rhinology

Document Sample
rhinology Powered By Docstoc
					           Rhinology

Teaching Topics for Mary’s Medics
          Steve Lewis
             2003/4

        St Mary’s Hospital ENT Department
           Founded by Joseph Toynbee in 1851
                    Physiology


•   Filtration                  (hairs/mucus/cilia)
•   Warming                     (30C)
•   Humidification
•   Olfaction
•   Vocal resonance




               St Mary’s Hospital ENT Department
                  Founded by Joseph Toynbee in 1851
               Anatomy (outside)


• Bony upper 1/3
• Cartilage lower 2/3
     • Alar
     • L Lat
     • U Lat




                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
               Anatomy (cavity)


• Septum
• Turbinates (x3)
• Ciliated epithelium

• Sinus drainage to around middle turbinate




               St Mary’s Hospital ENT Department
                  Founded by Joseph Toynbee in 1851
Use of the bony septum!




   St Mary’s Hospital ENT Department
      Founded by Joseph Toynbee in 1851
                Anatomy (sinuses)

• Anterior drain to middle meatus
  – Frontal
  – Maxillary
  – Ant Eth
• Posterior drain superior
  meatus/sphenoethmoidal recess
  – Post Eth
  – Sphenoidal


                 St Mary’s Hospital ENT Department
                    Founded by Joseph Toynbee in 1851
Anatomy (sinuses)




 St Mary’s Hospital ENT Department
    Founded by Joseph Toynbee in 1851
Anatomy (sinuses)




 St Mary’s Hospital ENT Department
    Founded by Joseph Toynbee in 1851
Anatomy (sinuses)




St Mary’s Hospital ENT Department
   Founded by Joseph Toynbee in 1851
Anatomy (sinuses)




 St Mary’s Hospital ENT Department
    Founded by Joseph Toynbee in 1851
                 Blood Supply

• Very extensive anastamoses
• Int Carotid & Ext Carotid branches

• Ethmoidal arteries above MT
• Sphenopalatine/Palatine/Labial below MT

• Little’s Area
• Kiesselbach’s plexus

               St Mary’s Hospital ENT Department
                  Founded by Joseph Toynbee in 1851
                  Examination



• Point to yourself!

• Rigid scope (0/30/90)
• Flexi ‘scope




               St Mary’s Hospital ENT Department
                  Founded by Joseph Toynbee in 1851
                       Epistaxis
• ABC
  –   Hx Ex Ix as you go
  –   Basic first aid
  –   Bloods (FBC/G&S/INR/U)
  –   Fluids

  – Consider co-morbidity in the elderly




                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
                     Epistaxis
• Beavis and Butthead




              St Mary’s Hospital ENT Department
                 Founded by Joseph Toynbee in 1851
                       Epistaxis

• Find the bleeder and cauterise it
• Pack the nose
  – merocel uni/bi lateral
  – BIPP
  – Foley catheter and BIPP
• Cautery or packing under GA
• Ligation of feeding vessels (EC if necessary)

• Antibiotics if pack staying >24hrs
• Naseptin when settled
                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
                         Trauma

• # Nasal bones (not urgent)
  – see in 1/52
  – MUA in 2/52
  – Rhinoplasty >3/52


• Septal haematoma (URGENT)
  – prompt drainage
  – poor cosmetic result possible



                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
                    Obstruction

•   Congenital/Acquired
•   Deviated septum
•   Rhinitis
•   Polyps
•   Foreign body
•   Neoplasia



                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
 Rhinitic Mucosa




St Mary’s Hospital ENT Department
   Founded by Joseph Toynbee in 1851
                              Rhinitis
• Allergic (10-20% people)
   –   Obstruction                                   Type I hypersensitivity
   –   Vasodilatation                                IgE & Mast Cells
   –   Oedema
   –   sneezing
• Discover and avoid allergen
• Prevent swelling/oedema
• Stabilise mast cells

   – MEDICAL problem with treatment, not cure
                   St Mary’s Hospital ENT Department
                        Founded by Joseph Toynbee in 1851
                              Rhinitis

• Intrinsic (10-15% population)
   –   Obstruction
   –   Vasodilatation
   –   Oedema
   –   sneezing
• Imbalance of ANS supply to mucosa
• PNS overrides SNS
• watery rhinorrhoea


                   St Mary’s Hospital ENT Department
                        Founded by Joseph Toynbee in 1851
                         Rhinitis

• Medicamentosa

• OTC decongestants are usually designed for
  short term use
• Like heroin
• Very difficult vicious circle to break free from




                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
                             Polyps

• Inflammatory origin most common
    – neoplastic
    – CF
    – idiopathic
•   Aspirin/Asthma/Obstruction
•   Hx Ex Ix
•   Steroids/Surgery
•   Recurrence


                   St Mary’s Hospital ENT Department
                      Founded by Joseph Toynbee in 1851
          Polyps




St Mary’s Hospital ENT Department
   Founded by Joseph Toynbee in 1851
                  Acute Sinusitis

• Inflammation of the MM lining the paranasal sinuses
• May be in conjunction with CAUSATIVE FACTOR
• Medical Rx resolves most:
   –   Analgesia
   –   Decongestants
   –   Steam
   –   Antibiotics
• Surgical Rx includes sinus washout


                 St Mary’s Hospital ENT Department
                    Founded by Joseph Toynbee in 1851
               Chronic Sinusitis


• Retained secretions
  – blocked nose
  – frequent acute episodes
  – sinofacial pain
• Take careful pain history before diagnosis
• Visualise drainage system by CT
• FESS


                St Mary’s Hospital ENT Department
                   Founded by Joseph Toynbee in 1851
           Nasopharyngeal Carcinoma

• High incidence in those of Eastern origin
   – Hong Kong boat people (male)
• Associated with:
   – Dried, salted, smoked fish
   – EBV
   – Genetic
• Radiotherapy
• Little place for surgery (not curative)


                 St Mary’s Hospital ENT Department
                    Founded by Joseph Toynbee in 1851
             Foreign Bodies


• Pictures of FBs




             St Mary’s Hospital ENT Department
                Founded by Joseph Toynbee in 1851
                   Cosmetics


• Pictures of septorhinoplasty
• Pictures of facial proportions
• Grades of uglyness




              St Mary’s Hospital ENT Department
                 Founded by Joseph Toynbee in 1851
   The End




St Mary’s Hospital ENT Department
   Founded by Joseph Toynbee in 1851

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:5/17/2012
language:
pages:29
fanzhongqing fanzhongqing http://
About