The parts described in this chapter may be the site of almost every tumor which is met with in any other part of the body; in addition to which there are two which are peculiar to the nose and adjoining tissues. These are rhinophyma and rhinoscleroma. They have both been described briefly in the chapter on Tumors, and each is to be differentiated from the other, having a very different etiology.
Rhinophyma consists of vascular engorgement, with hypertrophy, especially of the glandular and connective-tissue elements of the skin, which begins about the tip and the alæ of the nose, and produces disfiguring deformity. It is, however, at first, quite innocent in its character. It occurs most often in hard drinkers, and is to be regarded as an overgrowth, coupled with a large amount of secretion, of the sebaceous glands of that portion of the skin. This secretion is often so great as to escape and lead to the formation of scabs, as it dries, until more or less ulceration takes place. The nasal enlargement is rarely symmetrical, and is nearly always lobular, so that the overgrowth may consist of a series of nodules whose escaping secretion becomes offensive. The parts are often discolored, even to a purplish color, in consequence of venous stasis. Frostbite frequently predisposes toward it.
Fig. 419
Fig. 420
Plexiform angioma of face; cirsoid aneurysm. Not benefited by ligation of external carotid. (Lexer.)
Illustrating ravages of rapidly growing vascular sarcoma of face, involving all the cranial and facial cavities. (Lexer.)
Treatment in incipient cases may consist of a sort of massage, by which the overloaded glands are emptied. In more serious instances the diseased tissue should be extirpated, and either left to granulate or be covered by a plastic operation.
Rhinoscleroma is a serious and fatal lesion, consisting of a parasitic invasion by a peculiar bacillus. It begins as a painless induration, either at the edge of the nostril or upon the upper lip, grows slowly, the tissue affected becoming firm and dense. The growth is usually lobulated, with fissures or excavations between the lobules, which may crack and give rise to a yellowish discharge that dries into crusts. While the affection may begin in the deeper parts of the nasopharynx its occurrence there is usually the result of extension from the anterior growth. The disease may occur either in the young or in the adult. A case illustrated elsewhere (see [p. 55]), for which I am indebted to Dr. G. W. Wende, proved fatal after a couple of years. In this country it is rare, but occurs frequently in some portions of Russia.