[RuINoLo6y @ Gross ANATOMY ; = pyramidal shape — tuo pods : A+ External Nose B. Tnlertor at nosal cavity ——— Root af Nose f a) JN. Bridge of Nose a Figuve + Nose # Anterter Naves* open aerials separated by columella@ ExteRNAL Nose + S maintained by skelelal framework ~ Bony part: support upper port ot external rose. « Nasal process ot Frontal bone . Nasal. hone -Ascendiog process of Maxilla = Cartilagious pat: support lovsey pack of external nese. + Upper and Lower lateral carte ‘ «Alar cartilage : Quadvi lateral catilge d ‘nasal seplum. —comecked utth each other and wth bone by eanbesae pet chon dytum al petiasteum. ~ Skin. Thin over outer pact and thicker over lower a Aa pot and contains sebaceous fend - ~ Vestibule: tnduded in emer nele rise (bese ik is Lined with skin on contains sebae us glonds en vibvissae Chair) @ Interiog / Nasa Caviry (Fossae) ; - divided into tise halves by 4 central seplum ~ Anterior ar posterfor apertures of the mse ore called anterior and posterior choana - Each ‘nasal ossae communicates with +the PNS Avaugh thet oslia « S Each dossae is hounded by : 9) Floov: Tk ts abot 5 em lng ou 45a wide aad tovmed by ~ - Palatine process of Madlle in atthertec aluth . Hovtzontal parts of Palatine hone. tn post feb) Roos It is very narrow , om Long are 2mm wile : and dormed by - + Nasal process ot trontal lone antex’- ory - This slopes dounwards and uvwards rom the highest part. . Cribrifonm plate of Ethmoid +hrayh which Fives of Lhe tery nerve passes : Body of sphernid posteriorly and slopes downwards om backwoods -©) Medial wall: This is Nasa Septum. (iitlen + Vie) 7 ib ts the medion vskeocatlgtneus postion bebe the shoo halves of nasal caviky « on each side ; it is covered by mucus membrane and doen | the medial wall al both raed! cavities . - the rnagor constituents of nasal septum ove: i Cuttcular part Clowex end}: ~ dovmed by Sibvodally tresue amd covered by skin. The lower marin of septum fs called colurnella « 4 it. Con lagnaus prt: — Sovrmed by Quadyilateval [ seplal cactilage iti. Bony pet: - Samed by - Rexpendicular plate of Ethmoid bone above ond behind - Vomex —belnw and — lachind—the wtoor cinstttuerts of nasal seplum ave: - Anlestor nasal spine of — Maxi llae Nasal crest of Masillary ond Rhine bone - Rostrum — and crest of sphenoid bone Nasal spine of Fronlel bone - Crest ok Nasal bone + Nasal Seplam ts vexely otuidly medtan- it ts dedlected om one oy another side.- Artery Supphy CNasal Seplur) : : Anterior ethrneidal avlesy C septal branch) | «Greater polectne artery Cexminal bench) | : Sphens palackine artery Coeplal branch) Septal branch’ of - Greatest contribution and it is called : + Branches of Arclery : - Kisselbach's Plexus « superior labial aclery 15 en Sphenopalaline wctery. Artery of Epistns’ Above 4 + Bst.. Ehmoidel Arlery Formed h above. vessels tn the Y relating trlerioy pert of nasal septum.—Funcktons ot Nasal Sephur t L Support of the tramewsork of the ee nose 2 Support of the tip of she nose. Car arg depression aw ur) - Divides the musa cavity and helps in xesphealory physiclagy 4. Tnerense surface area of olfaction ond cilliary wo acliv \y uO - Gives support + nasal vaseulichave, and blood supply + DNS Ar Nasal seplum ay compensalory hyperlogly a, to cempensele the unction of the sephum e LATERAL WALL OF Nose > (witHen) =the skeleton of the Lele wall ts pally bony. ply avtlginous and pacth mae up only of sb tissue as Follows :A. Bony Par: . Nasal hone. » Frontal prowss of Maxilla » Lacr?mal — hone. i wLabycinth of Ethmatd bone , Superior pel middle conchae. » Tatertor’ nasal ercheel « Pespendicula plate. of Paletine bone. » Median pbenygsid plate B. Cattlgtnous Park: : Uppex snusal carklage © Lover msal cath lige - 3/4 small eactilages of ala c. Cuticulay Tack : — Lower cabicular park is ered by Sibveatl tissue covered by skin -= The main dentures of leleval saall ave. turbinates: Superior, middle , indettor - The intertor -habinae ts the latgest one. Three meals named adter he -lurbinetes : Superior, widdle and tnderisr meortus - + Turbinate « Living bedy ww wews ~ Sphenvethioidal yecess + Lies ahove the superioy clurlinate and receives the ostium of the sphens- dal staus- = Superioy ae contains asta of posterier thins. dal cells.Middle meclus * The ostia of maxillary 5 antexior elhme dal and drortal sinus open heve -- Taterior metus : Naso Lacvimal duct opens here ~ Blood Supphy (Lateral wall of Nose) : : Lateral wall of nose is supplied by the breaches of both external ond internal conotid avery As Branches of Internal Cavetid Artery: I Antevior ethrnoidal artery u Pasterior —_ethmoidal artery Choth ove bvanches of ophthalmic ackery » which ts a bovanch of internal carotid artery) B- Branches of External Cavelid Avery i Superior labial branch ot Suctal avery ii Greater jolatine artery ii Spheno palatine arteryo Para NASAL Sinus (PNS) | ~ Group A + Anteviey qe I. Maxillary Sinus te Frontal Sinus - Anterior amd Middle gmp of ethmeidal sinus — Group Bi: Pskerior yop I Posterior yor of ethmnaidal an acell u. Spheridal sinus ~ Functions of PNS: 4 At condition’ 2 Lightening of the skull 3. Resonance of voice 4 Tacrease. errpnyrs aYea toe deeth exuplion 5 Rapid growth of Sacial skeleton@ FUNCTIONS _OF Nose : 4- Obbaction - Taspivelory air cantent : 2. Respiration ~ Pavabltc “4 Expiedory aty realy - Central eddy 3 Protection of lower xespivalory tract and lungs : O- Paridic: ion of aly by -Vibvissae : erlangles biggew dusk particle of inspire aly. — Muco thay hawier + cilia have an ethelive stroke and o Yecovery stroke ond beats 10-15 reals] sec: imes|sec - Lysezymes + bacleviehybic enjyme of nasal Mucosab. Wasming of alt { @ Moistening 4. Resoaaking box = Ae helps tn the vesonance of voice and production of nasal conse nav 5: Protective vellexes: a Sneezin b- Tahibibion ot breathin c. Naso saltvaty vedlex d. Nase gpohic eee & Aexalion « helps im rons of the PNS a Al the middle eay hough exslachion tube ae Passage dw aso lacximal Shad are secretions of the PNS-© OlracTORY PATHWAY : (viva) ; Oactory cells 72 alfactory axons —? Al Neyve fi laments | | comps 0 Uockry ; — factory bulb — 0 ily nerves meyulus JL olfactory tract — Wactory shia = hypothalamus * 20 olfactory mnevves passes Hreagh exibricorm plote of | edhmoid © SYMPTONS (of nose. and PNS disease) 4+ Nasal Aeon 5 unilateral / bilateral ~ Causes of nasal deel Unilateral | Biloleval | - Congenital unilateral choarel’ « Congenital Lilsteral choanal atvesia atvesion DNS Cc shaped } - ELhmaidal polyp | Antrochsanal polyp - tasal allesgy and VR4 Fovcign budy in nasal exit + Acute schtailis and sfinusi/ . Bhinalith is : Bileleral chronte staustlfs HIT Ciypertnphied saderi « Adrophtc. vhtntlis Caith e urkinates) usls) o Nesoher geal angiehbromn « Malgnast lesion od nose and NS - Rhinusporidiasis (bilaterd, axe) + Seplal hematoma . Seplal absass . Unilateral sinusitis » Synaechia of odheston - Rhinosperidiests Cuvilatent) : Neoplasm a} Nose and PNS Pa ACVMR + Vaso motor Rhinitis 2+ Nasal dischaage vuaibteral i bilateral ( Rhinorrhaea) — watery + oF srhinorshaea — mcid | allergic sinusitis Ss purulent {- ee strusitis — oul smelling—Couse of nasal dischage : —— Unilekeral Bilateral - Old Soveign body in nose: Alleygic thinidis in childven + VAR + Bilateral sinusttts + Bilateral choanal “atresia . Unilateral choanal stesia he dal + Actvochoanal aly L re Oa _ PNP » Advophic +hinidis + Nnmosporidiosts - diphtheribic shinitis + CSE vhinorrhoes “specific thinilis “and » Rhinelith ee hn . Neoplasm of nose and PNS Unilateral chronic sinusitis grenulomatus disease 3 Bleeding per nose oY Epistanis 4. Disorder of smell : = Hypesi: partial Lass of seme of amell is called -hypernie There ave seveve causes” 1 Nesal obstwe: ion Jor a Rhp batt [aM© Gross Septal deflection / DNs d Rypillome 2 VMR 3 Resipheral neuritis 4 Alvephic thinilis 5. Trauma specially im busal skull Seacluves invelsing the anterior cxanial fossa with Loosing of . he olfactory Silamenct & Trtvacranial lesion May cause compression al the olfacly lvoe Cobscass , tumor, rresingt) 7 Exposuve 4o Noxious gee? «4 Bromine - Ancsmia Complete less of the Sense of smell. ob must be bileteral bebe tL ts noticeble Causes * 4. VMR 2. Abyophic chiniis a aimee ai iavelyernenrt of arterioy ceria fossa, uatth Aewcing of Wacesy Hilamet— Cacosmia + The perception of bad smell due +e some. trlvinsic cause - Common causes ave 4 Anillary simsitis usualy of donb origin, Cdue ty increased amasiebe3) 2 freign body in nose 3. Presence of oki pus fn chronic indections ef the middle ent cleft. ~ Faosmia. A” perversion eee of smell or a subjective sensation of son existent smell: iH may be - 4. Finctional . Schizophrenic 2 Organic, a) Freflunzal snewtibis 1) gptleplic aura Q Unetnle Jit 4) Drags Steeple mycin+ Bll 5 leadache ¢ Bat nasal discharge and hassking: common “in stnustlts 4 Nasal tmtonation ( ehtnelalia) = Rhinclalia + @ Rhindaba clause © Rhinclalia opera ® Rhinolelia deus: due a cbsleuctive pethelyy in nose and nasopharynx © Rhindlelia eperl: is te peal! tnsucfciency (eed alate) Pr Acklagy of Rhinela iat Rhtnalalia Clause. | Uhielalic. Ape 1 Nasel obstruction 4+ Cle palate 0) Typ Cem eal press a submucous del palate Palalal — cicatrisetion ¢) DNS ~ Pladal . perdevation 4) Rhinidis medicamentosa aan 7 b) ait6) Nasal growth a teagan * Enlanged adenatd b) Aasepheoy agen! angie Yorn, Q Ay rasophary nga mass 3 Choanal alvesia & Sneezing: Allexgic Bhinils, VMR 2. Snoring CNetsy brevthing). Adensids, Php. AIT JO Sleep apnea: Cessation of ateflou at the math and rnastyils lasting 0 seconds © SLeeP APNEA SYNDROME, may be diagrse if there is at least 30 apneic cplsales dosing beth wap eye movemen ond non sopid eye smovetexit sleep axing at hou pesied - ‘Types: lwo — @ Central sleep apres © obstructive sleey apne Cause’. INS, Ethinsidal polyp, Adenvids\o @ 5 TmroRTant Cause. OF UNILATERAL Foul SweLunle Discharae : a Old doieign bedy tn the nose b. Alrophic shinikis (uslateal c Unilateral chronic sinusitis 4. Unilateral carcinoma of nose amd RNS e. Granulomatous disease. Ge, Leprosy) bilateral ger pk 4a attendant ear pe Tarr ash NEF eae einer eee alfaction AA nerve damage art | e Foreign Body Gn the. ws) - they ove raosthy seen in dildven and may be oggante ond nowganic — Wees OF Forelan Bory * ® Lwig Conimate) « eatkeroach «sg + on Sly® Non living Caaniede) = Wygroscopic: —- Jaa «magic. bal + olen + peas + seeds, —Non hygroscopic + + butlen * onamen + glss piews + shone + battery "chalk + pebbles ~ Clinica Features? A. The ft may preset tonmedildly th the lo Soregn body is known 2 Hf overkoled the child presents ith nldere nasal discharge which is oflen Jul omeling and cccassicnaly blood stained: a H is a diclum that 4 a child presents with usilateral oul omellng sansa discharge Soreignbody ust be exduded - ~ ANvesTIGATIONS Crelal materiel) . occassionally a radi raph of nose is usedul so ee and localise 4 Soreign body it ih is radio opagus — TREATMENT ¢ * Foreign bely having che Like piece of paper or callen swab com he easily Pena by a pair of Surceps - | Rounded Soreign body an be pores by a blunt Soveiga body hook, 3 past he Sreign bed) and ge dragging % locsard along the loo - » Medalic oveign body tered by mgr bar . . In babies and anco-opetve childxen , GA is & cdlbed endotracheal tube ts eee (cause, bleed —epivake ara nye and Loachea 9 “wer taa trea)~ COMPLICATION + _A Seveign bady left in the nose may yesults tn: 1) Nasal infection ond —stnusitis ii) Rhiaclith itt) Inhalotion inte -Lrachesbronchtal -Lree - NASAL Mytasis (magarts ta nése)0 SEPTAL HEMATOMA * = Collection of blood beneath the snucoperchondviam oY Mu periosteum a the seplum. - AETIOLOGY The. condition ts neatly allagys Lraumatic in of ae may he due. te: A Deck bless ov alls on she Wse , specially in childven 2. Operation on nose Example SMR 3. Blood dyscrasias , ravely -C/F a Nasal shstruckion usually bilateral and atten complete 2. Septal sulling is sot and somedimes ‘el.— COMPLICATION ! 4 sepa es ad ealilge nerns we due ty secondary tefectien. 2 Eatertal debontly such as Selig ae 3. Permanent thickenta ct the seplun may he cused by flrs. + Septal chscess — pecoration (due + Necrosis of carllge) _ TREATMENT: 4 Strple aspiva Hon mar sidfice when hema ma is small. Et ‘may haven aL ‘epeated io - Incision and dratnage. 3- Nasal pockin will preveat ducther ovzing blood —heneaths the snacoperichondiio. 4. Systemic antibislic. + preveat secondary infection.9 SePTAL ABSCESS : ~ Glection of pus beneath the srucoperichond tam or snucoperiesteum of the septum: ‘ — AeTIOLOGy : 4 Traumatic: an abscess ts usually secondary te haematoma 2 Spontanesus : may dllow measles ot Scarlet | Sever 3 Moy compl cate nasal furunculosis - CIF. 4 Pan ‘may he severe and robbing 2. Nasal cbstuction ts often complete 3: Resin will aoually disbinguish —absess dem haemaferna 4. symmelacal swelling of the sephuin This is comm aby cf a dull © purplish celoy-— COMPLICATION * 4 Bternal dedocantly may result trom cartilage Necrosis . 2. Rerderation of septum sloughing of mucus membrane. ar car lil eo. (due +e rebepade infection because ob the presence of velveless vein) 3 Meningitis and Cavernous staus throm hosts ave ave. — TREATMENT > A. Tneision a drainage gently 2. Syskernte antibiotic 3. Plastic surgical covrection of debarerly may be. required later on jee@ RHINOLITH + 5 tt ts the stone in the nasal catly - AetioLoay : A shtndleth usually Jorms around the mdens Re a smell exigt nous dexelgn bedy , blood clot ov insptssaled secretion by tee , depesition of Ca and My salls. Over a pesied of ime it ToS tale a Inge teres ae mass which Sills the ‘nasal cavity and then may couse pressure , Necrosis of the sephora oY bteral wall d nose = Rhindiths . ave commen tn adult. - ci; 4. H's common presentation ts untledeval nasal obst-vuedi on: 2 faal smelling dischage , Shh aes very eflen bled stedmed Cee episleods 4. Neal yic pean may sesutt Sion alavetinn af surround Dy mucosa:— Siens Con Examination) ¢ A are: baum | greenish blacle mass wrth Fevegula surface and stony havd eel is seen in the tasal covily in beleen the sephem amd turbinates. Hots edlen bite and a partion of tt way break of uahile smaripul ating - : Sometimes it is sorveunced by granulation tissue. — TREATMENT * : They ave. semnoved under GA. +. Most - them com be fone hgh he naves. . Lage ones need te be broken tale pies bedore xemoval > Some patbealarly hard and iol ones , vaguve tsteral shinetorny :@ SEPTAL PERFORATION: - Causes 4: Frowmia : 6) Suaical og SHR Repeated cauhery 9 Digial Arauma a Malina disease : a) malignant humors b) wal ignant granuloma 3 Chronic tadlarmetion: a) Weshes's } syphilis ©) Tuberculosis 4) candida 2) Lupus exythemalesis 3) Theumnatoid avlhvitis 4 Bisons: a) Industrial W) Cacaine addi 9 Topical corlicostercids 4) Topical decongsait~ 5 Hisporhic— cle: adwitation in the vse, is commonly the first, alen the only symptom. 2 Crusls— way be blown auay or picked off 5 Fpslevs lls sepeeln of tHe cus. 4 whisking fs semedimes caused by smaller pectin — TREATMENT + «Repair ot the septum vif ik is lage pechreion Chey gredt) A A ts le small, make the pechreion leger@ EPISTAX!S : ~ Any bleeding per nose is called eptstins - Tt is a synpbom as well os sign: i is at a Aeeeer bat aly vesult of some local | systemic diseases od the body - — Aetiooay (Care of Cpa) A Lol Guse: Fisk cause t alianys idiopathic @Corgentl : + Osler Rend Syndrame = Heererchagi Alaiecl, sis. ab she nose, and sep we Unilateral cheanal atresia Cbileleral 2 pt cen’ survive) w Meningocele w Encephale v- Glioma ® Acgt ved 8 1 Traumatic ~ ialagesics alli apetston in the se Cane, -fesbinecomy , Seplplesty)7 physical Arawmna blows, fracture mose , external cLauma , nose picking. - chemical Ayauma: rom inhaledion im chemical Suet thermal Lrauma: — excessive heat - Soveige body a Inf lammarony | Talective ~ Acube: thinilis, sinusibs Specie: nasal diphtheria _ Chronic: thinikis, —sinusilis Specific: B, syphilis - Fungal : shinaspovidiass — Non spec . avophic ahinitis a Neoplastic: a Banga: Transitional call papilloma, Agee, Hemangioma b. Malt: Squamous cell caxebnom AlnnernenatAdenoideystic coycimoma , OHactory reurtblastora , Melanoma , Lymphoma - wv Day induced — Rhinitis eolicmnceiese (Topical decongestants Coctaine) ~ Inhalats = Tobacco, Camabis, Heroine, Chrome, Mercury , Phosphorus, Weed dust - Tdiopathie B- General cause: Fisk cause ts alsa idiopathic a Bleeding disorder a Congelopetics: Inherited cangultion aces dediiency (congenial) Ufacoy vin, Ls Waernephilia A, 8) Aye: ankiacglst liver disease Vit K defi enc » DIC, acqaived inhibitor 1) Plalaled disorder: t “Thrombecylepenia . Congenital Required: . dystunction: may be congenial Lacqpived one. marred jailwe, | | |©) Blood vessels disorder: ~ Congenttal : Osleagenesis tmperdecls, Hereditary haemorrhagic “blengiecasi ~ Acquived . Armyleid, Vasculitis , vit @ dediciency 4) Hypercibovinelysis : Congenital [Aaived 2 Dugs < Asphin, Acticoaguleat, Chlovamphenica! , Melhrbre. vate , ienmunosuppressive , aleshol 3 Neoplasm: Leukaemia, Hodgkin's disease , Lymphosarcoma 4 Tiopathic 5. Others: Liver doilure, HIV, Hyperthy vidi 10 Tnporlant Guse 04 Epistaxis: 4 Aiopathie 2 Trawna Physical Accideral Suagieal 3. old Jexeign budyvos o “ 10- s a 2° Rhinospovidisis « Mvophic. chinikis . averted papilloma : Angichibrema a Hazmangioma » Co of Nose. ond PMS Hypertension Leukaemia ~ Artery of Epislans pheno palatine artery - a Cause OF Epishanis : -In Od Age: L iypertension ne Co ot: Nose. and PNS in Taverted prpilloma — Jn Adult. © Bhinesperdiesis i Alvophie ahinikis wt Trauma~ dn childien: 1. Bleeding disorder n Old Soxign body Ms Mesoghary ages angiadbrom Cenelusively in case at male) — Manage MENT ®@ Gredul History . Ho Avouma | sporaneous ( anprovoctive aponlenecus bleeding per mee: naro- pharyngeal angiedrbvoma) - Mode of onat (usually Rhimspori diss) insidious (Ca nose and PN9) - Duvation end sreyperey Pe bleed w Amount of blood less J? al ei nie }-+ modavale vnosparic igsi9) Ly severe (Nasopharyrges! 89 irons} Vv. Site of Leng Chiou onlerior nes) behind Ccheana > pheryne-rseth Ary lenoumn bleding tendency im che. pts dhsily sy wok: (Haesnophilt) vlBAN vile HO known rnedical ailmesit : such as HIN, leukseria , anttyal valve. disease , chrchosis ne livex , nephritis vite — HO dug inlake : such a3 analgesics onkiagplarts. ® Local examination t - od the nose and PNS - Antericy amd posterios athineseo: A: Lillle's area by be acted or any other bleedi| yy source strom any bleeding tumor - © Genexal examination’ ~ Anaemia, Paller , shock - Examinelion af the nec dor ony lymphodenspathy. BP Pulse and any evidence of @ systemic examination: ee cVor Resphrerkery szskem, Liver, spleen, kidney ele. © Gornplete hassontolegical euarnt nection: — Abi, lalood count aletelet eon aeeGNCl Prothvombin ime eke.© Rosalia! Examination: - at PNS , nasopharynx chest , cawelid angiogaphy ete. Cou yet erlaged LAL = Xevay_—sasogharye) ECG — TREATMENT ° @ medical @ sungfeal + Home therapy’ . Ressure. fra am 2, using episexis 4 stk on a chair 4 One hand over the chat 4 Face “the nose. by othex hand L breath by mouth for to ming (couse, Br, CT is £46 min) ald om pression. i vat waotks 5; q° + ‘nearby hospital + - eesessment ae ta whether pe is examme he pte ‘emove <— stp epistaxis «in shock | not the lead lat by sucker machine , alse identify the site f Ulediog L Eleclrcaidery ANS pack PNS pack + Trorter's MetHod * absolele L pt hypovelexnic —s then bleling slop ® Medical : Flow chart’ or Epistar cnanagement= Ackive episkes~ eee | ; Clinical examination : I Jlexible nat shmop ile ie welll “— Decking 4 ; Tenkidy the sile of Weeding4 Shop the bleeding od nasal caitery | 1 | 1 | | 1 1 unsuccessdul Steel | 4 l I vnasal packing General one ---y- ne J I Ank. 2 Past? attevier ' ki ' i a | L I ! \ i I 1 \ Il Yemove. packing = tie tae exky 4 Nae 1 ve- bleeding — repack — Yemovi- eonsider i 4 q stranstusion 4, surgical ilervenion > « Aiterial Iyetion Gab sgh 3°) ug e ‘ - Endascopie calesy pe + an take “== » Embolféa-tion \ Lx) — Sugieal Sit eentinn hy Epistaxis: J. Coulevization Gh we ‘om tecagrnize he. stle of bleeding) LC Chemical Chy TCA: vi chloro acetic. acid) : urnipelay Biathersy ~ bil . 2 ANS Pack 3 PNS Bek callowed by ANS Pack 4 Arterial Ligation: eral maaillery Gilery ii- ant. elhmoidal actery an eet aaa iit. external conckid artery ted epistods 5. SMR 6 Endoscopic caurlery 7. Aging apy & Embslisation — In Gse of Nasopharyngeal Angiodibroma : Facision under @A ~ Jn Gase ot Rhinospuridioss: Diathermie excision ~Iy Case of inverted papilloma : Excision@ DNS: 5 Deviated Nasal Septum = Synonym: Septal Dedlection = Derinition: shibting of the nasal sep bum partly ov 05 a shale ty ome of other side or beth sides od nasal covities and thus producing disexip. ancy Casymmelvica in the size of nasal cavity. Sometimes utth the external dedormn- thy, ts called DNs. ~ Aetiology : ® Congenital Discripaney or stanlasty 4 development of ditlevent parts of nasal septum HOD het ore the pects eb nas sep? «Bony pat d Covalaginaus pat » Cutialar pat Acayived ) Bath lroumas Palonged ond oveedul shess daving binth — process odfects the nose pe dedormities cquses disheations ond Seu) Physical Arauina assaulls , Sports injury, fall Srom height 1) Road -Lvadfic accident Ww) Diseases * Sod k issue ‘mass oY hemor gral push the nasal sephura te cthey side eg Nasal polyp Tapillorna © Racial actors: The deflections ave more common tn Europes than ta Asian ef or Africans — M1 in Asia O54 Carp mp lara) < st Csymptomaic) ® Age: Dedlectiens ove uncommon in dhl Common =m ld age: Idren than adults . © sex: Males sutler SF ce © Heredily: Hevedily may he a aclrs in its causation @ igh wwched palale: Seplum ean aol comme dann al tls 4 “e position So, ~this vaight couse buclding of the deacleping seplum— CLASSIFICATION ! @® Analomteal Classitieation « a Deviotion + ) C-shaped deviation « mn) §- shaped deviation : 2 Spurs Aauke [sharp angulation a nasal seplan Pp 2 Rid: Lnlaed thidsing of sal phan5 4 Dislocection + Anterior dislocation - i what type of disloeatien 9 _ Anterior dislocation FS thy wk posterior 2 - Becouse postedter pat ot Nasal septum ts Sieonly atlached dle the ves — of sphenetd bene - vy, f + Gitexia of anterior dislocation + 1 Coudal end of nasal septum ty dheeded fa one side (may be sight [edt ) 2 Noslrls ave asymmelvcal tn size. 3 Caudal end ob nasal septum is expesed - 8 Clinical Classification 5 1 Single deviation2 Naval “obstruction: - open (+/-) 3 Impaction ~ Nasal septum is taapacted ith lateral wall od asa! cavity - = geelion must be eae - CF: _ Symptoms: Asyouplomalc in rajoily cases - Some case shows symplorns Like - “i Nasal cbskuction (aay be urileleval / biliteral , may be continuous / catermifleat depen on degree of deviation) 2 Mouth bresthing 3. Dryness of mouth a phory (due to evaporation of saliva with 4)4. facdol pains due ts dedective aeration of tse and sfruses of, moy due. ay pressure on she ankertex thm’ dal newve. (called Slader’s neuralpia S Eptotands & Cosmetic, dedormily : hen here is anterior dedlection od the. sephim oY, suelling in the masal votes | 1 Nasal dischage (Rhinorvheea) & Headache. 3. Favache and sore threat” 10 Some may come -epeated change of vie due to chnic Laryrgitis Ab Hypesmia or Anosmia - very sceasionally m srajvily of cases pottent may ome uth combination above. 1516S: 1 dena delay oy pst 2 Shi bog of the — nasal seplum on one ot othe side (on antevisr — thnescepy)3 Amlestor nares wmy be dissimilar 4 One nasal cavity may lage { roomy ard other ome is narrow: 5. Occasionally taberior clusbinate hypertrophied on the cmcave side dor compensatory Increase of Space - 6 Nasal mucosa ‘ay appear reddish watth —qceamula- ted secretion tn nasal cavity % There may be spurl dpe ~ TREATMENT | + No symptom no veatment It DNS produces symptom , “q 0 Asal sdabuclan + gos dain eases Vege J sinuses —» sinusitis b) Higher incidence of rasopharypils © Cold + alter normal tee cyde d) Ih very youy child my produce abst: bructive dep prong Sioving, then a will be done«The nome. of operation tgs SMR. | _ tf potent ts above 16 years (septoplasty ts also dene) @ Bedove 16 ents - Seplaplasty ts the choice of operation o Tk there is external defocily with Dus - Seplarhinplasty is she Nomne. of operation. eSMR: Se yesockion of lovioted pect of nasal septa .* Anesthesia: vsuall done under G/A- TH ma be done \ qd 4 under L/A- Gide Railton : Supine position uth head eee X bout pis of the able Chy giving a pillors under the head) - To pelea the venous congestion: -& Phovyrgel peck : hypophavye and inlet of Laryme (do preweit espivaion oS Wad tale larynx and pharyre)— STEP OF OPERATION ¢ 4 Tnilledion of nasal seplum: i is he in ts sub pevichord fal planes with 4p xylocaine and 12 90000 advenaltne - 2 Incision: A cuwilinear tndsion with convently dorward is made q at the riucocudameous fonction on the led side of the seplon HE ads only Ahvough the mucosa and pevichondstum. 3 Elevebon of maunperichondrivm and smucperinsleu. 4 Andsion > crlilage ts incised. jurh posterior te drvsk indsin- Avil adling the opposite mucopexichond ium otherwise tt will wake perdoration 5 Elevation of opposite rmucapetcondatam and vnucoperiosteum & Removal af cortege ( Sovcep| : ) and bene (Lue's x Gauge. and Hammer : Bong spur and vide con be vemmved. 1 stitching . | & Tacking: Anterior nasal pack + hen desing <> ailsopore FIR |— COMPLICATION ¢ 1 Epiolants | Haaserthage 2 Soplal haematoma 3 Septal abscess 4 Septal perdoration a Depression a nasal bide (Sadel nese) 6 Rebre: ion of clumella t Supsalip depression & Pevsttence ef deviation 2+ Seplal adhesion (synachio Is- Mexigi hi cs rehogrde infeclion aceurs, 99 valveless vein present te Covernous — strus thrombosis 2 Infection 3° Flappy sephum | \ lil eel = i nae Re aLts iy ace MOT | # Renclonery haerarmye RE AT couse bight pace a x ANS Pack ear giz 9 1 : wk beast 24 hours, thew Yemeve i { nH | > and Bel operative manegemant aa thet % Ve ond ? 4~ COMPARISON BETWEEN SMR 2 SEPTOPLASTY : AMR SEPTOPLASTY Ohi the wadical operation @ It is velaltvely & conser. at the nasal 5, ty votive operation of the ma- renee ae aad te correct its @ The operation isnot odvoca- Q) Tn dilden under 16 yeas t shed sox dildven ups the old, ek is prederable + age of 46 Yea"s- The vesec. SMR- sion operation, if peclormed in guy oye may inked. Ye with ~the develop mest of Jacial bones. ® Stree the anterior and de @ this ts beck dor enter sal slips ove preserved to dileclioy aod tr tutntain the normal contour deviation ining desu the nese this eperain the. sapluon: stheredore i act Seasthle or dislocation of the ante. vior end of the septum ov ox deviations tavalvin dorsum of the seplum @ 3 tunnels ave made ® 2 durnels ave madeea) @ The opexation is approachad © The operation is approached Aheagh comer side Ahrugh concave side. © Both side perithondstum ob G The duplaced cartilage he sephisn coe nested end caredully seperated “by bon devated Som the cask neling ond veplaced back and bone +o pustbion by vavielio d technique cod trans ftce- Aton sukure- @ Complications like paeralis @ Flapping ot the sephm vy Fall of the nasal bi and pertovetton de nat dhe aye = @mymnon- usually ocKUy + © Funconal bene ts @ fencttond benedil ts ‘move - less ® chance of reeurrence @) chance of reeurrvence ts Less is move. @ If Yeeur, revision sue: @ Revision susjerp 1S ay ® wey thal: me move easy Q) Meteo —amousit of GB) Less ammount of bane bones and exeblage | cxvtilige are axe Yemoved- removed.NASAL PoLyP . @ DEFINITION Edematous , shagging duon of the mucous membyane of the ose and PNS hosing undas , boly and stlh/ peduncle is called php. tt Whed- ave. the ae of polyp in case of ENT 9 @® Nasal php = © Ac pp ® Vocal cord polyp o Eriousay » Exact cause. in unknown . There axe five main theories of porhagenests 7 » The Bernouslli Phenomenon : vesulls tn 9 pressure drop next fo Lei This sucks th, a constriction . This mucosa of the ethmoid into the nose. - ‘ 1 Palsaccharide changes: An allevalisn to the polysaccharide oF ground subslnnce as been postuladed by Ticeson ool = _ aAxthood - Vasamelox trhalance : May cause polyps but thts conjecture alone. ve Infection : tong slending trlection gre we 4b pestlrnphangtt and periphlebitis resulting tn poe chsexplion of Tissue Sluid in the mucosa and thus this water legged mucosa leads to polyp formation v: Allergy : has been tmnplicated because of three daclers : a) Hiselgical picture where 901. | more of nasal polyps have ain costnaphilita : W) The association with asthma ©) The nasal Sadings ubich may mimic allergic. symptoms and signs 5 Vie Mixed + most commen All wor contitlce opel evmalion bul none abvine ly the commonest elislegy-@ OTHER Faciers I Aye incidence : ELhmoidal pps ave a disease of adult and Ardvacheanal polyps ave a disease of children Sk Sex : There t§ 0 sbiong male. predomtnance in patients who have polips , Sgures ranges belween ait te ast depending the sludy . ute Racial dackors : Blyps have been veparted in all major racial groups: WN. Genebic prettposilion: Several members of mil say be edJected with nesal php:an 0 TYPE: { According te ste of: origin 2 ® Ethmoidal peyp : -artses om ethmeidal afr cells and d gees ounssards and forwards. - wubliple in no. Corape Like) : ~ bilateral 5 pale calor, shiny appearance , srnovth sushace. © Artrochoanal php : ~ arises from maxillary eval usm ea then goes + nasal cavidy through i ostium then gees + nase pharymx rough posterios choama - ~ direction of natural osttasm ts baclouae dso it goes backwards and uptaasds ond examine bi posteviox sthivoscopy. ~ single mss, pale color, smarth such shiny appearance. nil adeval to ae) diloction , 2 anstriction.Elilegical classification : Me Trdeclive - Vasometor Mixed z s och: + Symptoms 4 Nasal chstweton : Signs . ~ Stmple peyp Alexgic polyp Antrechoanal Cunilatexal) Hhracidal bilateral) y . Smeezing + Rhinovrhoea ~ Nasal trfonetion (Rhinelalta clause) Sow a Disorder of smell (Hyposiata or Anvomia Pee Ly late case) Rt cial Pain lad Headache 4 Paslertor nasal drip » Anleriox chinoscopy: ~ done by Thadteum nasal speculum ~ hmaidal pop is seen eller.ow | . RBstevior sthinoscapy: mena by PNS mivyoy with Longue | depressey = Ambsochoanal pdyp ts seen belles. | - Probing: Rake ty dound and whelher ch | bleeds [net | + Nasal alway potency est : done by metallic oogue depressor ot collon piece Ee Macroscopic iodine ab omlerior and posterior 4 Rhvoasporlioss alisayy Heals @ INVESTIGATION ? + Yay PNS omy + CT- seo Q TREAT MENT ¢ ~ Surgical: @ Elhmedal polyp : + Inbranasal polypectamy @ Arochonal pap: . Intranasal pelypecamy Cundex 16 geass af) cal Well Lae opevection Cable 16 years) FESS surgery— I$ recur: © Ethmoidel polyp: - ethmotdecto )Fabranasal ethmideclamy si) External elhmcideclomy 1) Fransanbal ethrniacomy @Aoleochsanal pelyp: - coll well- ue opention » FESS Suagery = Medical +. Anlihisbanine ¢ mnths . Sleraid drops ¢ month @ COMPARISON °- Tears Antrochoanal peyp —Ethmotdal pshyp Ape Common in childven and middle age. and sdolescance elderly people 2. Ebalegy snainhy feck allergic 3: Sile of origin arises yom rraxillary arises Sum anterior, Malan ad “beset idle med ator hgh the eskiam. gap af elbmal a dls. Site ob trvely. Unilateral Bilateral emen 5. Number Single Multiple6 Direction y+ Ps g- Chance of Neeurrence 9. Extension “ Elends backwards and upesords and best seen tn posterior thineseopy: No pus i seen ta metus. Nek usually offer Cold Well Lac operation may extend to rasopharyme and ore- Pharyme Oo) Daonusards and Serssasd 3 and best seen tn anterior shineseapy - Pus seen in middle meatus Common after radical operation not 50[Carp Wet - Lue _OPeparion | @ SYNONYM 2 @ DEFINITION ° OINDICATION * el w a ~ Vidion Sub Labial antrostomy H is opening the mnaxillary antrum ~thraugh canine ssa by sub labial approach and dealing with the palegy inside the antrum. Chuonte vnarsllary sinusitis with tveversible changes in the sinus mucosa. - Removal of reign bedy oY vat! of the oath. - Dental opt / Dentigerous gst . Repay of oroartyal fislula. : Artrocheanal polyp Cage > 44 yes) oy yecseredt anbocheanal rye : Fractuve of maxilla {blow owt Sractuves of she obit. neweclomy Cin case of ver) Approach ty plerypopeletine oss Sor Ligation of — maxil ory eatery :oy @ CONTRAINDICATION? Pent belaw -16 eo of: qe @ STEPS OF CPERATION’ © Anassthesta sally under GA, con be done under ae @ Pasition : Reclining with the head oa of she able vatsed . Patient Lies tn supine psition with dace cherned alghtl + the opposite side. @ Incision: A horizontal incision with as ens uproar ts made belas the gingivaba suas yom lateral tmeisor to athe amd apolar “both. He eats “thieugh yaucus — membrene, and periotourn Oélevfion of Sop . enucoperiosteal Hap is toised yom the. canine. ssa te cthe trbhaorbital nexve ovciding Sngfaoy ~to 1 ~the neve© Opening of avrbvum: using calling bury / gauge sad hammer , oa hole ts made in the artyum. © Dally with petblegy: once maxillary anton has been opened , pathology ty vemved - Diseased amlral mucosa con be removed with elevaters, cnvelles ond ovaps- Qpst, beni. gn camer, Soveign body ev a php fs Yemoved « O Making nassantval windos: curved hammer hemesat ts ‘ pushed inl the antrum hom the inferior meatus ® Tracking she antrum : Rhbon age tpregaled wrth Ligue d paradfin / ‘neomycin etelnelit™ can be pocked th the axtrum and th weds braght- gat daa -the ms antral window tate the tose. Tack 15 also kept tn the nese. ioS © Close of wound? Sublubiol tnesion closed wth one] “boo cagal” shares @ Bs Bodh Cdeohast) 11 5 oleae (aoe) P+ Poredsin Clubricant) Py Paste Gah) @ Tro intustamy ty dome tn Cal) tell Loe opensten ® sublobial ankrostomy @ Inbenll anlrstamy Clhagh infestor mesclus) © COMPLICATION ° 4) Hernoelage 2) Anaesthesia | Pavesthesia of cheek R Natl 2 See 3) Cheek sella Be ok ssaler compression 8) Tefection Coase + Sidlabisl cuocalrel Jurbala) 4) Sublabial penal stoleRHINOSPORIDIOSIS LKHINOSPORIDIOSIS @ DEFINITION: His a chyonte specife qrorulemelous snpeal: disease of the Nose caused by Rhinospevdin seeberi or kines « oAcncoay » one. aganism Bhinesporid fume seer or bea @ PREDISPOING Factor : ‘Sex: mare common in male than Female . 2) Me: Peake incidence ard and ad decade of Ube 3) Ruval populations are more otfeeted 4) Sutmming and Wing tng shynant waster, provided chat the calle beth there . 4) Occupation: Famer and is herman OMODE oF TRANSHISSION * 4) div borne: high dist sefecled by calle dong %) Water bomeay @ RESERVOIR a Cottle 2D Deg 3: Fish and snail @ PATHOLOGY ? ~» Macroscopic pelelgy L » Strauberry [bitchin shape ox leak Like. + Reddish in calor, granule sua , soft in coasiste wey driakle , bleeds on -fouch- - On the dependent” pat she under suxsaca ‘nay conlam tumerus bile spots hich one angel spores. > Microscopie pathlegy :~ + Histalagy shows vascular Eibtomyxomecous skazhe in ushich lage tals exe. Jound conlatsing sporangia ‘ o OneR ses 2. (of sthinospuiiesis) 2 Repiveloy rack ple the buondicl2 Oral coviby 3 Sebk pulls 4. Coxjunciva 5. External audilery canal 6 Axilla + Vulva ond vagina ocr: = Symptoms 7 + Unilateral nasal obstruction (22 case) 2. Reewryeat™ epistanis 3° Nasal invitation . 4 Sometimes,” pebent> may complatn somelhing coming down on blowing of the vase. ~ Sign ' On examination of nese by aritevioy vHimoscopy + Shasberry / Leaf he! leh lhe sbruclane 2 Ganulay surdace 3 Reddish tn color 4 leads on euch scanty bleeding 5 Thee ore some while dotted op I sporangia ” the undersuitace: o d/D: 4: Nasopharyngeal angiedibroma (prodase unprovocting epiterts) 2- Inverted papilloma 3- Ca nese and PNS 4. Infected pep @ [REATHENT: ~ Wide exesion with caulertealion at the base (some. halhy issuc + diseased porlion) > pu mai AEC ENCE * Abvolages ot Cuclertzadion: t+ Hasimestasts 2 To prevent” Yeeurvence, - I recur: wide excision + Cardy rtzation - Medication : hhh ‘Dapson Coo mg day for € months) -To pe vert Yecurvence. Amphotextein B| Arropnic Rawr ~ Ozaena ODEFINITIONS Th is chron inflammation of the masa) mucosn th uhich al, various consttLucats undergo cdriphy a5 a resull of petiecdieuler Silrosis and end crleries of the Levent nal arterioles . o Types : There aye, -boo ovms a the d @ Primary odrophic his ® Secondary orophic shinilts ‘sease — @ Paagy Argoriic Rains * AETIOLogy * 4 Age : common ty qung odilescent 2 Sex? Female predamtnaat” 3: Toor saute econownie status 4: Theories of aeligy: 4) infective theery vious oxgentsms Uke Gabacilles wean, Klebsiella ozaena , and Diphthassids have been tsclated vom the nase of such poten» aop L) Endocrine theery, The disease %s common in Jemales portal aly at puberty. The highes inctdence tm females and improvement with estragen therapy has given ise ts speculations that endocrinie imbalance has a part 4, play tn this causabion . . 0) Dieloy dick thes: 4, 4 Fak sable vtlemtes specially vit A and D. © PATHOLOGY + ~ Degenesabion of the dltabed epithelium and the Sevomici nous alent - - Formation of thick adherent —exusts in the nose these become. secondarily infected with seprophy tc | oxgenisns ~The bony stuchse of the -bedktmales “ea ied and the rainy become satdened: - The sinuses may be small due -bo arrested preumentzation — bat” ave oflen smallecle: - Symptoms t b =. Dynes of nose Nasal obstruction > due to ) Nasol cust formation b Codaneous sensafion ot the olfactory nerve ts lost r 3 Hadache (dee lo prov presmonteaten 7 Epishexis (due to crust perenl) s Hyposmnia / Anosmnia 6. Ful smelling drom nose comp ans by athendance + (Husband, wile, spouse ele) - On Examination + a sich potist presest with broaned nase and uidened nastrils 2. The rasal cavidies ave filled up with cxusts. 2 Sometimes . dreley isa very marked Faodure noted by the exarniners 4 The rancosa — Looks congested etvophied ; oo = aBw usbinates look, elvophied , shrtvelled up ao nasal cavities are. . more rovmy - 5: Somekimes even the aso phasy mx (clrophiel] may be visible on anterior sthinoscopy + @ INVESTIGATIONS ¢ ls various radiole fcal Ml Hoemesegical ser Co cede if 8) aM. Sexdgieal t fo wule oat a, syphilis , Lupus , Leprasy 0 TREATMENT? @ Medical -reelment, + 4) Nosol ieigation and emol of ests by warm normal saline ov on alkaline sclution. ii) 257. glucose in ghycerine XD opinion Cat frst doops then weah as ghyerine acls as lubyicaat™ 50 eany whe clecen') Can “ak fast dap, then sash ths apt hop fs deon saprofic= How to wash + 4) Higginaea's Syringe: 2) HE wat ound, take normal optige , or via har im how we clean our rose during or uid hu. iil) Local ontibickics spraying or pointing the nase. with appropriate antibictics help te eltmmtnacte secondary infection Kemicatine anti camena, seluljon contains chlormycetin, cestiodial ov vit 2, may be. und w) Oestradiel spray: helps tot vascularity of nasal mucosa and regeneration of Seromucinous lands. Placental exebiack + tnjected sesomactlly provide some relief. In nose, may® Sugical treatment i. Young's operation sto shop the dunckion of one cavity to allow vegenerabon tor € months Then afker 6 months do the same ev other nose- ] Te Sordana's operation / Modisied Young’ operation: ~ Block, eth nasal cavity at esp small hole in middle. = Young's operocion: beth the nostrils are closed completely or parally just within the vestibule by valing lags thy oxe opened oder € months or later - — Sesdomne's operation: Nawraaing the nasal cavities * i i submucosal infection of teflon pl i. Trsation of dat corlilege bene | x Tedlon stops -® Sconnary AteoPHIC Rains: e CAUSES ¢ \ 4 Gress DNS 2. Syphibis 3- Taheralosis 4 Gromulematous disease * Todrogentec ( Excessive. sugical vemoval of dbuchtnste. + ater taferier-turkinectomy) “ KR ot Ayperbophic inferior slavbtnace : @ Inbexiee -Lushineclomy CRarlial) + Why partcl 9p ethensise there will be: ~ probase bleeds ing - Long clerm lect CAbvphic vhinthis) 4 @ SMD CSubrmucosal — dicthermy) «bat no dunclion! —benelil & Lupus ¥ Leprosy & — Rhisclexomaal 9. Chronic Stnusthis 40. Fadisthexopy to nose i Septal perdoredtion t- External dedorratly of nose i Maygetsdermabion SINUSITIS O DEFINITION: Inflammation of staus mucosa is called stnustlis- \ 4 j @ SEQUELE oF ATROPHIC RHiNiTS = AND COMPLICATIONS ¢ @ Types! a Aude stnusttts 2 Chronic sinusitis ® Acute Sinvsits 2 eer eee e DEFINITION, Acsde inflammation of staus mucosa - The sinus mast commonly tvelved tthe mestllary —llnved tn churn boy elhmoid : Srontal and sphenoid . Very efken more thom one simas ts tnfecked | which ts colled —mulltstnusttis-Sometimes , all the stnus of one | both side are involved simultaneously which ty called pansinusitts (untlecteral | bilale ral) A stousitts may be open | closed ype depending m whether the intlammacory products of stous cavity can drain Sveely ints the nasal cavity ~Ahvough the nectuval ostta or vat- A dhsed — stousitis causes more severe symp oma and ts alse likely bh couse complications. @ AETIOLOGy * ®@ Exciting cause: A) Nasal tafections: due 45 sinus mucosa ts a continuation ch nasal mucosa and infection Seem nase cam “hovel develly by continuity of by way of submucosal ymphatics- 2) Sutmming and diving: Trfecled wler can enter the sinuses Hheough cthety — ostia- 2 Fauna Compound droctuve oY pene licting injuries | sinuses = Frontal , Mozilla, Edhmotd may pesmi: Breck infection — of sinus mucosa.uw 4. Dertal infectton + This applies +p maxillary sinus - nection trom the molax ox premelas teeth or their extraction ‘may emeelnned by acre sinusitis. ® Pre disposing causes + — Local : 4) Obstruction to sinus vertilackon and dratnage : a- Nasal packing : b. DNS c HIT Pe allespy /vMR e. Nasal polyp 5. Shruclusal abnormality of edhmeidal air cells Benign | snal net neeplaom 2) shasts ot secretions tn the nasal cavity 2) Previons ollacks of sinusitis — Local delenas ab sinus mucosa are aheody davinged — General 0) Envtenment : common ta eld ond wt teste. Abmogh exic pollution , sooke., dusk ond evexcraoding alse. predi pose fo sinus tnlertion-b) Poor general hea kth» Recent aklacks of exanthematous fever like — measles, chiken per, tahooping cough ete others factors Uke nutritional dedtcienctes , systemic disorders Qu, temumnodedticiemey syndrome) e BACTERIOLOGY : mast cases cb acute stusttts as vival tafections Jllowsed soon by backerial frvasion. The badtesta mit commnly responsible dor acate suppurative sinusitis ove. — . Streptococcus pneumoniae + Haemophilus —tafluenzae ~ Moraxell, catarrhalis ( Granharnella cotehalts) ~ Shreplecaceuss —pyagens streptocaccus aureus Klebsiella preumoni ae Anaerebic ovganton and mized tafections ave seen bn stnustlis of dertal origin 5ww” 5 PATHOLOGY OF SINUSITIS i Acate tnflammation af sinus mucosa causes hyperemia; exsdate of dlid octping eb paymorphomuclear ells ond ted | activity of serous and mucous glands. Depending on the vile nee. of organisms , dedences of he host and capability of sinus ostium bo dvain exudates the disease muy be mild (ow suppurative} oY severe (suppurative) » Infill the exete ts serous , Later may become nucopucrlest | purulent. Severe. tafe tions cause destruction of mucosal Lining Failure. ot the sstium -b dain results tn exnpyema of the sinus and destruction of ts bony walls lending compltclfons- Denld infections are very Amtoaking and soon results tn supp solve. shnusilis 0 C/E? 4 Cons i4udSonal symptoms « Fever , gence vnalatse. and body ache They ave. he yesulk of toxaemia 2 Headache 3 Poin: typieally skis sthucted over the upper {ae in cose, of maaillany strustlts , bat’ te roy. be vibes te gum or teeth4: Tenderness ee Redness and elena over the cheek. & Nasal dischav % Post nasal dischagge @ DIAGNOSIS * - CF is the most important diagnesti tel. - Transillummnation test (sinus sab. film sa Fes wR fig light “taa) — Xvay PNS (omy) oe TREATHENT? ® 3 principles of medical treatment ; J) Relieve of pain rales) To combat? -the bacteria - Anlibiclic + + Amoxicillin —> Reserve Antbiobe: 7 Exythromein . CiproSloxacin + Gdeimoxasol. + Sparfloxacia + nj Ceflsiqrone 9 Reredablishmeat ob sinus dain 0) systemte nasal deconges Laat drops 4) shaun inhalation cok,ww 4: Antihiskumin Gf asal discharge present) ® Anka Lavage: mist causes of ocube maxillary stnustlts | respond 45 medical reakment - Lavage revely necessary * Th ts done only when medteal -Lreatmert has dasled | ond that boy only undex coverage of emdibiote - ' @ COMPLICATIONS * | “1. Subocuke or chionte stnusthts a Frenkel stnustlts say ecarr chon swenllany stasis 3 dstettis or esteemyeltis et the maxilla | Srna! a Orbital callus ts ov. abscess 5: Meni ts extradural abseess or rome! lebe. abscess 6. Cavernous sinus Ahvom basis 1 Brain abscess@ CuRowic Sivusins : _ Tk is chronte tnd lammocdton ot the sinus mucosa - Stnas infection lesking der months or gens is called chrontc sinustht 3. = ome Impor ha cause + tailuve of acute tefee! fon resolve. @ PATHOPHYSIOLOGY | ~ Aucte infection destroys normal dilliated epithelium impairing drainage dom the sinus. Peaking and stagnation of secretions tn the sfnus invites tafection - Peesence: ot indection causes mucosal changes such as loss of cilia, edema and pep Jormation utth conkinuing the vicious odewe Pallucion , chemicals, tn elton Loss a cilia | A Paypi : pee apse Mucosal a adenetd , drainage changes 4 llergy Avene, alley ‘a a Infection 4 Inalepoke therapy of acute stoustlis Fig, Causative. FACTORS AND — “PATHOPHYSI0LOsiY OF CHRONIC = SINUSITIS0 C/E: * Headache : + Nasal discharge CRhinevshoea) + muceid, rucopurulent, wrulent F commonest spmptom » Abnormaltties of smell: ~ Nasal obstruction v. Episkaxt 3 Hyposmmia, Cacosrmia, Rosita = Vie Symptoms Like dynes of the throat and repeated sere thvost may occur. vil General symptoms Uke redness, Las grate dever ond sealing of being unwell - 6 DIAGNOSIS > Ie X-ray PNS a Pros ponclure : Pus dor c/s a TREATMENT @ Medical + 1. Antibiolic Arabs 7 Neca dacngestast Dalnge oF Sek — e talalinule ts Inbyomasal awlyostomy i: Cald Well- Luc sugey tv. FESS Suagerty @ COMPLICATION 3 + Orbital complication » Tnblarnmatory edema ot Lids . Subpertosteal abscess » Orbitel callulitis . Supesior orbital syndrome = Symptom consists of : e deep orbital pata — ronal headache - progressive paralysis of cn Can, wv, vt, x) 2d Osleonge itis 3 Intracranial complication : meningilis - encephalitis~ exbadurel absass - subduval abscess ~ Cavernous’ sinus —thrombosts 4. Descending vindee tions « te + Othis media 7 Chronic : Pharyngitis ene tonsil liLis » Resistoat lavyngitis and trachesbronchttisut ~ Fb ts vere tumour though rk ts the commonest af all benign —turnours af nasopharynx @ AETIOLOGY : The exact cause ts unlnown « As the tramour 15 predominantly seen tn addescent male tn the second decade of life Ae is Thought so be Aestostevene depen denk- Such patient: have hamartornetous nidus ok vasculax Yssue in the nasop hasty ond this is ackt vated to frm ongtedilsvoma when male sex. herman cere ORIGIN: Ik is still smaller et dispute 0 4) A originales strom the periosteum of one| other side af tthe. “roo of the nasopharyi 2) Anterior wall of sphensid bone 3) ate may oxise. J posterior wt of nasal cwiy -@ EXTENSION ? a Tato the nose: ty bend the lateral inte the antral cavtly ints wall and the septum opposite nasil cavity. 2 Tats the plorygeid essa 3. Tote the ethmoida! Yegion 4 Ochits giving tise ty proplosis and dng doce dedwtly. a Moy extend be the cranial aovity ~ middle "cranial cavtly @ PATHOLOGY + -A fem shemour censtotiny of Fibrous issue with varying degrees of vasaalastly « The blood channels may oY may wat have Oo muscle cit This accounts. for severe bleed; as the vessels [ose the ability —b contrac « @ INCIDENCE: Age age. group at 10-20 gens a. extelusively male,ub oC/F * A) Progressive nasal obstruction Custlateral /bileterl) D) Reeuvent , profuse, anproveccking epislats 3) Nasal speech CRhindlalia clause 1) Conductive deafness cceuvs pressure, on the Eustachian tube ' usually of one side. 5) A smooth lobulated , rubbery tumour fs bund im the nasopharynx Hk is reddish or qry in calor: ©) take tecdures due lo exlenston tnelude: {Broadening of the nal bridge (tug dice deformity) ii. Uniloderal prominence af —the cheek ii Displace ok the globe Ceye| of the aco . iv. Twelvement ot eats Vol cranial nerves will depend on the extest af cLucmnour -@ INVESTIGATION * I evar seth sue naepbroyre tn lofel ote ths seb issue of lhe raspy: K-Yoy PNS (OM) Co exclude antrochoamnal pul MCT sean — tp seo 1 Carotid angiography shaws octension of soamour , tts vasculavtty and Secding vessels . ve Hstopethalgy = adler operation: « D/D: - Ankeachsenal pyp 8 TREATMENT, = Subperiesteal excision of nasopharyngeal angichbrorne undex G/A- He Subperiostea! incision ar war pioke haemorrhage ae |ve APPROACHES + (ob susgery) ~vesius sugicl appches “eafbiona. dee on its origin and extensions are sled elon: 4) Tanspalelice nefsten Cper oully) 2) Fanspaletine + Sublabtol (Saclanas approach 3) Extended lateral —chtneory 9) Exended — Denlet’s approach Py Trough taped erporal stesso: Ke Pee - operetive ediedion also help te veduce vascular -ty but tk ts wat goreelly avoused - Cryotherapy oJ she slemour of snbdtantto n ot the Sealy vessels may also help -ly ie blood loss ok surge Ytar (Cathe A prlent ot 10 gests boy, comes fo go with —the complatnts at nasal obstruction , unptovocating veeurvant, praduse epistuxi $- What 15 yon diagnsis p 2 “Hos will qe mange this case 2 3 what are —the sugical approaches of *perection of —this disease ) tel Mhock ave. she shuclures seen in —the lateral wall of the rasopharyme 9 als Phar geal opening of Eustachian —tube 2. Taba eleveclion ( sored by Cc shaped carblege of Eustachian ~bube) 3 Fossa of yosenmulley — Clinica temporlance: as the communes t= site. chy rlianey: - hy 20 ? (due 4a Sy mph predomi ne) Seeceeeemee ~—