investigations, nasal trauma & epistaxis dr.muaid i.aziz ficms
TRANSCRIPT
Investigations, nasal trauma &
epistaxisDR.MUAID I.AZIZ
FICMS
Investigations of nasal diseases
• History• Examination• Radiology
history cardinal symptoms are• nasal blockage • sneezing • rhinorrhoea • postnasal drip• facial pain • halitosis • snoring & nasal bleeding & disorders of smell the time of onset of symptoms, periodicity, severity, exacerbating
& relieving factors , all should be asked about it. A full medical , drug , family history with past medical & surgical
history should be asked.
examination
• Inspection• Anterior rhinoscopy• Posterior rhinoscopy
OMV
Imaging OMV (waters )
OFV
Lateral view
Lateral view
Ct scan
MRI CT SCAN
Nasal trauma
• Septal haematoma & abscess• Fracture• Epistaxis
SEPTAL HAEMATOMA
In the adult, nasal bones are three times longer than their width. In the child, the length of the nasal bone nearly equals the width .
NASAL FRACTURE
CLASSIFICATION
• Class 1• Low degree force , simplest form is depressed
fracture segments remain in position ,septum generally not involved
• More severe variant ,both nasal bones & septum involved (below 0,5cm from the dorsum)
• Can involve bony septum through perpendicular plate of ethmoid
• In children greenstick type –nasal deformity may develop at puberty.
CLASS 1
IMAGING
CLASSIFICATION
• Class 2• Greater force, with significant cosmetic
deformity• Nasal bones , frontal process of maxilla &
septum are involved, surrounding structure remain intact
• Gross flattening & widening of dorsum• C-Shaped fracture of septum
CLASSIFICATION
• Class 3 • Most severe due to high velocity• Also termed as naso-orbito-ethmoidal
fracture often associated with maxillary fracture
• CSF leak
CLASS 3
epistaxis
• Kiesselbach plexus• Woodruffs plexus
classification Aetiology Clinical• 1ry ( no proven cause )• Secondary ( proven causal factor )• Childhood < 16 y .• Adult >16 y.• Anterior ( bleeding point anterior to piriform apreture )• Posterior ( bleeding point posterior to piriform apreture )
Pattern of presentation
ManagementStop bleedingResusitationNon surgical measuresSurgical measures
thanks
Test
1. The Occipitomental ( waters view ) imaging is specific for sphenoid sinuses .
2. In depressed # ,unilateral nasal bone is affected .
3. Trauma is the most common cause of epistaxis.
4. 1st line in management of epistaxis in casuality ( emergency department ) is admission.