Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

Definition: Acute staphylococcal infection of a hair follicle in the vestibule of the nose (hair bearing area).

Etiology: It may be due to:

a) Mechanical trauma as in nose picking.

b) Lowered immunity as in diabetics, long term steroids and agranulocytosis.

Clinical picture of nasal furunculosis

Symptoms:

• Pain
• Swelling at the tip of the nose.

Signs:

• The furuncle is seen in the vestibule of the nose as a firm, tender, red, hot nodule with surrounding edema.
• Later, it enlarges and becomes more painful and fluctuant and it may show pointing.
• Multiple and recurrent furunculosis is usually seen in diabetics.

Complications of nasal furunculosis:

The majority of cases show spontaneous discharge in the vestibule and resolve but occasionally complications may occur, and these include:

• Facial cellulitis.
• Septal abscess.
• Cavernous sinus thrombosis: the nose lies in the dangerous area of the face. Retrograde thrombophlebitis can occur through the facial vein, then through the ophthalmic veins to the cavernous sinus.

Treatment of Furunculosis of the nasal vestibule:

1. Systemic antibiotics.
2. Local antibiotic cream.
3. Analgesics.
4. Local moist heat.

N.B.: Squeezing of a nasal furuncle should be avoided to prevent the occurrence of cavernous sinus thrombosis.

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