3. Definition of Granuloma
Granuloma is a tumor like mass of nodular
granulation tissue with actively growing fibroblasts
and capillary buds due to chronic inflammation
with vasculitis.
6. Definition
Rhinoscleroma or scleroma is a chronic granulomatous
disease caused by gram negative bacillus Klebsiella
rhinoscleromatis [von Frisch bacillus].
17. Medical treatment
Streptomycin 1 g OD im and Tetracycline 500 mg QID:
oral together for 4-6 weeks plus 1 month (till two
consecutive negatives from biopsy)
Rifampicin: 650 mg OD orally
18. Radiotherapy & Surgery
Radiotherapy: 3500 rad over 3 week
Surgery: Removal of granulations & nodular lesions
with cautery or laser
Plastic reconstructive surgery
20. Syphilis
Acquired or Congenital
Acquired:
Chancre of the vestibule of nose
Saddle Nose
Congenital:
Saddle nose, corneal opacities,
deafness and Hutchinson’s teeth
Diagnosis:
Treatment:
VDRL
Benzathine pencillin
21. Leprosy
Nose:
Nasal septum and ant. inferior turbinate
C/F:
Nodular lesion
Atrophic rhinitis, dep. of nose,
destruction of ant. nasal spine
Diagnosis: Scraping & Biopsy
Treatment: Dapsone, Rifampin and Isoniazid
22.
23. Definition
Chronic granulomatous infection of the mucous
membrane by Rhinosporidium seeberi, mainly
affecting nose & nasopharynx
Characterized by formation of friable, bleeding and
polypoidal lesions
Other sites: lips, palate, conjunctiva, epiglottis, larynx,
trachea, bronchi, skin, vulva, vagina, hand & feet.
24. Epidemiology
88 – 95% cases in India, Pakistan & Sri Lanka
Common in Kerala, Karnataka & Tamil Nadu
Age:
20 – 40 yrs.
Sex ratio: Male : Female
4:1
34. Mode of transmission
Bathing in infected water; infective spores enter via
breached nasal mucosa
Droplet infection by cattle dung dust
Contact transmission: contaminated fingernails are
responsible for cutaneous lesions
Haematogenous: to other sites in infected patient
36. Investigation
Biopsy & Histopathological examination
Microscopic examination of nasal discharge for spores
Sporangia of different shapes oval to round and
bursting spores are present.
40. Medical Treatment
Dapsone: arrests maturation of spores
Dose: 100 mg OD orally (with meals) for one year
Iron & Vitamin supplements
41. Surgical management
General anesthesia with Oro-tracheal intubation
2% Xylocaine with adrenaline infiltrated till
surrounding mucosa appears blanched
Mass avulsed using Luc’s forceps & suction
After removal of mass, its base cauterized
Laser excision: minimal bleeding
42.
43. Fungal Sinusitis
A. Invasive (hyphae present in submucosa)
1.
Acute invasive
(< 4 weeks)
2.
Chronic invasive
(> 4 weeks)
Granulomatous
Non-granulomatous
B. Non-invasive
1.
Allergic
Fungal ball
Saprophytic
Aspergillosis & Mucormycosis are common
44. Aspergillosis
Etiology: Aspergillus niger, As. fumigatus & As. flavus
C/F: Acute Rhinitis, sinusitis, black membrane nasal
mucosa, semi-solid cheesy white fungal balls
Treatment: Surgical debridement & anti fungal drugs
like Amphotericin B
46. Mucormycosis
Acute invasive fungal sinusitis by Mucormycosis
Unilateral nasal discharge and black crusts due to
ischaemic necrosis, proptosis, ophthalmoplegia
Fibrosis & granuloma formation seen in chronic
invasive fungal sinusitis
Locally destructive with minimal bone erosion
54. Treatment
Surgical debridement of necrotic debris
Amphotericin B infusion: 1 mg / kg / day IV daily / on
alternate days
Itraconazole: 100 mg BD for 6-12 months
57. Definition & Etiology
Definition: Chronic systemic disease of unknown
etiology which may involve any organ with noncaseating(hard) granulomatous inflammation
Etiology: Resembling Tuberculosis
Unidentified organism
58. Clinical Features
Nasal discharge, nasal obstruction, epistaxis
Mucosal: Reveals yellow nodules surrounded by
hyperaemic mucosa on anterior septum & turbinates
Skin (Lupus Pernio): Nasal tip shows symmetrical,
bulbous, glistening violaceous lesion