ABSTRACT
Figure 17.1 Sarcoidosis involving the left side of the nasal septum. Note the ulceration (short arrow) and the submucosal thickening caused by the sarcoid granulomas (long arrow)
Figure 17.2 The sarcoidosis in the patient of Figure 17.1 involved the columella
sarcoidosis. Note the crusting (short arrow) and the scarring (long arrow)
Figure 17.4 Rhinitis sicca involving the nasal septum (short arrow) in a patient with hypohidropic ectodermal dysplasia, an uncommon X-linked recessive inherited disease of the skin. Note the incidental small polyp (long arrow) on the left middle turbinate
Figure 17.5 A developing stenosis of the left anterior naris, in a patient with cicatricial pemphigoid disease. Note the active inflammation
Figure 17.6 Right nasal stenosis in a patient with cicatricial pemphigoid disease
Figure 17.7 Right and left nasal stenoses in another patient with cicatricial pemphigoid disease
Figure 17.8 A spider angioma noted on the right side of the septum in a patient with scleroderma. She had no nasal symptoms
Figure 17.9 Telangiectasias of Osier-Weber -Rendu disease or hereditary hemorrhagic telangiectasia noted on the septum (short arrow) and on the left middle turbinate (long arrow)
turbinate in another patient with Osier -Weber-Rendu disease
Figure 17.11 Telangiectasias in Osier-Weber -Rendu disease; involving the lips and the tongue
Figure 17.12 Fibrinous exudate and ulcerations on the right side of the septum in a patient with active Wegener ’s granulomatosis. Successful treatment usually resolves these findings totally
Figure 17.13 Right septal ulceration in another patient with Wegener’s granulomatosis. It is expected to heal completely after successful treatment
patient treated unsuccessfully for acute sinusitis, first with medications and then with sinus surgery. A biopsy was non-diagnostic and cultures were negative. The diagnosis of Wegener ’s was eventually made because of an elevated ANCA and the total healing after treatment. Six months later, the patient had not manifested symptoms or signs of Wegener’s elsewhere in the body
Figure 17.15 A patient with rhinosinusitis symptoms which did not respond to antibiotic treatment. Hemorrhagic ulcerations (short arrow) of the left inferior turbinate were the only manifestation of reactivation of Wegener’s granulomatosis 1 year following its first successful treatment. Three weeks after the start of a new course of treatment, the ulcerations healed totally. The long arrow points to the septum
Figure 17.16 A young female with severe sickle cell anemia presented with a recent onset of nasal crusting, epistaxis, and pain. The anterior part of the right inferior turbinate was ulcerated and swollen
Figure 17.17 A CT scan of the patient shown in Figure 17.16 confirmed the presence of mucosal disease in the nose. Note the absence of significant sinus involvement
cavitiy did not look to be involved in the same way as the anterior part shown in Figure 17.16
Figure 17.19 A year later, the patient’s symptoms became worse. Endoscopy revealed ulcerations (short arrow) and a fibrin/necrotic membrane (long arrow) in the depth of the left nasal cavity. The same findings were also noted on the right side
Figure 17.20 After suctioning and endoscopic debridement of what was shown in Figure 17.19, the ulcers in the atrophic mucosa became more apparent. The cultures did not grow any pathogens and the biopsy was non-specific
Figure 17.21 A CT scan confirmed the progression of the disease, which remained unidentified in this patient with sickle cell anemia. It showed the missing left inferior turbinate (short arrow) and the new large septal perforation (long arrow)
several months ’ history of recurrent bilateral epistaxis. Anterior rhinoscopy revealed a granular mass involving the floors of the nose and the tips of the inferior turbinates. This picture shows the right side. The diagnosis of rhinoscleroma was made on culture and biopsy. The patient responded to prolonged antibiotic treatment but developed the symptoms and signs of atrophic rhinitis. Repeat cultures grew Klebsiella ozaenae, and not Klebsiella rhinoscleroma tis
Figure 17.23 The CT scan of the patient of Figure 17.22 showed the presence of the intranasal disease and the sparing of the sinuses
