Allergic Rhinitis: The inside of the nose is swollen and
there is thick secretions. The
turbinatesare pale wit clear secretions. Pictured in
these photographs is the space between the
nasal septum
and
inferiorturbinate.
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Nasal Polyp:
A nasal polyp is a mass of gelatinous
tissue which usually forms from allergy. If only on one side, one must
rule out a carcinoma or cancer. Allergic
nasalpolyps can be treated by topical
nasalsteroids or by surgical removal.
Often
endoscopic sinus surgeryis needed for their removal.
Search PubMed for Nasal Polyps
Click on pictures to enlarge !!!
The
pictures shown to the right are of a patient's CT Scan (far right) and of her polyps in
the left (middle picture) and right (far left picture)
nasal
cavities.
The CT Scan shows polyps "*" and
opacified
maxillary sinus
"MS" and an
opacified
posterior
ethmoidsinus "ES".
Click on pictures to
enlarge
The nasal polyps on the below and to the right are from a 65 year old
patient who has had four previous sinus operations. The last one
was twelve years ago. The polyps fill his nasal cavity. On
CT Scan there was erosion of the posterior table of the frontal sinus
and intracranial air.
Click on pictures to
enlarge !!!
Rhinophyma
is a chronic end-stage skin condition caused by
hypertrophy of the skin's
sebaceous
(oil) glands. The skin thickens and becomes filled with cysts and
pustules. Treatment is surgical excision and shaving the thick skin in
layers with CO2 laser, dermabrasion or electrocautery.
Click Here To: View Stages in Operation and
Post Operative Result
Medical treatment to prevent progression has
been targeted at the treatment of sebaceous hypertrophy. Rosacea has
been implicated as a causative factor. For this reason topical
antibiotics such as metrogel have been prescribed and to keep the skin pores
open, soaps, moisturizes, gels, sun screen may also be recommended.
Rhinophyma is NOT related to alcohol consumption but an end-stage
presentation of sebaceous hypertrophy.
Click on pictures to
enlarge !!!
Mucocele:
A mucocele is a collection of mucoid fluid from a blocked sinus
which forms an expansile mass. The lining of the sinus continues to
secrete mucus which places a mild continuous pressure on the surrounding
sinus walls. This pressure over many months to years slowly expands the sinus and may
impinge upon important structures.
The patient below is a 31 year old patient who sought medical attention for
double vision and facial numbness. The patient's face was asymmetrical
(left hand picture below) and on CT Scan a large mass was seen in the Maxillary Sinus
(middle picture below). On nasal
endoscopy the sinus was entered and abundant thick fluid was removed from
the sinus a septoplasty to straighten the nasal septum was also performed.
Post operative result is show in the right hand CT Scan below.
Septal Spur:
This patient had chronic headaches which were
relieved with
intranasal
hurricane spray (numbing solution). It was felt that the large
septal
spur
impinging upon the middle
turbinate
may be contributing to the headaches. A
septoplasty
was performed. The headaches disappeared after the operation.
(Left
Photo: CT Scan of Septal Spur, Middle Photo:
SeptalSpur-
Pathological Specimen; Right Photo:
Septal
Spur
Pre-Operative Appearance.)
Click on pictures
to enlarge !
Although
some patients have reported headache relief from the removal of
septal
spurs,
the results are variable and cannot be guaranteed.
View Article Headaches are
caused by a wide range of etiologies. Before surgery, it is best to
anesthetized (numb) the nose to see if the headache is relieved.
Surgery for "sinus headaches" is also
debated and results cannot be guaranteed. Shields has shown
the there was no correlation between the severity of pain and the
severity of
sinus
symptoms. This brings into question whether sinus disease is
causing the symptoms at all. One explanation is that most head
pain is caused by tension headaches and migraines. The
patients just assume the pain is from sinus disease because of the
mass marketing of
sinus
medications they see on
television.
View Article
Nasal
Adenoma: The
pictures on the right shows a large
nasal
mass in a 60 year old patient. The far left hand picture shows
the patient's preoperative CT scan. The
adenoma was removed in the office.
The
mass was removed with and
endoscopic
intranasal
anteriorethmoidectomy.
The post-operative cavity is shown in the right hand picture. The
final pathology reveled a
benign
nasalpapilloma. The picture on the left shows the four month
post operative result.
Endoscopic removal of papillomas has a high rate of cure without producing a
cosmetic defect (Kraft 2004).
View Abstract
Click on pictures to
enlarge !!!
Theses
photographs shows patient with an adenoma
of the nasal
cavity. On CT
scan, the center of the adenoma can be seen to be calcified.
The
pictures below show the appearance of the papilloma before (left) and during
(far right) surgical
removal. Note that the preoperative appearance of the papilloma
resembled a normal turbinate. Endoscopic removal of papillomas has a high rate of cure without producing a
cosmetic defect (Kraft 2004).
View Abstract
However, inverted papillomas are locally
invasive and patients must be followed for recurrence.
Click on pictures to
enlarge !!!
This
photograph shows a huge
nasal
polyp in a 10 year old white female extending
into the
oral pharynx. In a young Caucasian patient cystic fibrosis
should be ruled out.
Post
Endoscopic Sinus Surgery: This is a picture of the
middle meatus, the space between the middle and
inferiorturbinate.
Large openings can be seen into the
maxillary
and
ethmoid sinuses.
The mucosa is moist and without significant drainage.
Click on pictures to
enlarge !!!
Chronic
Rhinitis:
This is a picture of chronic rhinitis secondary to
smoking. The secretions are dry and the
turbinatesare whitish.
Unfortunately, quitting smoking often does not reverse the symptoms
since permanent damage has been done to the nose. After quitting,
nasalsecretions may worsen as the
goblet cells recover, but the ability to clear secretions does not.
Search PubMed for Vasomotor Rhinitis
Search PubMed for Smoking and Rhinitis
Foreign
Body in the Nose:
This picture shows a plastic "hot wheels" toy
in the right naris of a 5 year old. The foreign body is wedged below
the middle
turbinate.
Attempts at removal in the emergency room was unsuccessful and the child was
taken to the operating room for removal.
Click on pictures to
enlarge !!!
This picture shows a wood chip foreign body in
the nose. It is located under the middle
turbinate,
deep in the
middle meatus. It was removed in the doctor's office under local
anesthesia.
This
picture shows prominent
anterior
(up-front)
septal
vessels which will
bleed easily. This type of nose bleed (epistaxis) usually
occurs in children.
Click on pictures to
enlarge !!!
Prominent
Anterior Nasal Septal Vessels. In young children
nasal
bleeding is often caused by chronic
nasal
inflammation and rupture of small blood vessels located on the
anteriornasal septum. The
picture on the far right shows prominent vessels on the
nasal septum.
This vascular formation is often called
Kiesselbach's
plexus. The same child was seen a week later just after a nose bleed. The
picture on the left shows the source of bleeding.
Learn More About Epistaxis
Click on pictures to
enlarge !!!
These pictures show a
posterior
nosebleed (epistaxis)
with a large clot on the floor of the nose.
This type of nose bleed usually occurs in adults with high blood pressure.
Note the blood coming out from under the middle
turbinate.
Click on pictures to
enlarge !!!
This
patient presented with left sided
epistaxis
and was found to have a mass in
her
nasal
cavity. The mass was an inverted papilloma. This is a
locally invasive tumor which is treated with surgical resection.
Endoscopic sinus surgery can be used to remove this growth. In this
procedure fiberoptic scopes are placed in the nose and the growth is
resected without any external surgical incisions. The overall success
rate has been reported to be as high as 94%
View Article
Click on pictures to
enlarge !!!
Nasal
Necrosis from Drug Abuse:
The appearance of the inside of the nose from inserting a pill into the
nose. The robin egg blue is characteristic of narcotic abuse.
The picture on the right shows necrosis of mucosa on the medial portion
of the inferior turbinate and the inferior portion of the middle
turbinate. The lower septal mucosa is also white and necrotic.
Click on pictures to
enlarge !!!
Rhinolith:
A rhinolith is a rock which forms in the nose. It occurs from the
solidification of mucus and
nasal debris. As shown on the CT Scan
x-ray, the rhinolith was displacing the
inferiorturbinate
superiorly and had to be removed under general anesthesia.
Click on pictures to
enlarge !!!
Nasal
Septal Mass:
Shown in this photograph is a pyogenic granuloma on
the
nasal septum. This mass is
benign
and is not a true
neoplasm. In the nose, it usually presents as bleeding.
Treatment is by surgical removal. Unfortunately, recurrences are
common.
Click on pictures to
enlarge !!!
Perforation
of Nasal Septum: A perforation of the
nasal septumcan be caused
by a complication of surgery,
nasal trauma, autoimmune diseases, chronic
use of
nasalsteroids, use of topical
nasaldecongestants or cocaine
abuse. The perforation can cause crusting,
nasalbleeding and
whistling when the patient breaths. Treatment involves the use of
nasal wetting agents, placement of a plastic button over the perforation,
and surgical repair. Repair with surgery is very difficult and
failure to close the perforation is common.
Search PubMed for Septal Perforation
Perforations
of the
nasal septum
can also be caused by drug abuse. To
the right is a photogra ph of a large
nasal
septal
perforation, the margin of which is shown in
blue (click on pictures to enlarge). Note the
nasal
synechiea
(scaring shown in green) between the
nasal septum
and right inferior
turbinate.
The specks through out the
nasal
cavity are a whitish dust which has been
inhaled or snorted.
Click on pictures to
enlarge !!!
The
perforation shown on the right in in a 5 year old. The hole was
produced from a button battery which the child inserted. This type
of foreign body should be removed immediately. Prior to removal, the
use of nose drops of any kind is absolutely contraindicated. The
electrical charge of the battery will produce electrolysis of any
electrolyte-rich fluid. This produces hydroxides which will cause a
severe alkaline burn. Healing took several weeks and damage to the to the
nose which produced a
nasal septal
perforation occurred. In children,
there is some evidence that damage to the
nasal septum
may cause failure to the mid-face to grow.
Learn More About Button Battery
Foreign Bodies:
***View & Read Article - Adobe Acrobat 4.0***
Wegener's
Granulomatosis:
This patient is a 62 year old with a two year
history of Wegener's Granulomatosis. This is an autoimmune disease
which attacks the blood vessels of the body, causing a vasculitis. The
disease often damages the
nasal septum
and sinuses. It can also attack the
eyes and kidneys, causing visual loss and renal failure. This patients
was treated with methotrexate ( an immunosuppressant ), bactrum and folic
acid. The picture on the right shows a very large perforation of the
patient's
nasal septum.
There is also almost complete loss and scaring of the left middle
turbinate
and
middle meatus(see
arrow) which is blocking the drainage of the
ethmoid sinus
cavities.
Septal
Hematoma: This picture shows a unilateral left
septalhematoma
which has been present for over one week. This condition requires
immediate medical attention. The
septalcartilage has no blood
supply and receives all of its nutrients and oxygen from the perichondrium.
If the hematoma is bilateral, the cartilage can die within 24 hours,
resulting in a saddle nose deformity. Treatment consists of surgical
drainage, packing and antibiotics.
Search PubMed for Nasal Septal Hematoma
Click on pictures to
enlarge !!!
The
pictures below are from a 5 year old male who sustained a blow
to his nose four days prior to his visit. Note the bilateral swelling
of his
nasal septum
(picture to the extreme right). The child was
taken to the operating room where a
septal
hematoma and abscess was drained.
The vast majority of the
septal
cartilage had liquefied, turning yellow and
translucent (see middle picture). The
nasal
cartilage is
important both for the support of the nose and in children for mid-facial
growth. This child is at risk for developing a saddle nose deformity, and mid-facial hypoplasia (flat cheeks and poor occlusion with a
maxillary under bite). Two weeks out (left picture) the nose is
starting to show a mild saddle deformity.
Frontal
Sinus Osteoma: An osteoma is a
benign
slowly growing bone
tumor. It is commonly found in the
frontal sinus. Removal is
recommended if the osteoma shows significant growth, is blocking the
sinusor is very large and threatening to produce an acute
sinus blockage.
The picture to the right shows a very large frontal osteoma (located
between and above the
orbits).
Click on pictures to
enlarge !!!
Undifferentiated
Carcinoma
of the sinus. This is a 33 yr old male who presented
with three months of deep facial pain and recently developed unilateral
nasal
bleeding and airway obstruction. He was a woodworker and exposed to
sawdust. These tumors can be successfully treated with a combination
of chemotherapy and radiation therapy
View Abstract
Search PubMed for Nasal Neoplasms
Click on pictures to
enlarge !!!
Squamous
Papilloma
of The Anterior
Nasal Septum; This growth is a benign locally
invasive and destructive lesion. It was found in a 62 year old male
with a 37.5
pack year
history of tobacco use. Treatment is with surgical
excision.
Verrucous
Vulgaris: Shown in the picture on the right is a verrucous
vulgaris or wart which is on the inside of the nose. This is a skin
growth which is caused by a virus. In this case, it may have been
implanted in the nose by nose picking.
Click on pictures to
enlarge !!!
Ossifying
Fibroma of the Ethmoid
Sinuses:
This is a rare condition caused by a
slowing growing
benign
process which can cause serious problems by placing
pressure on important structures as the mass expands. Often the sinus
lining protrudes into the
nasal
cavity and
nasalpolyps can form. Treatment
is surgical excision or debulking. Shown in the pictures is the patient's
CT Scan and a photograph of a mass (NM) in the patient's nose.
Search PubMed for Fibrous Dysplasia
Search PubMed for Ossifying Fibroma
Nasal
Hemangioma: This patient presented with
nasal
bleeding. A
mass was found growing from the
inferior
edge of the middle
turbinate.
The mass was surgically removed. The pathological diagnosis was
a hemangioma.
Click on pictures to
enlarge !!!
Large
Nasopharyngeal
Cyst in
an 89 year old who presented with
serous otitis media. Always check the
nasopharynx
for masses in adults with an
otitis media.
Congenital cysts in the posterior wall of the nasopharynx are called Tornwaldt cysts. Theses cysts are thought to
form from a remnant of the notochord.
Click on pictures to
enlarge !!!
Mucocele of the
Anterior
Ethmoid Air Cells:
The CT scan and intranasal photographs shows a large mucocele of the
anterior
ethmoid sinusair cells. The cyst is expanding the
surrounding bone and can be seen in front of the middle
turbinate
(photograph second from the left). The post-operative drainage photograph
is shown far right.
Jacobson's
Organ ( vomeronasal organ and vomeronasal pit ) :
In many patients, if one looks closely, a small pit can be seen at the
bottom of the
anteriornasal septum.
This pit is felt to be a vestigial organ used in lower vertebrates to detect
traces of chemicals and in humans it may act as a pheromone receptor.
