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

Syphilis Lupus vulgaris and tuberculosis Sarcoidosis Wegners’s Granulomas Fungal aspergillosis Mucormycosis Rhinosporididosis Scleroma Leprosy Foreign bodies Rhinoliths

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 4 th -5 th 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