Rinosclerom

RinoscleromRinoscleromul is a chronic granulomatous condition of the nose and other upper respiratory tract structures. Rinoscleromul is the result of infection with the bacterium Klebsiella rhinoscleromatis. Family incidence suggests genetic control of host response to bacteria. Nasal infection caused deformation, rhinorrhea, epistaxis, nasal obstruction. It affects the nasal cavities, pharynx, and bronchi trahea.
Treatment includes long-term antibiotics and surgery in patients with symptoms of obstruction. Given the high recurrence rate of disease requires a prolonged antibiotic therapy with follow-up bronchoscopy. Evolution is usually chronic recurrent.
Pathogenesis and causes
Rinoscleromul is contracted through inhalation of infectious droplets directly. The disease begins as epithelial transition zones nasal vestibule, the area of subglotica the larynx or nasopharynx and oropharynx. Cellular immunity is impaired in patients with rinosclerom, the humoral being maintained.Rinoscleromul usually affects the nasal cavity, but associated injuries can affect the larynx, nasofaringele, oral cavity, paranasal sinururile or soft tissues of the lips, nose, trachea and bronchi. Although it is mainly caused by Klebsiella rhinoscleromatis or isolated forms of K. ozaenae.
Signs and symptoms
Rinoscleromul is a rare chronic granulomatous infection that must be considered in perosanele with nasal polyps adhering to avoid sinus nasal septum. The most common presentation is not specific. Because of similar clinical picture of chronic rhinitis is often not recognized. The clinical picture includes the following allegations:-Nasal obstruction, rhinorrhea, epistaxis-Dysphagia, nasal deformity, anosmiaDifficulty breathing, which progresses to stridorAnesthesia-soft palate, hoarseness.
Physical Exam
The disease affects mainly the nasal cavities, but can also affect nasofaringele, oropharynx, larynx, trachea and bronchi. Oral cavity, paranasal sinuses, soft tissues of the nose, lips may also be affected. In rare cases rinoscleromul extend to the orbit. The presentation is often nonspecific.
Rinoscleromul is divided into three stages:Catarhal, or atrophic: the first stage begins with an intro that evolves nonspecific rhinitis fetid purulent rhinorrhea and crustificare. This stage can last for weeks or months.Granulomatous, or hypertrophic: nasal mucosa starts to become red and granular with the formation of polyps in the nose or muriforme formations. Appears once with the enlargement of nasal epistaxis, nasal cartilage deformation and destruction. Destruction can cause anosmia, anesthesia of the soft palate, uvula enlargement, hoarseness and varying degrees of airway obstruction. Lesions appear as atrophic changes and granulomatous, fibrotic stage of healing. Front-bottom of the antrum and medial wall are more often affected than other structures. Involvement of the maxillary antrum is suggested in sclerom and entrepre jaw can act as reservoir of infection.Soft palate is thickened at the junction with the hard palate. The sign may help early diagnosis of the condition. Physical examination showed granulomatous or nodular erythematous swelling covered with scabs. Similar appearance of tumors and are suggestive of local extension of cancer. Can be located intro pseudo Rinoscleromul variety of areas, including septum and rinofaringele.Sclerotic: characterized by sclerosis and fibrosis. In stage sclerotic nodules are replaced by fibrous tissue, leading to extensive scarring and stenosis.
Diagnosis
Studies:Klebsiella-culture is positive for only 50% of patients-Bacteria can be identified by Gram stain, Schiff, Giemsa and silverCT-assessment with and without contrast showed homogeneous lesions without involvement of adjacent fascial plans, forcing irregular concentric airway collapse, the trachea, similar lesions are characteristic of crypts, with calcifications, nodule, luminal narrowing and wall thickeningCytology analysis is performed by brushing the lesion are characteristic Mikulicz cellsShow signs of nasal endoscopy-three stadium-Bronchoscopy.
Histological examination. Features include rinoscleromului vacuolated Mikulicz cells and transformed plasma cells with Russell corpora. Mikulicz cell is a large macrophage with clear cytoplasm containing the bacilli. The disease is diagnosed mainly in proliferative phase clinical tablooul chic when it is easily recognized histologically.The differential diagnosis is made with the following conditions: actinomicoza, basal cell carcinoma, leishmaniasis, leprosy, nasopalatin duct cyst, sarcoidosis, sporotrichoza, syphilis, warts carcinoma, Wegener's granulomatosis.
Treatment
Medical therapy.Will receive long-term antibiotics. The infection responds to treatment with third generation cephalosporins and clindamycin. Sclerotic lesions respond well to therapy with ciprofloxacin.
Surgical therapy.Surgery combined with antibiotic therapy is beneficial in patients with granulomatous disease and nasal obstruction or throat or sinus disease through proliferation of lesions. Tracheotomy should be considered in patients with laryngeal obstruction in stage two and three of the disease. Plastic surgery is necessary in patients with scar stenosis or when the nasal cavity, pharynx, larynx or trachea remain imperforate. Extensive granulomatous lesions are treated by open excision.Surgery and laser therapy are required to treat airway compromise and tissue deformation. Advanced Scar Treatment with carbon dioxide laser shows excellent results. The advantages of this technique include: general operating field, complete relaxation of the patient, good gas exchange, eliminating the risk of aspiration and opportunity debriurilor blood and oxygen administration.