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Nasal Disease PowerPoint Presentation

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Description : Check out this medical presentation on Ear, Nose, and Throat Facts, which is titled "Nasal Disease", to know about the anatomy and physiology of the nose, and the disease of the nasal septum.

Tags : Ear, Nose, Throat Facts, Nasal Disease, anatomy, physiology, nasal septum

Published on : Jul 10, 2021 | Views : 4210 | Downloads : 21

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NASAL DISEASE PR. Issam Al-amine DAMASCUS UNIVERSITY
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Anatomy And Physiology Of The Nose External nose: Pyramid in shape Consist Of osteocartilaginous framework Bony part:( upper 1/3) - 2 nasal bones -frontal process of maxilla 2. Cartilginous part :( 2/3 lower) -lateral cartilage - alar cartilage -lesser alar cartilage
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Anatomy And Physiology Of The Nose B. Internal nose : Divided Into Right &left nasal cavity by nasal septum Each nasal cavity communicate with the exterier through naris or nostril and with nasopharynx through choana Each nasal cavity consist of :a skin-lined portion –the vestibule and a mucosa- lined portion ,the nasal cavity proper
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Naris Nasal septum
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Anatomy And Physiology Of The Nose Lateral wall: - 3 turbinates - 3meatus : Inf meatus :nasolacrimal duct open in the anterior part middle meatus : opening of anterior sinus group (frontal sinus – maxillary sinus – anterior ethmoid cells) Superior meatus :opening of post ethmoidal cells
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Anatomy And Physiology Of The Nose Function of the nose : Respiration Air conditioning of inspired air Filtration &Purification Temperature control Humidification Protection of lower airway Mucocilliary mechanism Enzymes and immunoglobulins Sneezing Vocal Resonance Olfaction
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Disease of the nasal septum 1-Deviated nasal septum Aetiology : occur following previous nasal trauma Result from asymmetric septal development possibly following birth trauma Clinical features : Present as unilateral nasal obstruction and less commonly epistaxis The inf and middle turbinates on the side opposite the septal deflection often undergo compensatory hypertrophy Management: If the symptom warrant, the septum can be positioned in the midline in the operation of septoplasty and submucosal resection
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Deviated
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Disease of the nasal septum 2- septal haematoma :( a collection of the blood beneath the mucoperichondrium and posteriorly the mucoperiosteum of the nasal septum ) Aetiology : Usually complication of nasal trauma (accidental or iatrogenic) Rarely a spontaneous haematoma can occur in a bleeding diathesis Clinical features : Nasal obstruction with widening of the septum on inspection Management : In the acute stage treat by incision and drainage After 48 h ; organization of haematoma occurs and evacuation of the clot is difficult Antibiotics are given to prevent secondary infection
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Diseases of External nose and nasal vestibule Diseases of external nose : Cellulitis : Streptococcus or staphylococcus nasal skin infection Red & swollen , tender nose Treatment Systemic ATB Analgesic Nasal deformities: Saddle nose Hump nose Crooked or deviated nose Cellulitis
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Crooked or deviated nose Hump nose Saddle nose
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Encephalocele & meningoencephalocele
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Diseases of External nose and nasal vestibule 3. tumors: a) Benign: Dermoid cyst : midline swelling under the skin ,in front of nasal bones . Encephalocele & meningoencephalocele: herniation of brain tissue with meninges through a congenital bony defect present as subcutaneous pulsatile swelling in the midline aat the root of the nose (naso frontal) or side of the nose (nasoethmoidal). treatment:neuro surgery. skin wart
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Nasal Skin wart Dermoide cyst
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Diseases of External nose and nasal vestibule Haemangiomas Rhinophyma: slow growing benign tumour ,due to hypertrophy of sebaceous glands of the tip of the nose. often seen in long standing Acne Rosacea. treatment :surgery ,carbon dioxide Laser
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Haemangiomas
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Rhinophyma:
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Diseases of External nose and nasal vestibule B) MALGNANT TUMOURS 1)BASAL CELL CARCINOMA (Rodent ulcer): 87%of malignancy of the skin of the nose. ♂=♀ age:40-60 very Slow growing nodal metastasis are extremely rare treatment: surgical excision with 5 m.m safe margin around the palpable borders of the tumour Rx therapy
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Diseases of External nose and nasal vestibule 2)Squamous cell carcinoma 11%of nasal skin malignancy LN metastasis 20% cases treatment: early lesions :Rx therapy advanced lesions :wide surgical excision LN enlargement require neck dissection
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Diseases of nasal vestibule 1)Furuncle or Boil acute infection of the hair follicle by staphylococcus aureus pain++++ may spread to nasal tip &dorsum which became red & swollen it may complicated into cellulitis of the upper lip or septal abscess treatment warm compress analgesics (topical +systemic )ATB do not squeeze the furuncle (dangerous triangle) : spread infection to cavernous sinus I/D if abscess formed
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Diseases of nasal vestibule 2)vestibulitis: diffuse dermatitis cause : staph aureus treatment: cleaning nasal vestibule by cotton applicator soaked in hydrogen peroxide. application of ( ATB+STEROID) ointment
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Diseases of nasal vestibule 3)stenosis& atresia of the nares: congenital or acquired (accidental or surgical trauma). treatment :plastic surgery
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ACUTE &Chronic RHINITIS A) Viral Rhinitis: 1)common cold (coryza): viral cause :(adenovirus ,picorna virus) incubation:1-2 days. clinical features: * burning sensation *nasal stuffiness *watery rhinorrhoea then become mucopurulent *sneezing& low grade fever
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ACUTE &Chronic RHINITIS Treatment: bed rest fluids +++++ anti histamine +anti congestant analgesics ATB if secondary infection
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ACUTE &Chronic RHINITIS 2) Influenzal rhinitis: influenza virus :A,B,C symptoms & signs are similar to C.cold complications due to bacterial invasion are common. treatment: Rimantadine (X- flue) Oseltamivir (Tami flu)
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ACUTE &Chronic RHINITIS B)Bacterial Rhinitis: (pneumococcus ,streptococcus ,staph)+++ Diphtheric Rhinitis rare greyish membrane covering the inf turbinate + floor of the nose (removal of membrane cause bleeding). treatment: patient isolation systemic penicillin Diphtheria antitoxin
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diphtheria pseudomembrane
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ACUTE &Chronic RHINITIS C)ATROPHIC RHINITIS: primary or secondary Chronic inflammation of the nose characterized by atrophy of nasal mucosa and turbinate bones. female+++ foul smell+++ ansomia Crusting++++ Nasal obstruction in spite of wide nasal chamber Hearing loss may be noticed because of obstruction of E.T cause M.E effusion.
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ACUTE &Chronic RHINITIS Aetiology: unknown cause Various theories advocated: Hereditary Endocrinal disturbance Race :(white & yellow) +++ Nutrition deficiency (Vit A+D ,Iron) Infective Autoimmune process
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ACUTE &Chronic RHINITIS Treatment: 1)medical Nasal irrigation &removal of crust: Warm nasal saline Alkaline solution: -1teaspoon of soda bicarbonate -1teaspoon of sodium biborate -2 part Nacl/280ml water 25%glucose in glycerin :painting the nose after crust removal local ATB
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ACUTE &Chronic RHINITIS 2)surgical: Young operation: close both nostrils for 6 month. nnarrowing the nasal cavities: sub mucosal injection of Teflon. insertion of fat ,cartilage under the mucoperiosteum medial displacement of lateral wall of the nose
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ACUTE &Chronic RHINITIS Secondary Atrophic Rhinitis: Causes: specific infections : Syphilis ,Leprosy Rhinoscleroma Rx therapy Excessive surgical removal of Turbinate treatment :same as before Leprosy
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Allergic Rhinitis IGE mediated Immunologic response of nasal mucosa to air-borne allergen. Clinical types: 1)seasonal 2)Perennial aeotiology: -Inhalant allergen (Pollen ,Dust,….) -Food :rare
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Allergic Rhinitis Clinical features: a) NOSE: -sneezing++++++ -itching+++ -watery nasal discharge++ -nasal obstruction++→↓ smell
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Allergic Rhinitis B) ocular symptoms: - itching - oedema of lids - conjunctivitis - dark circles under the eyes C) otologic sign - ear itching - retracted TM → ↓ hearing
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Allergic Rhinitis Exanimation Post nasal drip Pale , oedematous mucosa Turbinate swollen with thin watery or muciod discharge
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Allergic Rhinitis Investigation : ↑ Eosinophils ( WBC) Nasal smear: eosinophils+++ Skin test: identify the specific allergen RAST (Radioallergosorbent test ): - measure the specific IgE concentration
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Allergic Rhinitis Complications A) recurrent sinusitis B) nasal polypi C) otitis media with effusion D) bronchial asthma
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Allergic Rhinitis Treatment : A) avoidance of allergen B) antihistaminics C) corticosteroids : local or oral D) sodium chromoglycate : stabilises the mast cell B) immunotherapy : desensitization
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Non – Allergic Rhinitis Vasomotor Rhinitis (VMR) : same symptoms as seen in All rhinitis with predominance of nasal obstruction which is alternate from side to side Skin test (-) Same treatment, as in nasal allergy
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Non – Allergic Rhinitis Other Form of Non- allergic Rhinitis : Drug-induced rhinitis: Anti- hypertensive drug ( propranolol , methyl dopa,reserpine) Neostigmine Contraceptive Rhinitis medicamentosa Excessive use of topical decongestant ++++ Rhinitis of pregnancy : Hormonal factors Care should be taken while prescribing drugs :oral antihistamine must be avoided
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Non – Allergic Rhinitis 4. Emotional rhinitis Anxiety, Tension , hostility , humiliation Psychological treatment Imipramine (antidepressant and anticholinergic ) found useful 5. Rhinitis due to hypothyroidism : ↓Sympathetic system → ↑ parasympathetic system → nasal obstruction Treatment: thyroid hormone 6. Non air –flow rhinitis : Seen in Patients of laryngectomy and tracheostomy ,choanal atresia
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Epistaxis
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Epistaxis Bleeding from inside the nose ENT emergency Epistaxis is a sign and not a disease Blood supply of nose Internal carotid system : Anterior ethmoidial artery Posterior ethmoidial artery Braches of opthalmic Artery
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Epistaxis Difference between anterior and posterior epistaxis Anterior epistaxis Posterior epistaxis Incidence More common Less common Site Mostly from little’s area or anterior part of lateral wall. Posterosuperior part of nasal cavity; often difficult to localise the bleeding point. Age Mostly occurs in children or young adults. after 40 years of age. Cause Mostly trauma Spontaneous; often due to hypertension or arteriosclerosis. Bleeding Usually mild, can be easily controlled by local pressure or anterior pack. Bleeding is severe, requires hospitalitisation ; postnasal pack often required.
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Epistaxis External carotid system: Sphenopalatine artery branch of maxillary artery . Branch of facial artery to nasal vestibule Little area Situated in the ant – inf part of nasal septum Most causes of epistaxis originate from this area There is rich vascular anastomosis In this area “kiesselbach’s plexus ”
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Epistaxis A) Causes of epistaxis : Traumas Infection F.B Tumor Benign Haemangiomas Papiloma Juvenile angiofibroma
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Epistaxis Malignancy :(nose, sinus , nasopharynx) 5. General causes: Hypertension Blood diseases Aplastic anemia Leukemia Thrombocytopenic Hemophilia Rendu- osler disease (hereditary haemorrhagic telangectasia
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Epistaxis Liver disease cirrhosis Kidney disease chronic nephritis Drugs anticoagulant therapy 6. Idiopathic : 90% causes B) Classification of epistaxis: 1.Antirior epistaxis 2.Post epistaxis
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Epistaxis Management: in any cause of epistaxis I is important to know 1)Mode of onset 2)Duration and frequency of bleeding 3)Amount of blood loss 4)Side of epistaxis 5)Whether Ant or post epistaxis 6)Any known bleeding tendency in the pt on his family 7)History of drugs intake (analgesics , anticoagulant etc.. ) 8)Medical illness history ( HTN, cirrhosis, leukemia )
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Epistaxis Intiales measure to stop bleeding consist of: pinching the nose with thumb& index for 5 minute If bleeding vessel seen : cautery AgNO3 ant nasal packing for ant epistaxis Removal after 2-3 days Systemic ATB to prevent infection Post nasal packing for post epistaxis
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Anterior nasal packing
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Posterior nasal packing
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
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Epistaxis Nasal balloons endoscopic cautery Vessel ligation external carotid Int maxillary artery embolization Laser :in case of hereditary haemorrhagic telangectasia :
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Epistaxis General Measures in Epistaxis: Make the Pt sit up with a back rest and record any blood loss taking place through spitting or vomiting Reassure the Pt .mild sedation should be given Keep check on pulse , BP and respiratory rate Maintain hemodynamic. Blood transfusion may be required Antibiotic may be given to prevent sinusitis , if pack is to be kept beyond 24 hours
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Epistaxis 6. Intermittent oxygen may be required in Pt with bilateral packs because of increased pulmonary resistance from nasopulmonary reflex 7. Investigate and treat the Pt for any underlying local or general cause
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Miscellaneous Disorders of Nasal Cavity 1)Foreign bodies (FB) children+++ any child presents with unilateral foul smelling nasal discharge FB must be excluded X-rays is useful to confirm the diagnosis only in radio-opaque objects treatment :removal
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treatment :removal X-rays for F.B
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Miscellaneous Disorders of Nasal Cavity 2)Rhinolith: stone formation in the nasal cavity treatment: removal under GA 3)Nasal Myiasis (Maggots in Nose ): maggots are larval forms of flies They infest nose, nasopharynx and paranasal sinuses causing extensive destruction Clinical feature : First 3-4 days : nasal irritation , blood – stained discharge, ooze from the nose After 4 days : maggots crawl out of the nose , foul smell Maggot cause extensive destruction of the nose ,sinuses soft tissue of face
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The fly responsible for maggots The maggot
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Miscellaneous Disorders of Nasal Cavity Treatment: removal by forceps after instillation of oil 4 . Nasal synaechia : Adhesion formation between the nasal septum and turbinates Causes : Nasal surgery Nasal trauma Rhinoscleroma Treatment : Removal of synaechia Placing thin silastic sheet to prevent recurrences
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Miscellaneous Disorders of Nasal Cavity 5. Choanal Atresia: Congenital anomalies due to persistence of bucconasal membrane Bony 90%+++++ Membranous 10% Unilateral : ++++++ may remain undiagnosed until adult life Bilateral :++ complete or incomplete Complete& bilateral ( emergency +++++++( life threatening ) Diagnosis Presence of mucoid discharge in the nose Absence of air bubbles in the nasal discharge Failure to pass catheter from nose to pharynx Putting a few drops of dye ( methylen – blue ) into the nose and seeing it is passage into the pharynx Installing radio opaque dye into the nose and taking lateral film CT
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Miscellaneous Disorders of Nasal Cavity Treatment: Bilateral choanal atresia Emergency opening of the atresia Feeding nipple with a large whole provide a good oral air way ( MC Govern’s< technique) Definitive treatment consist of transnasal or transpalatal approach > 1 ½ y 6. CSF RHINORRHOEA:
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Different between CSF and nasal secretion
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