Current challenges and achievements of otolaryngology Acute and

Current challenges and achievements of otolaryngology. Acute and chronic diseases of the nose and paranasal sinuses Department of ENT diseases of Tashkent Medical Academy www. tma. uz

ANATOMY OF EXTERNAL NOSE

The nasal septum

Lateral wall of the SASP

Functional areas of the nasal cavit Regio olfactoria olfactory area Regio respiratoria breathing zone

The functions of the nose n n n Respiratory; Protection; Olfactory; Cavity; Neuro-reflex;

Protective functions of the nose n n n Warming and cooling the inhaled air; Detention of micro-and microparticles, enveloping mucous; Neutralization of microbial particles (lysozyme);

Types of smell n n n Anosmatiki - Dolphins; Mikrosmatiki - man; Makrosmatiki - carnivores and rodents;

Types of disorders of smell n n hyposmiya; anosmiya; hyperosmiya; kokosmiya;

Sinuses n n Maxillary; Frontalis; Ethmoidal labyrinth cells; Sphenoidalis;

Anatomy of the paranasal sinuses

Methods of investigation of the nose n n n Rhinoscopy: front, middle and rear; Endomikrorinoskopiya; Rinopnevmometriya; Definition mukotsilliarnogo clearance; olfactometer; Saharinovaya sample;

Methods of investigation of paranasal sinuses n n n n Palpation; R-graphy; Computer magnetic resonance imaging; Thermography; Sonography; Transillumination; Catheterization; Puncture the top jaw and trepanopunktsiya frontal sinus;

Congenital anomaly of nose n n n Double nose; Splitting of the nose; Formation of the nose in one or two of the trunk; Fistulas and cysts of the nose; Malformations of the nasal cavities; Choanal atresia;

Acute and chronic diseases of the nose and paranasal sinuses

Diseases of external nose n n n Furuncle of the nose; Sycosis; Eczema; Erysipelas; Acne rosacea;

Furuncle of the nose Cone-shaped infiltrate covered hyperemic skin on top of which is usually 3 -4 days appears yellowish -white head - the abscess. Inflammation extended to the upper lip, cheek and soft tissue. Local adverse boil over: the development of carbuncle, accompanied by low-grade or febrile temperature, increased sedimentation rate, leukocytosis, increased morbidity and lymph nodes.

Clinical forms of acute cold n n n acute catarrhal rhinitis (rhinitis cataralis acuta); acute catarrhal nasopharyngitis, usually in childhood (rhinitis cataralis neonatorum acuta); acute traumatic rhinitis (rhinitis traumatica acuta);

Stage of acute rhinitis n dry phase of stimulation; n stage serous discharge; n stage of muco-purulent discharge (permit);

Rhinoscopy in the initial stages (1 - 2), acute coryza Hyperemic mucosa, dry, and she gradually swells, and nasal passages are narrowed, breathing is difficult. In the future there abundant mucus

Rhinoscopy in the third stage of acute rhinitis Characterized by the appearance of mucopurulent, first gray, then yellow and greenish discharge, crusts are formed. In the next few days of discharge is reduced, swelling of the mucous membrane disappears.

The principles of treatment of acute rhinitis n n Drug therapy; Antimicrobials; Physiotherapy; Distraction therapy;

The main forms of chronic rhinitis n n n Bluetongue; Hypertrophic; Atrophic;

Rhinoscopy in chronic catarrhal rhinitis Pastoznost and swelling of the mucous membrane, often with cyanotic hue, and slight thickening of her mostly in the lower shell and the front end of the middle shell, while the walls of the nasal cavity is usually covered with mucus

Rhinoscopy in chronic hypertrophic rhinitis The mucosa is usually flushed, full-blooded, slightly cyanotic, or purple-bluish, grayishred, covered with slime. Greatly increased the lower turbinate, which has various forms of structure.

Pharyngorrhinoscopy in chronic hypertrophic rhinitis The rear ends of the lower shell is usually thickened, often compressing the mouth of the pharyngeal eustachian tubes, causing the Eustachian

Rhinoscopy in chronic atrophic rhinitis Marked pallor of the nasal mucosa, atrophic turbinates. There is scant, viscous, mucous or muco-purulent discharge, which usually adheres to the mucosa and dries to form crusts.

Causes of atrophic rhinitis n n n Adverse weather conditions; Occupational hazard; Frequent coryza; Infectious diseases; Surgical intervention in the nose;

Rinoscopy picture at Ozen Brown or yellowgreen, dark crust, which covers the nasal mucosa, and often performs nearly all of its cavity. After removing the crusts nasal cavity is extended, sometimes on the mucous membrane is sticky yellow-green exudate.

Causes of ozeny Klebsiella ozeny (Abel-Levenberg in 80% of cases); n Metabolic disorders; n Iron-deficiency anemia defetsitnaya; n

Rinoscopy symptoms of vasomotor rhinitis Swelling and pallor of the mucous membrane, glaucous (bluish) or white spots on it

The triad of symptoms accompanying vasomotor rhinitis n n n paroxysmal sneezing; gidroreya nose; difficulty of nasal breathing;

Adrenaline test For the differential diagnosis of catarrhal rhinitis from true hypertrophy applied adrenaline test. Reduce swelling of the mucous membrane indicates the absence of true hypertrophy. If the reduction of mucosa expressed little or she is not reduced, it indicates the nature of hypertrophic swelling.

Treatment of various forms of chronic rhinitis n n elimination of possible endo-and exogenous factors that cause a runny nose and support; drug therapy for each form of rhinitis; surgical intervention if indicated; physiotherapy and climatotherapy;

Various forms of distortion of the nasal septum

Types of deviated septum n Physiological; n Abnormal: traumatic, compensatory;

Treatment deviated septum - surgical n n Indications for surgery: Difficulty in nasal breathing; Secondary pathological changes; Cosmetic damage;

Epistaxis Reasons: Local General

Zone Kisselbaha

Criteria for the severity of epistaxis n Slight - in the form of droplets; n Moderate-20 to 200 ml; n Bleeding-from 200 ml or more;

Principles stop minor nosebleeds n n n The introduction of sterile cotton wool moistened with 3% hydrogen peroxide solution; Infiltration of the bleeding area of 1% novocaine solution; Cauterization of bleeding areas lapis, 10 -30% solution of Ag. NO 3, 3% solution of trichloroacetic acid;

Principles of nasal bleeding At moderate - front tamponade; n With strong - back tamponade, ligation of common carotid artery; n Medications - increase blood clotting, blood transfusions, oxygen therapy n

The front nose tamponade Plugging produce orderly laying loops turundy impregnated with an ointment to the bottom of the nose of his entry to the posterior nares.

Stages of the back of the nose tamponade Holding the catheter at the bottom of the nose into the nasopharynx and removal of the distal end through the mouth Fixation pad to the distal end of the catheter

Stages of the back of the nose tamponade Summing up the pad to the choanal and pressing a finger Fixation pad at the front edge of the nose

Clinical forms of sinusitis n n acute; chronic;

Classification of sinusitis n n n Exudative form: Bluetongue, serous, purulent; Productive: wall-hyper-plastic, polypous, cystic; Alternative - holesteotomnaya, caseous, necrotic, atrophic; Mixed forms - purulent polypous, senoznocatarrhal, sero-polopoznaya; Vasomotor and allergic form;

Diagnosis of sinusitis. . . n n n n Complaints and history; Palpation and percussion; rhinoscopy; radiography; Computer-tomography; Puncture of the maxillary sinus; Trepanopunktsiya frontal sinus;

Radiographs of the paranasal sinuses with sinus The decrease in the transparency of the projection of the maxillary sinus

Computer tomography of the paranasal sinuses with sinus

Puncture of the maxillary sinus After preliminary adrenalizatsii and anesthesia of the lower nasal passage, the needle puncture produce 2. 5 cm away from the front edge of the inferior turbinate. The needle is introduced towards the lateral corner of the eye.

Minimally invasive treatments for sinusitis n n n Sinus catheterization; Rinsing the sinuses on Proytsu (displacement method); Sinus-catheter "YAMIK";

Washing on the paranasal sinuses by Proyts After preliminary adrenalizatsii nasal passages, the patient is laid on the couch threw back his head back. In one nostril entered a drug from another - is removed from the liquid contents by means of pathologic surgical suction.

Besunksion way to treat sinusitis Unit Overview "YAMIK catheter" Exhaustion of pathologists-cal content and administration of the drug

X-ray picture of acute sinusitis The decrease in the transparency of the projection of the frontal sinus.

Puncture of frontal sinus Layout for trepanopunction frontal sinus Trepanopunction

Stages of the operation by the method of Caldwell-Luc Mucosal incision under the lip of 3. 4 as a painter. Exposing the canine fossa and sinus is opened with the removal of pathological tissues. Performed with nasal sinus post-Tew bands on the inferior course.

Operation Ritter-Janssen 1 -incision brow with the transition to a side slope of the nose 2 -placental tissue 3 -opened the front wall of the frontal sinus 4 -post of the frontal sinus from the nasal cavity

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