating lesions of

lungs Haematuria

cANCA

Page 20: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Renal failure within one year Sex equal age incidence is 4th -5th

decade

Page 21: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Wegener’s granuloma

Treatment Corticosteroids Cyclophosphamide Azathioprine

Page 22: Nasal Granulomas. A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory

Stewart’s granuloma

Indurated mass of the nose or nasal vestibule

Leading to progressive ulceration of the cartilage and bone

as a variant of lymphoma Surgical excision and radiotherapy