DISEASES OF NASAL VESTIBULE

BY:RITU RAJAN

Disease of nasal vestibules

The disease of nasal vestibule may involve the hairs , skins of the nose which could be:InflammatoryTraumaticNeoplastic

Inflammatory Conditions Of Nasal Vestibules

1. FURUNCLE OR BOIL2. VESTIBULITIS3. ERYSIPELAS Furuncle or boil

Definition:

It is an acute infection of the hair follicle of nasal vestibule caused by Staphylococcus aureus

Causative Agent:

Staphylococcus aureus

Predisposing Factors:

1. Trauma from pricking of nose

2. Diabetes

3. Immunodeficiency state

4. Long term steroids

Clinical Features: Complain of pain over affected area. Swelling which involve the tip of the nose depending on the site of the affected

area.

Signs: Swelling and redness of the affected area. The affected area is usually Tender.

Treatment: Warm compression. Analgesics to relieve pain. Tropical and systemic antibiotics directed against staphylococcus.

If a fluctuant area appears, incision and drainage can be done.

In NO case should the furuncle be squeezed or prematurely incised because of the danger of spread of infection to cavernous sinus through venous thrombophlebitis

Complications: Cellulitis of the upper lip Septal abscess Cavernous Sinus Thrombosis.

as veins of the nose is connected with the cavernous sinus through two routes:-1). Through facial veins communicating with ophthalmic vein (both having no valves) ,

2). Through the pterygoid plexus of vein which communicate with facial veins on one hand the cavernous sinus through emissary veins on the other hand.

If the patient of nasal furunculosis complains of malaise, headache and pyrexia, cavernous sinus thrombosis should be suspected.

Vestibulitis

Definition:

It is diffuse dermatitis of nasal vestibule.

Etiology: Persistent infected discharge from nose leading to irritation and maceration of skin of the

vestibule like rhinitis sinusitis or nasal allergy . Nose picking or rubbing with finger. Frequent cleaning of nasal discharge with handkerchief. Traumatic ulceration of the projected skin over a caudally dislocated septum.

Types:

ACUTECHRONIC

Causative agent:

Staphylococcus aureus

Clinical feature:

Symptoms: Itching and irritation of the nose. Pain in the nose.

Sings:

In acute form: vestibular skin is red , swollen & tender. Crust & scales cover an area of erosion or excoriation. The upper lid may involve.

In chronic form: There is induration of vestibular skin with painful fissure & crusting.

Treatment

Consists of cleaning the nasal vestibule of all crusts and scales with cotton applicator soaked in hydrogen peroxide.

Application of antibiotic-steroid ointment. A chronic fissure can be cauterised with silver nitrate. Attention should be paid to the cause of nasal discharge and should be treated.

ErysipelasIt is an acute spreading dermatitis of streptococcal origin.

Clinical features: It present as a red swollen area spreading towards the face and eye. Nasal mucosa is congested. Constitutional symptoms may be severe.

Treatment:Antibiotics and anti-inflammatory drugs are useful.

Traumatic & congenital conditions of nasal vestibule

STENOSIS AND ATERISA OF THE NARESEtiology:I. Web formation and stenosis may occur after trauma or surgery of nasal tip or vestibule. In

Young’s operation, which is done in atrophic rhinitis, nares are deliberately closed with vestibular skin flaps.

II. Destructive inflammatory lesions of nose also cause stenosis.

III. Earlier, several case of vestibular stenosis resulted from smallpox.

IV. Congenital atresia of anterior nares due to noncanalization of epithelial plus between developing medial and lateral nasal folds fails to get absorbed during embryonic life . It is rare.

Treatment: Reconstructive plastic surgery

NEOPLASTIC CONDITION OF NASAL VESTIBULE

They can be divided into three categories:—

CONGENITALBENIGN

ORMALIGNANT

CONGENITAL

Nasoalveolar Cyst or Nasolabial cystThis squamous epithelium-lined cyst arises from the epithelial 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: It presents as a smooth and soft bulge in the lateral wall and floor of nasal vestibule

anterior to inferior turbinate. Large cyst obliterates the alar facial fold(nasolabial sulcus) The fluctuation and fluid thrill is best felt with one finger in vestibule and second

under the lip.

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.

BENIGN

Papilloma Or Wart Of NoseThis may be single or multiple and pedunculated or sessile.Treatment: It consists of surgical excision, which is usuallydone under local anesthesia

MALIGNANT

Squamous Cell Carcinoma (Epithelioma) This second most common malignant tumour of nose skin (11%). Equally affects either sexes. Occurs in the age group of 40–60 years.

Clinical features: It presents as an infiltrating nodule or an ulcer with rolled out edges. The common sites are lateral wall of the vestibule and columella . It which may extend

into nasal floor and upper lip. 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.

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