A mismanaged case of post herpetic nasal stenosis: a salvage story

Authors

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240703

Keywords:

Post herpetic nasal stenosis, Herpes zoster mismanagement, Nasal stent, Nasal obstruction

Abstract

 

Acquired nasal stenosis is due to loss of vestibular lining because of scar contracture or direct injury to the lobule-ala-columella complex. We present a patient of Herpes zoster mismanagement with scarring of the right nasal cavity who was treated by placing a stent to achieve nasal patency.  A 47-year-old male, previously diagnosed to have Herpes zoster, presented with complaints of right nasal obstruction, discolouration of skin and burning sensation over the right cheek and nose. He had applied an herbal paste given by quacks which led to scarring and hypopigmentation over the face. He tried peeling the scab off which resulted in a skin contracture and right nasal obstruction. Local examination revealed multiple erythematous hypopigmented plaques over the right maxillary region, scarring over the right lateral aspect of the dorsum, ala and tip and a skin contracture causing stenosis of the right anterior nares. The stenosed area was excised and diagnostic nasal endoscopy showed collapse of the ala and the vestibular region in the right nasal cavity. A red rubber catheter was used as a stent and sutured in place at the ala. Postoperatively, nasal cavity patency was maintained. Herpes zoster is usually self-limiting and treatment with analgesics suffices. Antiviral medication and corticosteroids may alleviate severe pain. However, mismanagement of the lesions by taking local herbal paste and medicines can lead to exacerbation of the lesions and complications like nasal stenosis.

 

References

Riley CA, Lawlor CM, Gray ML, Graham HD 3rd. Free Auricular Composite Graft for Acquired Nasal Stenosis. Ochsner J. 2016;16(2):150-3.

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Management of herpes zoster. Clin Infect Dis. 2007;44(1):S1-26.

Opstelten W, Eekhof J, Neven AK, Verheij T. Treatment of herpes zoster. Can Fam Physician. 2008;54(3):373-7.

Ziada HM, Gavin D, Allen PF, O’Connor TPF, Mehboob Ali KSA. Custom made alar stents for nostril stenosis: A 24-month evaluation. Int J Oral Maxillofacial Surg. 2005;34(6):605-11.

Ebrahimi A, Shams A. Severe iatrogenic nostril stenosis. Indian J Plast Surg. 2015;48(3):305-8.

Daya M. Nostril stenosis corrected by release and serial stenting. J Plast Reconstr Aesthet Surg. 2009;62(8):1012-9.

Francis M. Herpes zoster with post herpetic neuralgia involving the right maxillary branch of trigeminal nerve: A case report and review of literature. J Clin Diagnostic Res. 2017;11(1):ZD40-42.

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Published

2024-03-26

Issue

Section

Case Reports