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PublishLora McKinney Modified over 9 years ago
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Investigations, nasal trauma & epistaxis DR.MUAID I.AZIZ FICMS
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Investigations of nasal diseases History Examination Radiology
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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.
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examination Inspection Anterior rhinoscopy Posterior rhinoscopy
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OMV
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Imaging OMV (waters )
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OFV
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Lateral view
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Ct scan
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MRICT SCAN
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Nasal trauma Septal haematoma & abscess Fracture Epistaxis
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SEPTAL HAEMATOMA
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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.
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NASAL FRACTURE
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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.
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CLASS 1
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IMAGING
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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
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CLASSIFICATION Class 3 Most severe due to high velocity Also termed as naso-orbito-ethmoidal fracture often associated with maxillary fracture CSF leak
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CLASS 3
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epistaxis Kiesselbach plexus Woodruffs plexus
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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
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Management Stop bleeding Resusitation Non surgical measures Surgical measures
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thanks
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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.
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