Fracture of nasal bone
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Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thick Lower end: thin PowerPoint PPT Presentation


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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

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Fracture of nasal bone Etiology Traffic accident Physical combat. Sports injury Nasal bone--- Upper end: thick Lower end: thin

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Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Fracture of nasal bone

Etiology

Traffic accident

Physical combat.

Sports injury

Nasal bone---

Upper end: thickLower end: thin


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

  • Reduction of nasal bone

  • Before soft tissue edema

  • 5—7 days after injury

  • Walshan forceps

  • Nasal packing for 2-3d


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

  • Deal with septal hematoma & abscess

  • Septal hemotoma drainage as early as possible.

  • “L” incision on septum.

  • Postoperative nasal packing.

  • Adequate antibiotics.


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Fracture of frontal bone

Pathology:Often combine with fracture of naso-fronto- ethmoido-orbital complex.

Front wall Front & back wall


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Base fracture (frontonasal fracture)

Stringy, sunken and smashed fracture

Symptoms & Signs:

Epistaxis, edema or sunken front.


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Diagnosis:Frontal palpation, X-ray, CT scans

front wall fracture front & back wall fracture

(sunken fracture凹陷型) (smashed fracture 粉碎型)


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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 nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Fracture of ethmoidal bone

Pathology:Often combine with fracture of naso-fronto- ethmoido-orbital complex.

Fracture of naso-fronto- ethmoido-orbital complex


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Symptoms & Signs:

Edema of eyelid or nasal root, increase in the

intercanthal distance.

sunken front ,

vision disorder,

Diagnosis:

X-ray film,

CT scan


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Treatment:

Vision disorder——depression of optic canal

Nosebleed——nasal pack or arterial ligation (ligation of ethmoidal artery)

Cerebrospinal fluid rhinorrhea (CSF) ——surgical reparation


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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)


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Diagnosis:

Clinical manifestation, X-ray, CT scans

Treatment:

Reduction after 7—10d post-wound.

Operation approach: via infraorbit, via

maxillary sinus and external ethmoidectomy


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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—10d post-wound.


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Midface fracture

Le Fort , Le Fort , Le Fort 


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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.


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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:


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Extracranial approach :

nasal external approach

nasal endoscopic surgery


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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%H2O2, antibiotic ointment


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Treatment:

Unmature:antibiotic,physiotherapy

Mature:drainage,D’not crash and press

Ulcerate:drainage,antibiotic

Complications:antibiotics,call ophthalmologist and neurologist for assistance


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Acute & chronic inflammations of the nasal cavities

Acute rhinitis

Etiology:Rhinoviruses, adenoviruses, coronaviruses, influenza & parainfluenza viruses.

Common cord (coryza)

Causes:general factors, local factors


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Differential Diagnosis:

1、Influenza

2、Allergic rhinitis

3、Vasomotor rhinitis

4、Acute infectious disease

Treatment:

General treatment

Local treatment


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

General factors:1、chronic diseases, 2、malnutrition, 3、endocrinic dysfunction, 4、cigarette and alcohol

Pathology: Simple chronic rhinitis——no hyperplasia

Hypertrophic chronic rhinitis——nasal mucosa, submucosa, even periosteum & os: limited or extensive hypertrophy


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

Symptoms & Sign:

Nasal obstruction, rhinorrhea, hypertrophied inferior turbinate

Treatment:

1、Pathogenic treatment

2、Local treatment


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

1) Simple chronic rhinitis: Vasoconstrictor sympsthomimetics, acupuncture

2) Hypertrophic chronic rhinitis: Vasoconstrictor sympsthomimetics, electric coagulation, laser, microwave, radiofrequancy. Partial inferior turbinectomy.


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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);


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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)


Fracture of nasal bone etiology traffic accident physical combat sports injury nasal bone upper end thick lower e

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:vitaminB2、C、E 3、Surgery:


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