Investigations, nasal trauma & epistaxis DR.MUAID I.AZIZ FICMS

Investigations of nasal diseases History Examination Radiology

history  cardinal symptoms are nasal blockage sneezing rhinorrhoea postnasal drip facial pain halitosis snoring & nasal bleeding & disorders of smell  the time of onset of symptoms, periodicity, severity, exacerbating & relieving factors, all should be asked about it.  A full medical, drug, family history with past medical & surgical history should be asked.

examination Inspection Anterior rhinoscopy Posterior rhinoscopy

OMV

Imaging OMV (waters )

OFV

Lateral view

Ct scan

MRICT SCAN

Nasal trauma Septal haematoma & abscess Fracture Epistaxis

SEPTAL HAEMATOMA

In the adult, nasal bones are three times longer than their width. In the child, the length of the nasal bone nearly equals the width.

NASAL FRACTURE

CLASSIFICATION Class 1 Low degree force, simplest form is depressed fracture segments remain in position,septum generally not involved More severe variant,both nasal bones & septum involved (below 0,5cm from the dorsum) Can involve bony septum through perpendicular plate of ethmoid In children greenstick type –nasal deformity may develop at puberty.

CLASS 1

IMAGING

CLASSIFICATION Class 2 Greater force, with significant cosmetic deformity Nasal bones, frontal process of maxilla & septum are involved, surrounding structure remain intact Gross flattening & widening of dorsum C-Shaped fracture of septum

CLASSIFICATION Class 3 Most severe due to high velocity Also termed as naso-orbito-ethmoidal fracture often associated with maxillary fracture CSF leak

CLASS 3

epistaxis Kiesselbach plexus Woodruffs plexus

classification  Aetiology  Clinical 1ry ( no proven cause ) Secondary ( proven causal factor ) Childhood < 16 y. Adult >16 y. Anterior ( bleeding point anterior to piriform apreture ) Posterior ( bleeding point posterior to piriform apreture )  Pattern of presentation

Management  Stop bleeding  Resusitation  Non surgical measures  Surgical measures

thanks

Test 1. The Occipitomental ( waters view ) imaging is specific for sphenoid sinuses. 2. In depressed #,unilateral nasal bone is affected. 3. Trauma is the most common cause of epistaxis st line in management of epistaxis in casuality ( emergency department ) is admission.