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

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

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

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

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

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