Fracture of nasal bone Etiology Traffic accident Physical
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 Treatment：Hemostasia, cleaning & suturing wound, restoring alignment
Reduction of nasal bone • Before soft tissue edema • 5— 7 days after injury • Walshan forceps • Nasal packing for 2 -3 d
Deal with septal hematoma & abscess • Septal hemotoma drainage as early as possible. • “L” incision on septum. • Postoperative nasal packing. • Adequate antibiotics.
Fracture of frontal bone Pathology：Often combine with fracture of naso-fronto- ethmoido-orbital complex. Front wall Front & back wall
Base fracture (frontonasal fracture) Stringy, sunken and smashed fracture Symptoms & Signs： Epistaxis, edema or sunken front.
Diagnosis：Frontal palpation, X-ray, CT scans front wall fracture (sunken fracture凹陷型) front & back wall fracture (smashed fracture 粉碎型)
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.
Fracture of ethmoidal bone Pathology：Often combine with fracture of naso-fronto- ethmoido-orbital complex. Fracture of naso-fronto- ethmoido-orbital complex
Symptoms & Signs： Edema of eyelid or nasal root, increase in the intercanthal distance. sunken front ， vision disorder, Diagnosis： X-ray film, CT scan
Treatment： Vision disorder——depression of optic canal Nosebleed——nasal pack or arterial ligation (ligation of ethmoidal artery) Cerebrospinal fluid rhinorrhea (CSF) —— surgical reparation
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)
Diagnosis： Clinical manifestation, X-ray, CT scans Treatment： Reduction after 7— 10 d post-wound. Operation approach: via infraorbit, via maxillary sinus and external ethmoidectomy
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— 10 d post-wound.
Midface fracture Le Fort , Le Fort
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.
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 ：
Extracranial approach ： nasal external approach nasal endoscopic surgery
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%H 2 O 2, antibiotic ointment
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
Treatment： Unmature：antibiotic，physiotherapy Mature：drainage，D’not crash and press Ulcerate：drainage，antibiotic Complications：antibiotics，call ophthalmologist and neurologist for assistance
Acute & chronic inflammations of the nasal cavities Acute rhinitis Etiology：Rhinoviruses, adenoviruses, coronaviruses, influenza & parainfluenza viruses. Common cord (coryza) Causes: general factors, local factors
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
Differential Diagnosis： 1、Influenza 2、Allergic rhinitis 3、Vasomotor rhinitis 4、Acute infectious disease Treatment： General treatment Local treatment
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
General factors： 1、chronic diseases， 2、malnutrition， 3、endocrinic dysfunction， 、cigarette and alcohol Pathology： Simple chronic rhinitis——no hyperplasia Hypertrophic chronic rhinitis——nasal mucosa, submucosa, even periosteum & os: limited or extensive hypertrophy 4
Symptoms & Sign： Nasal obstruction, rhinorrhea, hypertrophied inferior turbinate Treatment： 1、Pathogenic treatment 2、Local treatment
1) Simple chronic rhinitis： Vasoconstrictor sympsthomimetics, acupuncture 2) Hypertrophic chronic rhinitis： Vasoconstrictor sympsthomimetics, electric coagulation, laser, microwave, radiofrequancy. Partial inferior turbinectomy.
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);
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)
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：vitamin. B 2、C、E 3 、Surgery：
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