tailieunhanh - ENT diagnosis and color atlas (Fourth edition): Part 2

Separate sections cover common and uncommon disorders of the ear, nose, pharynx and larynx, and the head and neck. High-quality photographs are complemented by guidelines for the effective diagnosis and treatment of each clinical problem Invite you to refer. | 131 Inflammation nasal vestibulitis Fig. Vestibulitis presents as crusting and irritation in the anterior nares with resulting nasal obstruction. Examination shows excoriated vestibular skin and septal mucous membrane. Rubbing or over-diligent cleaning of the nose by the patient usually causes vestibulitis particularly if as in this case the septum is deviated anteriorly and impinges on the lateral wall of the nose. Advice and the use of antibiotic and corticosteroid ointment are effective in controlling vestibulitis. Correction of the septum may be necessary. Fig. Nasal vestibulitis with squamous epithelium replacing the mucosa. A deviation of the septum has predisposed to a chronic vestibulitis. Digital irritation or the use of cocaine which may also lead to a septal perforation may underlie this problem. Bull Color Atlas of ENT Diagnosis 2003 Thieme All rights reserved. Usage subject to terms and conditions of license. 132 The Nose Fig. Vestibulitis in a child overlying a grossly deviated anterior septum. Septal surgery is avoided in children but cases in which the obstruction is gross require a conservative septoplasty. Exessive cartilage resection may retard nasal growth predisposing to saddling or an infantile nose Fig . Fig. Vestibulitis. Painful crusting of the nasal vestibule and anterior nares may be a simple eczematous type of skin lesion which settles with a topical antibiotic and steroid ointment. There should however be an awareness that this vestibulitis is a granuloma or part of the manifestation of systemic disease such as polyarteritis nodosa or systemic lupus erythematosus. A further possibility is an irritative vestibulitis from cocaine snuff or columellar carcinoma as in this case Fig. Granular rhinitis. Granulation tissues in the nose requires biopsy. Sarcoidosis not infrequently involves the upper respiratory tract mucosa of the nasal fossae and larynx. In the nose the granulations are pale but tuberculosis .