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Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone---

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

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Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone---

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  1. Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thickLower 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. Diagnosis:Frontal palpation, X-ray, CT scans front wall fracture front & back wall fracture (sunken fracture凹陷型) (smashed fracture 粉碎型)

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

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

  14. 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.

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

  16. 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.

  17. 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:

  18. Extracranial approach : nasal external approach nasal endoscopic surgery

  19. 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

  20. 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

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

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

  23. 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

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

  25. 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

  26. 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

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

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

  29. 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);

  30. 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)

  31. 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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