nose 11 asu

The Nose

Nasal Septum

Paranasal Sinus Anatomy

Paranasal Sinus Anatomy

Paranasal Sinus Anatomy

Paranasal Sinus Anatomy

Adenoids

Deviated Nasal Septum(Caudal Dislocation)

Investigations:• CT scan PNS to see

if there is sinusitis• Acoustic

rhinometry

Deviated Nasal Septum(Caudal Dislocation)

Treatment: Septoplasty Operation

Deviated Nasal septum

Deviated Nasal septum

Deviated Nasal septum

Fracture Nasal Bones

Investigation:

Plain X-ray nasal bones

Fracture Nasal Bone

Treatment:• If presenting early:

– If there is no edema: Immediate reduction by Walsham’s forceps under G.A.

– If there is edema: anti-edema measures till edema subsides then reduction

• If presenting late: (more than 3 weeks): Rhinoplasty operation

Fracture Nasal Bone

Nasal Polyp

Investigations:1. CT scan PNS2. Biopsy3. Tests for

allergy e.g. skin sensitivity test or serum Ig E

Nasal Polyp

Treatment: Excision via Functional Endoscopic Sinus surgery (FESS)

Nasal Polyp

Nasal Polyp

Nasal Polyps

Nasal Polyp

Antro-Choanal Polyp

Investigations: CT scan PNS & Biopsy

Treatment: Endoscopic Excision or Radical antrostomy operation “if recurrent”.

Septal perforation

Investigations:• CT scan PNS • Investigations to diagnose

the cause e.g. for Syphilis TPI, FTA or Tuberclin test for TB

Treatment:• Alkaline nasal wash for

removal of the Crusts.• Oily drops to moisture the

nose for dryness • Closure by Silastic Septal

button.• Closure by mucosal flaps.

Septal Button

Use: To close Septal perforation

Orbital complication of sinusitis

Investigations:• CT scan PNS &

orbit• Eye assessment• C&S of

discharge Treatment:External or

endoscopic Drainage of the affected sinus

Orbital complication of sinusitis

Orbital complication of sinusitis

Orbital complication of sinusitis

Maxillary Sinus Tumour

Investigations:• CT scan PNS• Biopsy for histopathology

Treatment:•Excision (Maxillectomy)•Radio &/or Chemotherapy

RhinoscleromaInvestigations:1. Biopsy for

histopathology2. Swab for C&S for

bacillus of Frish.

Treatment:In granulomatous stage: Antibiotics as

Rifampicine or Quinolones

In stage of fibrosis: Recanalization of nose by laser or scalpel

Oro-antral FistulaInvestigations:1. CT scan PNS2. C&S for discharge

if infected

Treatment:• Presenting early:

1. Conservative2. 1ry sutures

• Presenting late: 1. Radical antrostomy2. Closure by palatal or

buccal flap

Rigid Nasal Endoscope(Sinoscope)

USES: – Nasal examination– Endoscopic sinus surgery ESS

Flexible Fibro-optic NasoPharyngoLaryngosco

pe

USES: To examine:• Nasal cavity• Pharynx • Larynx

Nasal dressing forceps

Uses:– To do anterior nasal pack – Remove F.B. or crusts from the nose– Apply packs soaked with local anaesthesia in nose

Nasal dressing forceps

Nasal speculum

• Uses:1. Anterior rhinoscopy2. Used during nasal surgery

Nasal speculum

Posterior rhinoscopy mirror

Use:Posterior rhinoscopy

to examine: 1. The

nasopharynx 2. Posterior part of

the septum & nose

Nasal packs Anterior nasal pack Anterior & posterior

nasal pack

Anterior and Posterior nasal pack

Uses:Nasal packing in:

– Epistaxis– Post operative

Epistaxis Balloon (Nasal Tampons)

For anterior & posterior nasal packing

•Uses: Nasal packing in:• Epistaxis• Post operative after nasal

surgery

Epistaxis Balloon (Nasal Tampons)

For anterior nasal packing

The Larynx

Laryngeal Anatomy

Indirect Laryngoscopy

Laryngeal Mirror

Uses: Indirect laryngoscopy to:

1. Asses vocal folds mobility

2. Diagnose laryngeal & hypopharyngeal lesions

Laryngeal Telescope

Uses: To examine:1. Larynx2. hypopharynx

Normal Larynx

Vocal Fold Polyp

Treatment:Excision via micro-

laryngeal surgery “MLS”

Vocal Fold Polyp

Vocal Fold Polyp

Vocal Fold Polyp

Vocal Fold Polyp

Vocal Fold Nodules

Treatment:• Voice therapy• If failed

Removal by laser or MLS

Vocal Fold Nodules

Vocal Fold Nodules

Vocal Fold Nodules

Vocal Fold Nodules

Vocal Fold Cyst

Treatment: Excision by MLS

Vocal Fold Cyst

Vocal Fold Cyst

Vocal Fold Cyst

Vocal Fold Cyst

Reinke’s Oedema

Treatment:• Voice therapy and

stopping of smoking “in early cases “

• Excision via MLS “in advanced cases”

Reinke’s Oedema

Leucoplakia of the Vocal Folds

• Investigations:1. DL & biopsy2. Stroboscopy

Treatment:1. Excision via MLS

(stripping of the VF) &Histopathology

2. Constant follow up

Cancer LarynxInvestigations:1. CT scan neck2. DL & biopsy

Treatment:According to stage:

Partial or total laryngectomy &/or Radiotherapy

Cancer Larynx

Cancer Larynx

Cancer Larynx

Cancer Larynx

Cancer Larynx

Cancer Larynx

Acute EpiglottitisInvestigationsPlain X-ray lateral view

neck “swollen epiglottis”

Treatment:• Ensure patent air way:

– Corticosteroids– If severe stridor do

endotracheal tube or tracheostomy

• Antibiotics against H. influenza

Laryngeal Papilloma

Treatment: Excision by MLS, better with LASER

Laryngeal Papilloma

Right Vocal Fold Paralysis

Investigations:• CT scan neck from

base of skull down to upper chest.!!

• Laryngeal photography & Stroboscopy

Laryngeal Web

Investigations:• DL• Laryngeal

photography Treatment:• Excision by LASER

through MLS

Laryngeal Web

Laryngeal Web

LaryngomalaciaInvestigation:• DL• Laryngeal

photography Treatment:• Conservative

(prone position)• Rarely

tracheostomy in cases of severe stridor

Laryngomalacia

The Pharynx

Tongue Depressor

Uses:– Examine the oral cavity and the oropharynx – The metallic is used in Cold mirror test

Acute Follicular Tonsillitis

Investigations:– Tonsillar swab for C&S – C.B.C.

Acute Follicular Tonsillitis

• Treatment:– Rest, antipyretics & analgesics– Broad spectrum Antibiotic (e.g.amoxicillin +

clavulinic acid) for 10 days

Acute Follicular Tonsillitis

Acute Follicular Tonsillitis

Acute Follicular Tonsillitis

Acute Follicular Tonsillitis

Chronic TonsillitisInvetstigations:• Pre-operative

investigations (POI ) e.g. CBC, PT,PTT, BT.

• ESR Treatment:• Tonsillectomy

Chronic Tonsillitis(Kissing Tonsils)

Chronic Tonsillitis(Kissing Tonsils)

Oral Moniliasis Investigations:• Swab for fungal

culture• Investigations for the

cause e.g. CBC, Blood sugar

Treatment:• Stop the antibiotics,

good diet and vitamins.

• Local antifungal (nystatin or Daktarin)

• Systemic antifungal in severe cases

Post-Tonsillectomy Membrane

Post-Tonsillectomy Membrane

Peritonsiller Abscess(Quinsy)

Peritonsiller Abscess(Quinsy)

Investigation:• C&S for the pus

during drainageTreatment:• Antibiotics• Incision and

drainage with Quinsy knife or guarded scalpel

• Tonsillectomy later on (after 4 - 6 weeks)

Peritonsiller Abscess(Quinsy)

Peritonsiller Abscess(Quinsy)

Aphthous Ulcer

Treatment: 1. Analgesics 2. Analgesic, antiseptic paints

Aphthous Ulcer

Aphthous Ulcer

Herpes Simplex

Treatment: 1. Acyclovir systemically and locally. 2. Local analgesics& antiseptic paints.

Ludwig's Angina

Treatment:1. Antibiotics2. Incision and

drainage through submental incision

3. If respiratory obstruction: do tracheostomy

4. Control source of infection (carious tooth)

Ludwig's Angina

Direct LaryngoscopeUses:Direct Laryngoscopy:

– Diagnostic for laryngeal & hypopharyngeal lesions

– Biopsy

Laryngeal surgery:– MicroLaryngeal

surgery (MLS) or LASER surgery

Direct Laryngoscope

Direct Laryngoscope

Direct Laryngoscope

Flexible Fibro-optic NasoPharyngoLaryngoscope

Flexible Fibro-optic NasoPharyngoLaryngoscope

Tracheostomy Tube

Uses:• Bypass upper

airway obstruction:– Cancer larynx– Bilateral VF

paralysis

• Allows easy bronchial suction e.g. comatosed patient