Blood Supply of Nasal Septum Ant ethmoidal a

Blood Supply of Nasal Septum • • • Ant. ethmoidal a. Post. ethmoidal a. Sphenopalatine a. Greater palatine a. Sup. labial a. Kiesselbach’s plexus (= Little’s area ) Greater palatine a

Nasal bleeding (Epistaxis) • Ex – Local Trauma Nasal sprays Inflammatory reaction malig Anatomic deformities FB Intranasal tumors Chemical inhalants Nasal prong Surgery - Systemic vascular disorder blood dyscrasia hematologic allergies malnutrition alcohol hypertension drugs infectious

Nasal bleeding (Epistaxis) • Tx – General management • • • Sedation Head up position Ice pack apply to the neck BP control Transfusion, fluid (prn) – Local management • Cautery – Do not apply to blood dyscrasia patients • Packing • Arterial ligation • embolization

Nasal bone fracture • Most frequent fracture site in facial bone • Sx – – – Nasal swelling, bruise Ecchymosis Epistaxis Nasal obstruction Pain • Tx – Timing ; within 3 hours after trauma • If not children – 3~7 days adults – 5~10 days

Nasal Septum • Septal cartilage • Perpendicular plate of Ethmoid bone • Vomer • Nasal crest of Palatine bone • Nasal crest of Maxilla

Septoplasty

Type of caudal setal deviation

Correction of caudal septum • Type I ; Scoring on concave side (c septal batten graft) • Type II, Type III ; modified swing door methods • Type IV ; subtotal or total septal reconstruction

Subtotal septal reconstruction

Op procedure • Transcolumellar incision ; inverted V shape • Dorsal hump reduction • Extracorponeal septal reconstruction • Dorsal augmentation with soft Gore-tex • On-lay cap graft • Columellar strut with autologous septal cartilage

Septal perforation • Traumatic causes • – Previous surgery – Cauterization for epistaxis – Nose picking – Nasogastric tube placement – Septal hematoma resulting from any blunt trauma – Battery/foreign body in nose – Chronic nasal cannula use – Turbulent airflow Inflammatory/infectious causes – Sarcoidosis – Wegener granulomatosis – Systemic lupus erythematosus – Tuberculosis – Syphilis – AIDS – Diphtheria – Crohn disease – Dermatomyositis – Rheumatoid arthritis • Neoplastic causes – Carcinoma – T-cell lymphomas – Cryoglobulinemia • Other causes – Inhaled substances (eg, cocaine, topical corticosteroids, longterm oxymetazoline/phenylep hrine use) – Chromic acid fumes – Lime dust exposure – Renal failure

Septal perforation • Signs and symptoms – Nasal discharge (ie, color, smell, consistency of discharge) – Presence of nasal whistling sound – Infection (eg, cellulitis, fever, discharge) – Epistaxis (location of source, ie, right or left, anterior or posterior)

Repair of septal perforation

Nasal vestibular furunculosis • Ex – Nose hair extraction – Nose picking – Nose blowing • pathogen – staphylococcus • Sx – Pain and erythematous swelling • P/Ex

benjamin p 86, fig 2 -13

Nasal vestibular furunculosis • Tx – Dressing and Abts ointment – Analgesics, systemic Abts – If pustule I & D – Do not squeeze and compress • Danger triangle – Both mouth angle ~ glabella – Potential for cavernous sinus thrombophlebitis

Nasal foreign body • Cause unilateral nasal obstruction • Cause unilateral purulent foul smelling discharge

ben 2 -56, 57

Septal hematoma

Septal hematoma