Download presentation
Presentation is loading. Please wait.
Published byJasper Gibbs Modified over 7 years ago
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
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.