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

2. Investigations of nasal diseases History Examination Radiology

3. 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.

4. examination Inspection Anterior rhinoscopy Posterior rhinoscopy

7. OMV

8. Imaging OMV (waters )

10. OFV

11. Lateral view

13. Ct scan

14. MRICT SCAN

15. Nasal trauma Septal haematoma & abscess Fracture Epistaxis

16. SEPTAL HAEMATOMA

17. 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.

18. NASAL FRACTURE

19. 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.

20. CLASS 1

21. IMAGING

23. 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

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

28. CLASS 3

30. epistaxis Kiesselbach plexus Woodruffs plexus

31. 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

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

34. thanks

35. 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. 4. 1 st line in management of epistaxis in casuality ( emergency department ) is admission.