4. The NoseThe Nose
The nose consists ofThe nose consists of
thethe external noseexternal nose
and theand the nasal cavitynasal cavity,,
Both are divided by aBoth are divided by a
septum into right andseptum into right and
left halves.left halves.
5. External NoseExternal Nose
The external noseThe external nose
has two ellipticalhas two elliptical
orifices called theorifices called the
naris (nostrils)naris (nostrils),,
which are separatedwhich are separated
from each other byfrom each other by
thethe nasal septumnasal septum..
The lateral margin,The lateral margin,
thethe ala nasiala nasi, is, is
rounded and mobile.rounded and mobile.
7. External NoseExternal Nose
The framework of theThe framework of the
external nose is madeexternal nose is made
up above by theup above by the
nasal bonesnasal bones, the, the
frontal processes offrontal processes of
the maxillaethe maxillae, and, and thethe
nasal part of thenasal part of the
frontal bonefrontal bone..
Below, the frameworkBelow, the framework
is formed of plates ofis formed of plates of
hyaline cartilagehyaline cartilage
9. Blood Supply of the External NoseBlood Supply of the External Nose
Maxillary arteryMaxillary artery
External NoseExternal Nose
Ophthalmic ArteryOphthalmic Artery
External NoseExternal Nose
Facial ArteryFacial Artery
AlaAla
Lower part of the septumLower part of the septum
10. Nerve Supply - External NoseNerve Supply - External Nose
Ophthalmic nerveOphthalmic nerve
Infratrochlear branchesInfratrochlear branches
External nasal branchesExternal nasal branches
Maxillary nerveMaxillary nerve
Infra Orbital branchInfra Orbital branch
11. Nasal CavityNasal Cavity
The nasal cavity hasThe nasal cavity has
floorfloor
roofroof
lateral walllateral wall
medial or septalmedial or septal
wallwall
12. CellulitisCellulitis
Infection of nasal skin and soft tissueInfection of nasal skin and soft tissue
OrganismsOrganisms
StreptococciStreptococci
StaphylococciStaphylococci
Clinical featuresClinical features
RednessRedness
SwollenSwollen
Tenderness.Tenderness.
TreatmentTreatment
Systemic antibioticsSystemic antibiotics
Hot fomentationHot fomentation
AnalgesicsAnalgesics
18. Hump DeformityHump Deformity
BoneBone
CartilageCartilage
Both - bone and cartilage.Both - bone and cartilage.
TreatmentTreatment
Reduction RhinoplastyReduction Rhinoplasty
Exposure of nasal frameworkExposure of nasal framework
External approachExternal approach
Closed approachClosed approach
Removal of humpRemoval of hump
Narrowing of the lateral wallsNarrowing of the lateral walls
19. Crooked noseCrooked nose
Midline of dorsum from frontonasal angleMidline of dorsum from frontonasal angle
to tip is curved in A C or S shape.to tip is curved in A C or S shape.
Deviated nose-midline is straight butDeviated nose-midline is straight but
deviated to one side.deviated to one side.
EtiologyEtiology -- traumatrauma
BirthBirth
NeonatalNeonatal
childhoodchildhood
Deformities are identified with growthDeformities are identified with growth
TreatmentTreatment
RhinoplastyRhinoplasty
SeptorhinoplastySeptorhinoplasty
24. Meningoencephalocele orMeningoencephalocele or
EncephalocoeleEncephalocoele
TypesTypes
NasofrontalNasofrontal-subcutaneous pulsatile swelling in the-subcutaneous pulsatile swelling in the
midline at the root of nose.midline at the root of nose.
NasoethmoidNasoethmoid - swelling at side of nose.- swelling at side of nose.
Naso-orbitalNaso-orbital-on the antero medial aspect of orbit.-on the antero medial aspect of orbit.
Swellings showSwellings show
cough impulsecough impulse
Reducible.Reducible.
TreatmentTreatment::
• NeurosurgicalNeurosurgical
• Severing the stalk from brainSevering the stalk from brain
• Repairing the bony defect.Repairing the bony defect.
25. GliomaGlioma
• It is a nipped off portion of encephaloceleIt is a nipped off portion of encephalocele
during embryonic developmentduring embryonic development
• Firm subcutaneous swelling on theFirm subcutaneous swelling on the
•
BridgeBridge
•
Side of noseSide of nose
•
Inner canthusInner canthus
• 60%-extranasal60%-extranasal
• 30%-intranasal,30%-intranasal,
• 10%-both10%-both
• Extranasal gliomas are encapsulated andExtranasal gliomas are encapsulated and
can be easily removed by external nasalcan be easily removed by external nasal
27. Dermoid with SinusDermoid with Sinus
seen in infants and childrenseen in infants and children
pit or a sinus in the midlinepit or a sinus in the midline
dorsum of nosedorsum of nose
Hair may be seen protrudingHair may be seen protruding
28. Dermoid with SinusDermoid with Sinus
sinus track may lead to a dermoid cystsinus track may lead to a dermoid cyst
under the nasal bone in front of upperunder the nasal bone in front of upper
part of nasal septumpart of nasal septum
may have an intracranial duralmay have an intracranial dural
connection.connection.
sinus tract passes through thesinus tract passes through the
cribriform plate or foramen caecum andcribriform plate or foramen caecum and
is attached to dura or has otheris attached to dura or has other
intracranial connection.intracranial connection.
29. Dermoid with SinusDermoid with Sinus
ComplicationComplication
MeningitisMeningitis
TreatmentTreatment
Removal of the eermoid with tactRemoval of the eermoid with tact
nasal bones to remove any extension innasal bones to remove any extension in
the upper part of the nasal septum.the upper part of the nasal septum.
Combined approach neurosurgicalCombined approach neurosurgical
otolaryngologicotolaryngologic
Repair of the gapRepair of the gap
32. Rhinophyma (potato tumour)Rhinophyma (potato tumour)
• Slow growing benign tumourSlow growing benign tumour
• Hypertrophy of the sebaceous glandsHypertrophy of the sebaceous glands - tip of nose- tip of nose
•
Seen in long standing cases of acne rosaceaSeen in long standing cases of acne rosacea
•
Unsightly appearance of tumourUnsightly appearance of tumour
•
Obstruction in breathingObstruction in breathing
•
Obstruction of visionObstruction of vision
• Clinical featuresClinical features
•
Pink, lobulated mass over the nose with superficial vascularPink, lobulated mass over the nose with superficial vascular
dilations.dilations.
•
Mostly affect men past middle age.Mostly affect men past middle age.
• TreatmentTreatment
•
Paring the bulk of the tumour with sharp knife orParing the bulk of the tumour with sharp knife or
•
CO2 laser ablasionCO2 laser ablasion
•
Re-epithelialisationRe-epithelialisation
•
Completely excision and skin graftingCompletely excision and skin grafting
36. Basal cell carcinomaBasal cell carcinoma (rodent ulcer)(rodent ulcer)
• Most common malignant tumourMost common malignant tumour -- 87%87%
• Males:females = 1:1Males:females = 1:1
• Age group of 40-60.Age group of 40-60.
• Common sites: tip and the ala.Common sites: tip and the ala.
• Clinical presentationClinical presentation
•
CystCyst
•
Papulo-pearly nodulePapulo-pearly nodule
•
Ulcer with rolled edgesUlcer with rolled edges
37. Basal cell carcinomaBasal cell carcinoma (rodent ulcer)(rodent ulcer)
• CharacteristicsCharacteristics
•
Very slow growingVery slow growing
•
Remains confined to skin for a long timeRemains confined to skin for a long time
•
Underlying bone and cartilage may get invadedUnderlying bone and cartilage may get invaded
•
Nodal metastasis extremely rareNodal metastasis extremely rare
38. Basal cell carcinoma- treatmentBasal cell carcinoma- treatment
Depends onDepends on
SizeSize
LocationLocation
DepthDepth
Early lesionsEarly lesions
CryosurgeryCryosurgery
IrradiationIrradiation
Surgical excision with 3-5mm marginSurgical excision with 3-5mm margin..
Recurrent /extensiveRecurrent /extensive lesionslesions (involvement of bone or(involvement of bone or
cartilage)cartilage)
ExcisionExcision
Defect closed by local or distant flaps or prosthesis.Defect closed by local or distant flaps or prosthesis.
39. Squamous cell carcinomaSquamous cell carcinoma
(epithelioma)(epithelioma)
• 2nd most common malignant tumour -112nd most common malignant tumour -11
%%
• M:F = 1:1M:F = 1:1
• Age group - 40-60Age group - 40-60
• Clinical featuresClinical features
•
Infiltrating noduleInfiltrating nodule
•
Ulcer with rolled out edgesUlcer with rolled out edges
•
Affecting side of nose or collumelaAffecting side of nose or collumela
•
Nodal metastases – 20%Nodal metastases – 20%
40. SSC - treatmentSSC - treatment
• RadiotherapyRadiotherapy
•
Early lesionsEarly lesions
• Advanced lesions - bone or cartilageAdvanced lesions - bone or cartilage
•
Wide surgical excisionWide surgical excision
•
Plastic repair of thePlastic repair of the
• Enlarged regional lymph nodesEnlarged regional lymph nodes
•
Block neck dissection.Block neck dissection.
41. MelanomaMelanoma
Least common variety.Least common variety.
ClinicallyClinically
Superficially-spreading typeSuperficially-spreading type
Slow-growingSlow-growing
Nodular invasive type.Nodular invasive type.
TreatmentTreatment
Surgical excisionSurgical excision
42. MelanomaMelanoma
Least common variety.Least common variety.
ClinicallyClinically
Superficially-spreading typeSuperficially-spreading type
Slow-growingSlow-growing
Nodular invasive type.Nodular invasive type.
TreatmentTreatment
Surgical excisionSurgical excision
43. Furuncle - boilFuruncle - boil
• DefinitonDefiniton
•
Acute infection of hair follicle by staphylococcus aureusAcute infection of hair follicle by staphylococcus aureus
•
EtiologyEtiology
• TraumaTrauma
•
Picking nasal vibrissaePicking nasal vibrissae
•
Plucking nasal vibrissaePlucking nasal vibrissae
•
Clinical featuresClinical features
• Lesion is smallLesion is small
• Extremely painful and tenderExtremely painful and tender
• Inflammation may spread nasal tipInflammation may spread nasal tip
• RednessRedness
• Swollen.Swollen.
• Fever,Fever,
• MalaiseMalaise
• HeadacheHeadache
• Pus discharge _rupture spontaneously in vestibule.Pus discharge _rupture spontaneously in vestibule.
46. VestibulitisVestibulitis
• Diffuse dermatitis of nasal vestibuleDiffuse dermatitis of nasal vestibule
• Causative organism- Staph AureusCausative organism- Staph Aureus
• Predisposing factorPredisposing factor
•
Nose pickingNose picking
•
Plucking of nasal vibrissaePlucking of nasal vibrissae
•
Nasal discharge due to any cause coupled with traumaNasal discharge due to any cause coupled with trauma
due to handkerchiefdue to handkerchief
47. VestibulitisVestibulitis
• Acute formAcute form
•
Vestibular skin is redVestibular skin is red
•
Skin is swollenSkin is swollen
•
TendernessTenderness
•
CrustsCrusts
•
Scales cover over erosionScales cover over erosion
•
Excoriation. Upper lip may also beExcoriation. Upper lip may also be
involved.involved.
• Chronic form-Chronic form-
•
Induration of vestibular skinInduration of vestibular skin
•
Painful fissures and crusting.Painful fissures and crusting.
•
48. VestibulitisVestibulitis
Treatment-Treatment-
Removal of crusts with hydrogenRemoval of crusts with hydrogen
peroxideperoxide
Application of antibiotic steroid creamApplication of antibiotic steroid cream
Chronic fissure cauterized with AgNO3Chronic fissure cauterized with AgNO3
