Clinical images: Noses

Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey

Haemangioma

This elderly lady presented with nasal discomfort. She was found to have this lesion arising from the septum of the left nostril. She was referred and the lesion was excised. Histology revealed the lesion to be an ulcerated benign capillary haemangioma, requiring no further treatment. Her symptoms resolved.

Trauma


This man had a nasty fall, sustaining a range of injuries including this trauma to his nose. His nasal airway remained patent and an X-ray confirmed that it was not broken. As is often the case, investigation is important to establish the cause of the falls, as the next one may lead to a more serious injury.

Abscess

This young boy developed a very sore lesion in the nose. It was not possible to deal with it properly in the surgery so he was referred for proper drainage under anaesthetic.

Epistaxis

This man has a history of hypertension and developed a heavy nose bleed. He was unable to stop it by applying pressure to the correct part of the nose for 15 minutes, so went to the A&E department where it was packed. He is shown here having the pack removed several days later. He was reviewed by the ENT department and a vessel was cauterised. This solved the problem.

Basal cell carcinoma

This man had a slow-growing lesion on the end of his nose. It had a characteristic nodular appearance. It was excised and confirmed to be a basal cell carcinoma. Due to the size and position, reconstruction with a flap was required. Initially this appeared successful but two years later it recurred and required further surgery.

Septal perforation

This 37-year-old man had a history of chronic rhinitis. He had been treating himself with a nasal corticosteroid spray, which he had used in far higher doses than recommended and with a very poor technique. Proper instruction on how to use a nasal steroid is very important for both efficacy and safety. However, nasal perforation with topical steroids is actually very rare.

Rhinophyma

This 65-year-old woman had rosacea and was distressed by the increasing problem of her nose. She was not a heavy drinker and avoided alcohol as it aggravated the condition. Topical therapy was not effective. She is now taking long-term antibiotics (minocycline) with some success. However, in cases where there is only limited response to medical therapy, surgical operations should be considered.

Septal deviation

This elderly man complained of symptoms of allergic rhinitis, with marked congestion. On examining him however, this gross deviation of the nasal septum was noted. He then recalled the numerous injuries to his nose during rugby matches some 50 years earlier. He did not want to pursue surgical correction.

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