Investigations, nasal trauma & epistaxis DR.MUAID I.AZIZ FICMS

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.