nose 11 asu
TRANSCRIPT
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