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

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 4th -5th
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
