Furuncle Of Nose

 Definition:
it is an acute purulent inflammation of hair follicles and sebaceous gland of
outer or inner surface of wing of nose, tipe of nose, skin of nasal septum.
Note:
Carbuncle is: acute necrotic inflammation of several hair follicle and sebaceous
glands with extensive necrosis of skin and subcutaneous tissue of nose.
 Stages:
1) Stage I: characterize by:
 Infiltration.
 Local pain.
 Redness of skin.
 Presence of dense infiltration with necrotic dot in center.
2) Stage II: characterize by:
 Abscess of formation (melting of necrotic tissue).
 Thinking of skin.
 Floating in center of infiltration.
 Cause:
 Main cause of furuncle is staphylococcus aureas (pathogenic organisin).
 Causes:
1) Micro truma to nasal skin (nasal clean during plucking)
2) Irritation of nasal skin by discharge due to Ac rhinitis, sinusitis.
3) Diabetic or other metabolic disorders.
 Sign's and symptoms:
There is gradual development of inflammatory process.
1) Ostio folliculitis (infection of hair follicle).
2) Compression, flushing and swelling of skin (develop with in 1-2 days).
3) Pain (↑ by stress of facial muscles chewing).
4) Fever, it headache, weakness.
 Diagnosis:
1) History.
2) Physical exam.
3) Investigation blood for: 1- WBC (↑), 2- ESR (↑)
 Treatment:
1) Hospitalization (for bed rest and liquid food).
2) Antipyretic (to releife fever).
3) Analgesic (to releife pain).
4) Warm compresses.
5) Topical and systemic antibiotic.
Antibiotic use longen one moth. (at least 2 months).
6) Incision and drainage done of fluctuant area appear.
If no the furuncle should be squeezed or premature incised belanse of the
donges of spread of infection to cavernous sinus (in brain) becanse blood
vessles in this area (Triangle area) are drain into the brain →
thrombophlebitis.

Acute antral puncture and washout

 Definition:
It is a surgical procedures in which a cannula insert into an opening to allow
irrigation and drain the sinus.
 Objective:
It is a diagnostic procedure to exclude or confirm purulent sinusitis.
 Indication:
1) Acute and chronic maxillary sinusitis (not response to treat).
2) Dental maxillary sinusitis.
3) Oro antral fistula (it's abnormal condition where the maxillary sinus open
expose to oral cavity through a fistula).
4) Acute bacterial rhino sinusitis.
 Contra induction:
1) Age below 3 years.
2) History of bleeding disorder.
3) Fracture of maxilla.
4) Febrile stage of a cute maxillary sinusitis because lead to osteomyelitis
(ns a complication).
5) D.M.
 Treatment:
A) Surgical operation:
Insertion of cannula under inferior turbinate and puncture the lateral wall of
the nose through the maxillary process of inferior turbinate to enter the
antrum for irrigation and drain the sinus.
 Patient lies down for 10-15 minutes after op. and pack remove after 1
(one) hour.
B) Antibiotics e.g. penicillin and nasal saline irrigation.
C) Analgesic for post op. headache.
D) Decongestant.
 Note: opening of the para-nasol-sinus in lateral wall of the nose:
1) Sphenoid sinus opening → above superior Turbinate.
2) Frontal sinus opening → Middle meatuses.
3) Ethemoidol sinus op → Middle meatuses.
4) Maxillary sinus op → Middle meatuses.