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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: thickLower 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




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 front & back wall fracture

(sunken fracture凹陷型) (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—10d 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—10d post-wound.


Midface fracture

Le Fort , 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%H2O2, 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, 4、cigarette and alcohol

Pathology: Simple chronic rhinitis——no hyperplasia

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


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:vitaminB2、C、E 3、Surgery:


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