Fracture of nasal bone

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Fracture of nasal bone Etiology Traffic
accident Physical combat. Sports injury Nasal
bone--- Upper end thickLower end thin
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Symptoms SignsPain, epistaxis, nasal
deformity or deviation, bruising. DiagnosisX-ray
in lateral view. Septal hematoma?puncture Treat
mentHemostasia, cleaning suturing wound,
restoring alignment
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• Reduction of nasal bone
• Before soft tissue edema
• 57 days after injury
• Walshan forceps
• Nasal packing for 2-3d

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• Deal with septal hematoma abscess
• Septal hemotoma drainage as early as possible.
• L incision on septum.
• Postoperative nasal packing.
• Adequate antibiotics.

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Fracture of frontal bone PathologyOften combine
with fracture of naso-fronto- ethmoido-orbital
complex. Front wall Front
back wall
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Base fracture (frontonasal fracture) Stringy,
sunken and smashed fracture
Symptoms Signs Epistaxis, edema or sunken
front.
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DiagnosisFrontal palpation, X-ray, CT scans
front wall fracture front back
wall fracture (sunken fracture???) (smashed
fracture ???)
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TreatmentAccording 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. PrincipleTo isolate
the communication between frontal sinus and
cranial cavity, to prevent rhinogenic
complications, to keep the frontal part from
deformation.
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Fracture of ethmoidal bone PathologyOften
combine with fracture of naso-fronto-
ethmoido-orbital complex.
Fracture of naso-fronto- ethmoido-orbital complex
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Symptoms Signs Edema of eyelid or nasal root,
increase in the intercanthal distance. sunken
front , vision disorder, Diagnosis X-ray film,
CT scan
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Treatment Vision disorderdepression of optic
canal Nosebleednasal pack or arterial ligation
(ligation of ethmoidal artery) Cerebrospinal
fluid rhinorrhea (CSF) surgical reparation
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Blow-out fracture Symptoms Sign Swelling and
bruising involving all eyelids, lid and
infraorbital emphysema. diplopia,restricted
movement of the eyes vision disorder.
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Diagnosis Clinical manifestation, X-ray, CT
scans Treatment Reduction after 710d
post-wound. Operation approach via infraorbit,
via maxillary sinus and external ethmoidectomy
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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 Reductio
n after 710d post-wound.
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Midface fracture Le Fort ?, Le Fort ?, Le Fort ?
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Cerebrospinal fluid rhinorrhea (CSF) Etiology Tra
umatic 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.
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DiagnosisHistory, 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
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Extracranial approach nasal external
approach nasal endoscopic surgery
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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

Acutethermotherapy or infrared

Chronic3H2O2, antibiotic ointment
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Furuncle of nose Etiology Secondary to chronic
vestibulitis. Diabetics and weaklings will be
subject to the disease. Symptoms
Sign Redness, swelling, heat, and pain
matureulcerate. Serious cases Phlegmon
ComplicationsThrombosis of cavernous sinus and
cranial infection
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Treatment Unmatureantibiotic,physiotherapy Matur
edrainage,Dnot crash and press Ulceratedrainage
,antibiotic Complicationsantibiotics,call
ophthalmologist and neurologist for assistance
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Acute chronic inflammations of the nasal
cavities Acute rhinitis EtiologyRhinoviruses,
adenoviruses, coronaviruses, influenza
parainfluenza viruses. Common cord
(coryza) Causes general factors, local factors
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Symptoms SignSneezing, nasal obstruction,
malaise, fever. Nasal mucosa congestion,
swelling, secretion in meatus. Complications 1?Si
nusitis 2?Acute ototitis media infection pass
through the Eustachian tube to middle ear 3?Acute
pharyngolaryngitis, trachitis bronchitis
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Differential Diagnosis 1?Influenza 2?Allergic
rhinitis 3?Vasomotor rhinitis 4?Acute infectious
disease Treatment General treatment Local
treatment
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Chronic rhinitis Etiology Local
causes1?Acute?chronic, 2?Chronic
diseases of nose sinus,
3?Infective focus around nasal cavity,
4? Iatrogenic misuse nasal
drops Professional and environmental
causesdusts,harmful chemical gas,physical
changes
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General factors1?chronic diseases,
2?malnutrition,

3?endocrinic dysfunction,
4?cigarette and alcohol Pathology

Simple chronic rhinitisno hyperplasia Hypertroph
ic chronic rhinitisnasal mucosa, submucosa,
even periosteum os limited or extensive
hypertrophy
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Symptoms Sign Nasal obstruction, rhinorrhea,
hypertrophied inferior turbinate
Treatment 1?Pathogenic treatment 2?Local
treatment
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1) Simple chronic rhinitis Vasoconstrictor
sympsthomimetics, acupuncture 2) Hypertrophic
chronic rhinitis Vasoconstrictor
sympsthomimetics, electric coagulation, laser,
microwave, radiofrequancy. Partial inferior
turbinectomy.
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Atrophic rhinitis Etiology PrimaryEndocrine
imbalance, functional disorders of autonomic
nerve, infection,(coccobacillus foetidus ozena,
diphtheroid bacilli), poor nutrition, hereditary
factors, autoimmunophathy? Secondary1)Infectionc
hronic inflammation 2)Iatrogenic excessive
surgical destruction of mucosa (empty nose
syndrome)
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3)Irritant 4)Special infection tuberculosis,
syphilis. PathologyEndarteritis 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)
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3) Epistaxis
4) Anosmia
5) Foul or
fetid odor
6) Headache Treatment 1?Local managementnasal
irrigation by worm water, liquid paraffin
2?General managementvitaminB2
?C?E 3?Surgery