nasal granulomas. a granuloma is a tumour like mass of nodular granulation tissue with actively...
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Nasal Granulomas
A granuloma is a tumour like mass of nodular granulation tissue with actively growing fibrobasts and capillary buds due to chronic inflammatory process
It may occurs locally as a mass,
an isolated process or
it may be local manifestation of a generalized disease.
Classification
Bacterial
Fungal
Non specific
Bacterial
Syphilis Tuberculous Leprosy Histiocytosis Lupus vulgaris Anthrax
Fungal
Rhinosporidiosis Aspergillosis Actinomycosis Candidiasis Histoplasmosis mucormycosis
Non Specified
Wegeners granuloma Stewarts midline granuloma Sarcoidosis
Fungal granulomas
Grow by budding Commonly affects males Immunocompromised,diabetics,leukemia,malign
ancies,AIDS,burns ,organ transplant ,malnutrition more susceptible
Biopsy,serology antifungal
Rhinosporidiosis
Rhinosporium Seeberi In mucosa of upper&lower rt Bleeding polyp Friable strawberrry like,white dots Biopsy Excision,diathermy,antifungal
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
Leprosy
Chronic, laprae Bacillus Clinical types tuberculoid,borderline
&lepromatous Nasal involvement in lepromatous type Anosmia,crusts,atrophic rhinitis,bleed Dapsone,clofazimine,rifampicine
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
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.
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.
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.
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
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
Wegener’s granuloma
A systemic disorder Lungs,Kidneys, upper respiratory tract Necrotizing giant cell with vasculitis
Wegener’s ganuloma
Septal perforation unilateral discharge Raised ESR, multinodular and cavitating lesions of
lungs Haematuria
cANCA
Renal failure within one year Sex equal age incidence is 4th -5th
decade
Wegener’s granuloma
Treatment Corticosteroids Cyclophosphamide Azathioprine
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
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