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

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

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

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

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

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

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

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.

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

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

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

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 )

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

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.

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

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.

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 ：

Extracranial approach ： nasal external approach nasal endoscopic surgery

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

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

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

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

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

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

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

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

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

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

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);

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)

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 ：