Diseases of the external nose (外鼻疾病)

Rhinophyma (肥大性酒渣鼻)

Clinical features:

Red nodular masses centred around the nasal tip in association with acne rosacea, usually seen in elderly men.

Management:

If unsightly, treat by dermabrasion or surgical shaving.

Lupus vulgaris (尋常狼瘡)

Aetiology:

Inoculation of the bacterium Mycobacterium tuberculosis, possibly through nose picking.

Clinical features:

Red/brown patches or nodules on the nasal or facial skin. Perforation of the cartilaginous nasal septum can occur, with scarring in long-standing cases.

Management:

Treatment is by antituberculous chemotherapy.

Lupus pernio (凍瘡樣狼瘡)

Clinical features:

Skin lesions other than erythema nodosum occur in 20% of patients with sarcoidosis. Lupus pernio is common and is frequently associated with bone cysts and chest disease.

Management:

Treat the underlying disease.

Malignant tumours (惡性腫瘤)

Clinical features:

Basal or squamous cell carcinomas present as warty or ulcerating lesions, rarely with lymphadenopathy. Melanomas are more rare.

Management:

Excision biopsy when possible; radiotherapy for larger tumours not involving bone. 

Tumours of the nasopharynx (鼻咽部腫瘤)

Angiofibroma (鼻咽血管纖維瘤)

Incidence:

A benign vascular tumour occurring in males under the age of 25 years.

Clinical features:

Nasal obstruction, epistaxis and deafness due to middle ear effusion are common characteristics.

Management:

Treatment is by surgical excision, facilitated by preoperative CT scanning, arteriography and embolization.

Malignant tumours (惡性腫瘤)

Incidence:

Common in south east Asia, where they account for 20% of all malignant tumours.

Clinical features:

Present as nasal obstruction, epistaxis and deafness. Metastasis to cervical nodes may occur prior to local symptoms becoming apparent. Cranial nerve palsies occur in advanced cases.

Pathology:

Most are squamous carcinomas, although anaplastic carcinomas and lymphomas also occur.

Management:

Radiotherapy following biopsy confirmation, with surgery used only for cervical nodes not responding to irradiation.

Chordoma (脊索瘤)

A very rare locally invasive neoplasm arising from remnants of the fetal notochord found in the skull base. Presents with neurological, nasal and ophthalmic symptoms.