Diseases Of The Nose Throat And Ear

TUMOURS OF THE NOSE 63

Papilloma. This may appear as a wart-like growth arising from the skin of the
nasal vestibule where it may enlarge to become unsightly. It is removed by an
incision around its base under local infiltration of novocaine. The incision is
closed by a suture which is removed in a week.

Angioma. This uncommon tumour is sometimes called a bleeding polypus of
the septum. It is a fibro-angioma which arises from the bleeding area of the
septum as a dark red, rounded, often pedunculated tumour. It may cause
some nasal obstruction and frequent epistaxis, and is removed under local
anaesthesia by making an incision around its base which is then cauterized.
If removal is complete recurrence does not take place.

Cysts. Cysts may arise from retention in the mucous glands in the floor of the
nose or from the apices of the incisor teeth, and a differential diagnosis between
the two types may require dental radiography. The retention cyst may be
dissected out either intranasally or through an incision in the buccal mucosa.
If the cyst is of dental origin it is approached through the mucoperiosteum of
the premaxilla.

Cyst of the Middle Concha. This is not a true cyst but is a developmental
anomaly causing enlargement of the anterior end of the middle concha with a
cavity in the bone containing air or mucoid secretion. Nasal obstruction is
caused and this may be sufficient to justify a limited removal of the anterior
end of the middle concha including the cystic portion.

MALIGNANT TUMOURS

Sarcoma. Sarcoma is the most common intranasal malignant tumour arising
in young people or even in children. It also occurs in adults and in the
elderly. It may be a primary growth of the nasal septum or be an extension of
sarcoma in one of the sinuses. It gives rise to nasal obstruction which may be
considerable, to nasal discharge which is at times purulent and offensive, and
to Cjpistaxis which may be spontaneous or may be induced by probing the
tumour. Falnjs frequently met with. Sarcoma may resemblejysolypus but it
is more offen a reddish sloughing mass of friable tissue. When such an
appearance is found the nose should be examined under general anaesthesia,
not only to remove the tissue for histological examination but in an endeavour
to determine the origin. Radiography of the sinuses should be done. E^adio-
therapy is the treatment of choice, but in some instances resection of the nasal
septum or other parts of the nasal framework may be undertaken, followed by
the provision of a prosthesis once the tumour has been eradicated.
Carcinoma. Carcinoma is less common as an intranasal tumour. It is found in
elderly patients either as a growth arising from the lateral wall of the nasal
cavity or as an extension from the sinuses, especially the maxillary antrum.
It produces symptoms similar to those "of, a sarcoma, and there may be
considerable painf Epiphora will develop if the nasolacrimal duct is blocked.
Radiography of the sinuses should be carried out if a sloughing mass is found
in the nose. A small early carcinoma may be excised intranasally, but usually
the patient does not present until there is considerable growth which
necessitates radiotherapy, or major excision, or both.

Melanoma. This is an extremely lethal tumour which is occasionally found as a
smooth, dark, rounded growth arising from the lateral wall of the nose. It
bleeds readily If probed. Treatment is local excision with diathermy followed