aerodinámica nasal.ppt

8/17/2019 Aerodinámica Nasal.ppt

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APUNTES DEAPUNTES DEAERODINÁMICA NASAL ,AERODINÁMICA NASAL ,

NASAL AERODYNAMICSAUTHOR: SAMUEL J LIN, MD; CHIEF EDITOR: ARLEN D MEYERS, MD, MBA

SeminariosC!ni"a #e Asma $Aer%ia

Fa&or eer no'as a (ie

NEW !

http://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewmailto:[email protected]:[email protected]://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overview


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Nasal physiology is grealy

!epe"!e" o" he physi#al sr$#$reo% he "ose.

La fisiología de la nariz está en

estrecha relación, depende, de la

estructura misma de la nariz.


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External nasal anatomy can est e considered instructural thirds.

The $pper hir! i"#l$!es he paire! "asal &o"es.

The 'i!!le hir! is #o'pose! o% he si%% paire! $pper

laeral #arilages %$se! o he sepal #arilage i" he'i!li"e.

The lo(er hir! o% he "ose #o"siss o% so%er lo(er

laeral #arilages. )ro' a %$"#io"al sa"!poi", he lo(er a"! 'i!!le

hir!s o% he "ose play a" i'pora" role i" he "asal

*al*e.

natomy


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"he external nasal #al#e is defined laterally y the

nasal ala and medially y the septum,

(hereas the internal #al#e is defined &y he aa#h'e"

o% he $pper laeral #arilage o he sep$', (hi#h %or's

a" a"gle o% appro+i'aely 15.-1

"he anterior face of the inferior turinate defines the

lo$er oundary of the internal nasal #al#e.

The e"ra"#e o% he "asal #a*iy #o"siss o% he piri%or'aper$re, (hi#h is !e%i"e! as he %ro"al pro#ess o% he

'a+illary &o"e, %loor o% he "ose, a"! laeral %i&ro%ay

iss$e.


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%hysiologic function of the nose

The "asal physiologi# %$"#io"s, s$#h as (ar'i"g a"!h$'i!i%i#aio", are *ial %or $pper air(ay %$"#io". "

a!$l i"spires $p o a" esi'ae! 10,000 liers o% air

!aily.-1

)ilraio" o% e"*iro"'e"al pari#les o##$rs %irs i" he"asal #a*iy. The larges pari#les are %ilere! &y

*i&rissae. Epielio #iliar #epillo !e li'piea.

Nasal resisa"#e is a" i'pora" %a#or i" #o"si!eri"g

air(ay resisa"#e. &n adults, nasal resistance can

contriute up to half of total air$ay resistance.'() Thro$gh hea e+#ha"ge, he "asal '$#osa 'ai"ai"s

he "asal #a*iy a a ra"ge o% 3137 C.-1


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CONGESTION NASAL TIP…

In a#)'s, nasa resis'an"e "an "on'ri*)'e )( 'o +a o 'o'a air-a$. [1]

Kerr A, ed. Rhin!"#. Scott-Brown’s Otolaryngology . $%h ed. O&'rd( )*%%er+r%h-eine/nn0 12.

Siem(re en )n (a"ien'e "on (ro*emas res(ira'orios *a/os 0asma1,

Con&iene es'im)ar "on Laser , e ()n'o #e a")()n')ra en a &a&)anasa 2

34 Se%)n#os en "a#a osa, re(i'o a manio*ra #es()5s #e*ron"o#ia'a#ores,

6er a'as #e Y) in ian, C. Fo"7s2. A")()n')ra2 ()n'os Nei $in%8ian% , LI34

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MECANISMO CONTRACORRIENTE PARAEN3RIAR O CALENTAR EL AIRE.

One %her# re"/rdin" %he e45ien5# ' he/% e&5h/n"e re!/%e6 % %he!5/%in ' %he 67hen7/!/%ine /r%er#.

The 67hen7/!/%ine /r%er# 5*r6e6 /n%erir!# in %he n/6/! 5/8i%# 8er%he %*r9in/%e6, +here/6 /ir :+6 in / 76%erir dire5%in 'rin" /5*n%er5*rren% e&5h/n"e.[1]

Th*6, %he ; 776in" %in6 5re/%e / re e45ien% he/% e&5h/n"e7r5e66. -+e8er, %hi6 7r5e66 re/in6 i7er'e5%, /nd /6 *5h /61


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*umidification is another important process

of nasal physiology.'() as#$lar '$#osa i"#reases

relai*e h$'i!iy o 95 &e%ore air rea#hes he"asophary"+. hysiologi# "asal %l$i!s a"! #iliary

%$"#io" are *ial o 'ai"ai" i''$"e !e%e"se

hro$gh "or'al '$#o#iliary %lo(. "$'&er o%

"asal "e$ro*as#$lar re%le+es o##$r as (ell. "he nasopulmonary reflex suggests

that pressure on one nasal side$all

causes ipsilateral pulmonary

congestion.'()


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"he nose may ser#e as a contriuting factor in #oice

modification. re*io$s a$hors ha*e "oe! ha "asal

aero!y"a'i#s 'ay ha*e a role i" 'o!i%yi"g high

%re$e"#y so$"!s a"! #o"so"a"s.-1

Nasal aero!y"a'i#s #o"ri&$e o he ol%a#ory syse'.

The a#i*e pro#ess o% s"i%%i"g allo(s e"*iro"'e"al

pari#les o rea#h he ol%a#ory syse', (hi#h is

lo#ae! a he s$ll &ase.Ciliary %lo( is a *ial #o'po"e" o% "or'al si"o"asal

%$"#io". The #iliary sr$#$re i" he "ose is a 2

layere! sr$#$re, pro*i!i"g a" i'pora" !e%e"se

'e#ha"is'. :esi"g o" a pse$!osrai%ie! #iliae! #ell

layer, '$#o#iliary %lo( o##$rs hro$gho$ he "ose a"!

para"asal si"$ses.-2


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Nasal air(ay resisa"#e a##o$"s %or 'ore

ha" 50 o% oal air(ay resisa"#e.-2

The "asal #a*iy has &ee" 'o!ele! as 2

resisors i" parallel.-1, 4

The 3 #o'po"e"s o% "asal resisa"#e are as

%ollo(s;the nasal #estiule,

nasal #al#e

and nasal ca#um.'+)

Nasal esistance


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Ca$ses o% i"#rease! "asal resisa"#e

i"#l$!e i"%e#i*e rhi"iis, allergic rhinitis,

*aso'oor rhi"iis, hyper*e"ilaio", s$pi"e

pos$re, al#ohol, aspiri", a"! #ol! air.-6

&n #asomotor rhinitis, #agal o#eracti#ity

causes increased resistance.

Nasal resisa"#e i"#reases 'are!ly i" he%irs 23 #' o% he "asal air(ay.-1

http://emedicine.medscape.com/article/834281-overviewhttp://emedicine.medscape.com/article/834281-overview


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The "asal *esi&$le is he %irs #o'po"e" o% "asal resisa"#e. The

"asal *esi&$le is #o'pose! o% #o'plia" (alls ha are lia&le o

#ollapse %ro' he "egai*e press$res ge"erae! !$ri"g i"spiraio".-1

The *esi&$le has &ee" er'e! he e+er"al "asal *al*e.

=$!ies ha*e sho(" 30 L/'i" is he li'ii"g %lo(

!$ri"g i"spiraio" a (hi#h "asal air(ay #ollapseo##$rs i" his area.-1

The "asal *esi&$le is pri'arily s$ppore! &y alar

#arilage a"! '$s#$lo%i&ro$s aa#h'e"s.

>espie he e"!e"#y, air(ay #ollapse is pre*e"e! &y

a#i*aio" o% he !ilaor "aris '$s#les !$ri"gi"spiraio". >$ri"g e+piraio", posii*e press$re is he

!ri*i"g %or#e %or "asal *esi&$le !ilaio".


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maor area of resistance occurs at the anterior tip of the

inferior turinate at the entrance to the piriform aperture.

"his important area is called the internal nasal #al#e.

The "asal *al*e represe"s he "arro(es seg'e" o% heair(ay.-1 ?" oal, he *al*e area i"#l$!es he !isal e"! o%

he $pper laeral #arilage, he hea! o% he i"%erior

$r&i"ae, he #a$!al sep$', he %loor o% he "ose, he

%ro"al pro#ess o% he 'a+illa, he laeral %i&ro%ay iss$e,a"! he piri%or' aper$re.-4 The "asal *al*e area is

#o"si!ere! as a regio" raher ha" a" o&li$e #ross

se#io"al area o% he "asal passage(ay.

&n (/01, *aight and 2ole demonstrated that the

anterior end of the inferior turinate could ad#ance

as much as 3 mm $ith the administration of

histamine.'4)


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The Cottle's test

' @ :hi"ol. 2007 @$l$gA214;4569.

Effects of the 2ottle5s maneu#er on the nasal #al#e as

assessed y acoustic rhinometry.

Tia"o @1

, irilB T.

https://www.youtube.com/watch?v=ZfFxUBZBW1ohttps://www.youtube.com/watch?v=ZfFxUBZBW1o


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The "asal #a*$' is lo#ae! poserior o he piri%or'

aper$re. ?s o*erall #o"ri&$io" o oal air(ay

resisa"#e is s'all. The #o'po"e" o% "asal #a*$'

resisa"#e is !eer'i"e! &y !egree o% *as#$lar

e"gorge'e" o% iss$es. #o$si# rhi"o'ery

!e'o"sraes ha he ip o% he i"%erior $r&i"ae

"arro(s he air(ay i''e!iaely poserior o he"asal *al*e. The $r&i"ae! regio"s o% he "asal

passage ha*e relai*ely large #rossse#io"al areas.-1


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E*al$aio" o% "asal o&sr$#io" 'ay #o"sis o% a

physi#al e+a'i"aio", rhi"os#opy (ih a!e$ae

ligh a"! a "asal spe#$l$', #he'i#al a"alysis,

i'agi"g s$!ies, a"! rhi"o'a"o'ery.

Che'i#al a"alysis 'ay i"#l$!e "e$rophil #o$"s relai"g

o he prese"#e o% i"%e#io", eosi"ophil #o$"s i" allergi#

#o"!iio"s, a"! 'as #ell #o$"s i" %oo! allergy.

?'agi"g s$!ies i"#l$!e CT s#a"s a"! M:?.

:hi"o'a"o'eri# e#h"i$es i"#l$!e passi*e,

a#i*e, a"! a#o$si# 'eho!s.

Cli"i#al E*al$aio" o% he Nose


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RINOMANOMETRIA ANTERIOR

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RINOMANOMETRIA POSTNASAL

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CAUSAS DE O)STRUCCION NASAL

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RINOMANOMETRIA POSTERIOR

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&sr$#io"


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Se7%/! de8i/%in

T*r9in/%eh#7er%r7h#

Rhin7!/6%#

Se7%/!7er'r/%in

>/!8*!/r 5!!/76e

Ch/n/! /%re6i/Neo(asm

9o$(osis

Aer%i" r+ini'isSe('a +ema'oma

Se('a (erora'ion

R+ini'is

me#i"amen'osa6asomo'or r+ini'is

Sin)si'is

CAUSAS DE O)STRUCCION NASAL

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:D?NL=T N> N=L E:>NM?C=

4 #e os (a"ien'es 'ienen o*s'r)""i


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RAMAS O3TÁLMICA ? MA@ILARES, >1,>;

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T+e'ri%emina

ner&einner&a'e

s '+e(os'erior

nasa"a&i'$ 'o

#e'e"'no>io)ss'im)i.


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)I)LIOGRA3A

A'as Ne''er III e#i"i


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Fa&or eer no'as

a (ie #e(%ina2..

9rima "+ara

22 …..

…..

….. @ra"ias

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ANATOMA ? 3ISIOLOGA


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)I)LIOGRA3A EMEDECINE

Nasa 9+$sioo%$ A)'+or: Sanor# M Ar"+er, MD; C+ieE#i'or: Aren D Me$ers, MD, MBA more...

Oa"'or$ S$s'em Ana'om$ A)'+or: Amir 6o7s+oor, MD;C+ie E#i'or: Aren D Me$ers, MD, MBA more...

Nasa Aero#$nami"s A)'+or: Sam)e J Lin, MD; C+ie E#i'or:Aren D Me$ers, MD, MBA more...

Nasa Re"ons'r)"'ion A)'+or: Ai Sa//a#ian, MD, FACS; C+ieE#i'or: Aren D Me$ers, MD, MBA more...

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@ra"ias (or a o(or')ni#a#

Des#e a C!ni"a #e Asma $ Aer%ia

Mana%)a , Ni"ara%)a.

Lmenos:

33, 3GG? M, ?GGC

Dr. J)an Herrera Saa=ar2

Fa&or &er a II 9ar'e2

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