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Nasal Granulomas

Nasal Granulomas

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Nasal Granulomas

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  1. Nasal Granulomas

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

  3. It may occurs locally as a mass, an isolated process or it may be local manifestation of a generalized disease.

  4. Classification • Bacterial • Fungal • Non specific

  5. Bacterial • Syphilis • Tuberculous • Leprosy • Histiocytosis • Lupus vulgaris • Anthrax

  6. Fungal • Rhinosporidiosis • Aspergillosis • Actinomycosis • Candidiasis • Histoplasmosis • mucormycosis

  7. Non Specified • Wegeners granuloma • Stewarts midline granuloma • Sarcoidosis

  8. Fungal granulomas • Grow by budding • Commonly affects males • Immunocompromised,diabetics,leukemia,malignancies,AIDS,burns ,organ transplant ,malnutrition more susceptible • Biopsy,serology • antifungal

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

  10. 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

  11. Leprosy • Chronic, laprae Bacillus • Clinical types tuberculoid,borderline &lepromatous • Nasal involvement in lepromatous type • Anosmia,crusts,atrophic rhinitis,bleed • Dapsone,clofazimine,rifampicine

  12. 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

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. Wegener’s granuloma • A systemic disorder • Lungs,Kidneys, upper respiratory tract • Necrotizing giant cell with vasculitis

  19. Wegener’s ganuloma • Septal perforation unilateral discharge • Raised ESR, • multinodular and cavitating lesions of lungs • Haematuria • cANCA

  20. Renal failure within one year • Sex equal age incidence is 4th -5th decade

  21. Wegener’s granuloma • Treatment • Corticosteroids • Cyclophosphamide • Azathioprine

  22. 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