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Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thick Lower end: thin.

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Presentation on theme: "Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thick Lower end: thin."— Presentation transcript:

1 Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thick Lower end: thin

2 Symptoms & Signs : Pain, epistaxis, nasal deformity or deviation, bruising. Diagnosis : X-ray in lateral view. Septal hematoma?——puncture Treatment : Hemostasia, cleaning & suturing wound, restoring alignment

3 Reduction of nasal bone Before soft tissue edema 5—7 days after injury Walshan forceps Nasal packing for 2-3d

4 Deal with septal hematoma & abscess Septal hemotoma drainage as early as possible. “L” incision on septum. Postoperative nasal packing. Adequate antibiotics.

5 Fracture of frontal bone Pathology : Often combine with fracture of naso-fronto- ethmoido-orbital complex. Front wall Front & back wall

6 Base fracture (frontonasal fracture) Stringy, sunken and smashed fracture Symptoms & Signs : Epistaxis, edema or sunken front.

7 front wall fracture front & back wall fracture (sunken fracture 凹陷型 ) (smashed fracture 粉碎型 ) Diagnosis : Frontal palpation, X-ray, CT scans

8 Treatment : According to the situation: 1 、 stringy fracture 2 、 sunken fracture 3 、 smashed fracture 4 、 front & back wall fracture 5 、 base fracture (frontonasal fracture): restore the function of frontal sinus. Principle : To isolate the communication between frontal sinus and cranial cavity, to prevent rhinogenic complications, to keep the frontal part from deformation.

9 Fracture of naso-fronto- ethmoido-orbital complex Fracture of ethmoidal bone Pathology : Often combine with fracture of naso-fronto- ethmoido-orbital complex.

10 Symptoms & Signs : Edema of eyelid or nasal root, increase in the intercanthal distance. sunken front , vision disorder, Diagnosis : X-ray film, CT scan

11 Treatment : Vision disorder——depression of optic canal Nosebleed——nasal pack or arterial ligation (ligation of ethmoidal artery) Cerebrospinal fluid rhinorrhea (CSF) —— surgical reparation

12 Blow-out fracture Symptoms & Sign : Swelling and bruising involving all eyelids, lid and infraorbital emphysema. diplopia , restricted movement of the eyes ; vision disorder. 击出性骨折 ( 眶底暴折 )

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14 Diagnosis : Clinical manifestation, X-ray, CT scans Treatment : Reduction after 7—10d post-wound. Operation approach: via infraorbit, via maxillary sinus and external ethmoidectomy

15 Blow-in fracture Relatively rare. Symptoms & Sign : Protruding eye, swelling eyelids and zygoma, Palpation: infraorbital edge---“stairs-like”. Diagnosis : Clinical manifestation, X-ray, CT scans Treatment : Reduction after 7—10d post-wound.

16 Midface fracture Le Fort , Le Fort , Le Fort 

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18 Cerebrospinal fluid rhinorrhea (CSF) Etiology : Traumatic: Iatrogenic, and external trauma. Intracranial or extracranial surgery. Cribriform plate, sphinoid, frontoethmoidal complex. Nontraumatic : Spontaneous (or primary), direct erosion or increased intracranial pressure (tumors, congenital or acquired hydrocephalus, or infections.

19 Diagnosis : History, laboratory test, endoscopic examination, ascertain the nature, fix the precise location Treatment : 1 、 Conservative treatment : To prevent from infection, to prevent from high cranial pressure 2 、 Surgery : Intracranial approach :

20 Extracranial approach : nasal external approach nasal endoscopic surgery

21 Vestibulitis of nose Etiology : Irritation of rhinorrhea and dust ; secondary to skin infection Symptoms & Sign : Red, swelling and ulcerative skin , crusting inside the vestbule, tenderness of the nasal tip or alae. Treatment : Acute——thermotherapy or infrared Chronic——3%H2O2, antibiotic ointment

22 Furuncle of nose Etiology : Secondary to chronic vestibulitis. Diabetics and weaklings will be subject to the disease. Symptoms & Sign : Redness, swelling, heat, and pain ; mature—ulcerate. Serious cases: Phlegmon Complications : Thrombosis of cavernous sinus and cranial infection

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24 Treatment : Unmature : antibiotic , physiotherapy Mature : drainage , D’not crash and press Ulcerate : drainage , antibiotic Complications : antibiotics , call ophthalmologist and neurologist for assistance

25 Acute & chronic inflammations of the nasal cavities Acute rhinitis Etiology : Rhinoviruses, adenoviruses, coronaviruses, influenza & parainfluenza viruses. Common cord (coryza) Causes: general factors, local factors

26 Symptoms & Sign : Sneezing, nasal obstruction, malaise, fever. Nasal mucosa congestion, swelling, secretion in meatus. Complications : 1 、 Sinusitis 2 、 Acute ototitis media infection pass through the Eustachian tube to middle ear 3 、 Acute pharyngolaryngitis, trachitis & bronchitis

27 Differential Diagnosis : 1 、 Influenza 2 、 Allergic rhinitis 3 、 Vasomotor rhinitis 4 、 Acute infectious disease Treatment : General treatment Local treatment

28 Chronic rhinitis Etiology : Local causes : 1 、 Acute—→chronic , 2 、 Chronic diseases of nose & sinus , 3 、 Infective focus around nasal cavity , 4 、 Iatrogenic: misuse nasal drops Professional and environmental causes : dusts , harmful chemical gas , physical changes

29 General factors : 1 、 chronic diseases , 2 、 malnutrition , 3 、 endocrinic dysfunction , 4 、 cigarette and alcohol Pathology : Simple chronic rhinitis——no hyperplasia Hypertrophic chronic rhinitis——nasal mucosa, submucosa, even periosteum & os: limited or extensive hypertrophy

30 Symptoms & Sign : Nasal obstruction, rhinorrhea, hypertrophied inferior turbinate Treatment : 1 、 Pathogenic treatment 2 、 Local treatment

31 1) Simple chronic rhinitis : Vasoconstrictor sympsthomimetics, acupuncture 2) Hypertrophic chronic rhinitis : Vasoconstrictor sympsthomimetics, electric coagulation, laser, microwave, radiofrequancy. Partial inferior turbinectomy.

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33 Atrophic rhinitis Etiology : Primary : Endocrine imbalance, functional disorders of autonomic nerve, infection, ( coccobacillus foetidus ozena, diphtheroid bacilli ), poor nutrition, hereditary factors, autoimmunophathy ? Secondary : 1)Infection:chronic inflammation; 2)Iatrogenic: excessive surgical destruction of mucosa (empty nose syndrome);

34 3)Irritant: 4)Special infection: tuberculosis, syphilis. Pathology : Endarteritis and periarteritis of terminal arterioles, metaplasia of the epithelium, atrophy of the mucosa, glands, periosteum. Symptoms & Sign : 1)Nose, nasopharynx is dry 2)Nasal obstruction (detached crusts)

35 3) Epistaxis 4) Anosmia 5) Foul or fetid odor 6) Headache Treatment : 1 、 Local management : nasal irrigation by worm water, liquid paraffin 2 、 General management : vitaminB2 、 C 、 E 3 、 Surgery :


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