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بسم الله الرحمن الرحيم NOSE I & IV DR. SAMI ALHARETHY

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Presentation on theme: "بسم الله الرحمن الرحيم NOSE I & IV DR. SAMI ALHARETHY"— Presentation transcript:

1 بسم الله الرحمن الرحيم NOSE I & IV DR. SAMI ALHARETHY
associate. PROF. FACIALPLASTIC CONSULTANT KSU

2

3 Functions Of The Nose Respiratory channel
Warming and humidifying inspired air Cleaning and filtering inspired air Olfaction

4 Function of Paranasal Sinuses
to act as resonators to the voice They also reduce the weight of the skull When the apertures of the sinuses are blocked or they become filled with fluid, the quality of the voice is markedly changed

5 ANATOMY OF SINO-NASAL TRACT
External nose Nasal cavity Paranasal sinuses

6 Anatomy of the External Nose

7 THE NASAL CAVITY Nasal Vestibule Nasal Cavity Proper

8 THE NASAL VESTIBULE

9 THE NASAL CAVITY Roof Floor Lateral wall Medial wall (septum)

10 The Roof

11 The Floor

12 The Medial Wall (Nasal Septum)

13 Lateral Nasal Wall

14 Lateral Nasal Wall

15 The Lining Mucosa Respiratory mucosa Olfactory mucosa skin

16 The Olfactory Mucosa

17 The Respiratory Mucosa

18 Arterial Blood Supply External Carotid Internal Carotid Maxillary
Facial Internal Carotid Ophthalmic

19 Blood Supply Of The Nasal Cavity
Lateral Wall Nasal Septum

20 Venous Drainage Facial vein Internal jugular Angular vein Ophthalmic
Cavernous sinus

21 Venous Drainage

22 Lymphatic Drainage Submandibular Retropharyngeal
Superior deep cervical

23 Nerve Supply Of The Nasal Cavity
Olfactory General sensory: Trigeminal nerve Autonomic: sphenopalatine ganglion

24 Olfactory Nerve Supply

25 Sensory Nerve Supply Ophthalmic and maxillary branches of the trigeminal

26 ANATOMY OF THE PARANASAL SINUSES

27

28 The Maxillary Sinus

29 The Maxillary Sinus

30 The Maxillary Sinus Sinus ostium located in the middle meatus

31 The Ethmoid Sinuses

32 The Ethmoid Sinuses

33 The Ethmoid sinuses Anterior ethmoids: drain into the middle meatus
Posterior ethmoids: drain into superior meatus

34 The Frontal Sinus Rarely present at birth; usually not visible until age 2 Great variability in size; congenitally absent in 5%

35 The Sphenoid Sinus

36 The Sphenoid Sinus

37 Lining of the Sinuses Pseudostratified columnar epithelium with goblet cells (respiratory epithelium) which is continuous with the nasal epithelium

38 Blood Supply Branches from the internal and external carotids

39 Nerve Supply Branches from the trigeminal

40 Investigation of Nasal Diseases
Endoscopy Rhinometry Measurement of olfaction Skin allergy test Mucociliary clearance tests Imaging

41 Endoscopy

42 Rhinometry Objective measurement of the nasal resistance or the flow of air in the nasal cavities Poiseuille's Law

43 Skin allergy test

44 Imaging of The Paranasal Sinuses
Plain X-Rays CT scan MRI

45 Occipitomental View (Water’s View)

46 Occipito-frontal View (Caldwell View)

47 Lateral View

48 Submento-vertical view

49 CT Paranasal Sinuses Axial Coronal

50 Normal Axial

51 Normal coronal

52 MRI

53 Development of the sinuses
A) at birth B) at 10-years C) at 15

54 Development of the sinuses

55 CONGENITAL ANOMALIES

56 Anterior Nares Deformity

57 Dermoid cysts

58 Glioma

59 Glioma

60 Meningo and encephaloceles

61 Meningo and encephaloceles

62 CHOANAL ATRESIA

63 THE CHOANA

64 Choanal Atresia ? Due to persistence of the primitive bucconasal membrane Unilateral or bilateral Bony, membranous or mixed

65 Unilateral Choanal Atresia

66 Unilateral Choanal Atresia
Usually diagnosed late in life Presents by unilateral nasal obstruction and unilateral mucoid nasal discharge Treatment is by elective surgical repair

67 Bilateral Choanal Atresia
Isolated anomaly in 60-70% May be linked to CHARGE association

68 CHARGE ASSOCIATION Coloboma Heart disease Atresia Retarded growth
Genital hypoplasia Ear deformity

69 Bilateral Choanal Atresia
Usually presents at birth by attacks of cyclic cyanosis and respiratory obstruction Nasal discharge

70 Diagnosis Clinical examination: “mirror test”
Inability to pass a catheter into the nasopharynx Endoscopy Radiographs

71

72 Management Emergency Definitive surgery
Immediate airway support with oral airway, McGovern nipple, or intubation Definitive surgery

73 THE NASAL VESTIBULE

74 Acute Infections Acute vestibulitis Furunculosis

75 Acute Vestibulitis Inflammation of the skin of the vestibule, usually due to Staphylococcus aureus

76 Causes Habitual rubbing of the nose Allergy Rhinorrhea

77 Clinical Features Pain Irritation Redness and swelling Crusting

78 Treatment Local antibiotics and corticosteroids

79 Furunculosis Acute infection of the hair follicles with Staphylococcus aureus

80 Complications Local abscess Spreading cellulitis
Cavernous sinus thrombophlebitis

81 Treatment Avoid squeezing Local application of heat Antibiotics

82 Other Conditions of Vestibule and External Nose
Erysipelas Impetigo Herpes simplex and zoster Warts Lupus vulgaris Syphilis Basal and squamous cell carcinoma

83 بسم الله الرحمن الرحيم NOSE –IV- DR. SAMI ALHARETHY
Associte PROF. FACIALPLASTIC CONSULTANT KSU

84

85 Diseases of the nasal septum Epistaxis Turbinate hypertrophy
Nasal operations SAMI ALHARETHY

86 Diseases of the nasal septum
Deviated nasal septum Septal hematoma and abscess Perforated septum

87 DEVIATED NASAL SEPTUM

88 Etiology Trauma Maldevelopment

89 Symptoms Nasal obstruction

90 Symptoms Nasal obstruction External deformity Crusting, epistaxis

91 Examination

92 Radiology Unnecessary in most cases

93 Treatment No treatment Septoplasty

94 Septoplasty

95 Complications of Septoplasty
Septal hematoma & abscess Septal perforation Nasal deformity Synechia (adhesion)

96 HEMATOMA OF THE SEPTUM

97 Etiology Direct trauma Operative trauma Blood dyscrasias

98 Clinical Features

99 Complications Cartilage necrosis Septal abscess
Permanent thickening of the septum

100 Treatment Incision and drainage Systemic antibiotics

101 PERFORATION OF SEPTUM

102 Clinical features Asymptomatic Crusting Epistaxis Whistling

103 Treatment No treatment Nasal wash Surgical closure

104 Surgical Reduction of the Inferior Turbinates
Turbinate resection, total or partial Outfracturing of the inferior turbinate Destructive procedures, including electrocautery, cryosurgery, laser surgery, and submucous resection

105

106 EPISTAXIS

107 Why bleeding from the nose ?
Vascular organ secondary to incredible heating/humidification requirements Vasculature runs just under mucosa Arterial to venous anastamoses ICA and ECA blood flow

108 SITES Anterior ( Little’s area)
Posterior (vicinity of sphenopalatine foramen)

109 Kesselbach’s Plexus/Little’s Area:
Anterior Ethmoid (Opth) Superior Labial A (Facial) Sphenopalatine A (IMAX) Greater Palatine (IMAX) Woodruff’s Plexus: -Sphenopalatine A (IMAX)

110 LOCAL CAUSES Acute trauma Chronic trauma Deviated septum
Inflammation of the nose and sinuses Tumors Idiopathic

111 SYSTEMIC CAUSES Coagulation and bleeding diseases Atherosclerosis
Familial hemorrhagic telangiectasia

112 MANAGEMENT General measures Stop the bleeding Prevent further bleeding

113 CONTROL THE BLEEDING Digital pressure Cautery Anterior nasal packing
Postnasal pack Arterial ligation Maxillary, Ethmoids, External carotid Arterial embolization

114 Anterior nasal packing

115 Postnasal packing

116 Arterial ligation

117 Arterial ligation

118 Arterial embolization

119 ANGIOFIBROMA Juvenile nasopharengeal Benign Adolcent Males
Frequent chronic epistaxis Nasal obstruction Rhinorrhea Conductive hearing loss Diplopia Otitis Media Treatment: embolization & Surgery

120 What do you think? 25 years old man post RTA with fever and nasal obstruction. What is your diagnosis? What is your management?

121 What is this radiological study? What is A,B and C?

122 This is a CT scan of a newborne who presented with respiratory
distress. A- what is your diagnosis? B- what is the management?

123 thanks


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