Upload
juan-herrera-salazar
View
216
Download
0
Embed Size (px)
Citation preview
8/17/2019 Aerodinámica Nasal.ppt
1/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 1
APUNTES DEAPUNTES DEAERODINÁMICA NASAL ,AERODINÁMICA NASAL ,
NASAL AERODYNAMICSAUTHOR: SAMUEL J LIN, MD; CHIEF EDITOR: ARLEN D MEYERS, MD, MBA
SeminariosC!ni"a #e Asma $Aer%ia
Fa&or eer no'as a (ie
NEW !
http://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewmailto:[email protected]:[email protected]://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overview
8/17/2019 Aerodinámica Nasal.ppt
2/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 2
8/17/2019 Aerodinámica Nasal.ppt
3/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 3
Nasal physiology is grealy
!epe"!e" o" he physi#al sr$#$reo% he "ose.
La fisiología de la nariz está en
estrecha relación, depende, de la
estructura misma de la nariz.
8/17/2019 Aerodinámica Nasal.ppt
4/52
3 0 / 0 4 / 1
6TEL. 22781169, 88825513 M, 84316459 C 4
8/17/2019 Aerodinámica Nasal.ppt
5/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 5
8/17/2019 Aerodinámica Nasal.ppt
6/52
3 0 / 0 4 / 1
6TEL. 22781169, 88825513 M, 84316459 C 6
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
8/17/2019 Aerodinámica Nasal.ppt
7/52 3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 7
8/17/2019 Aerodinámica Nasal.ppt
8/52 3 0
/ 0 4 / 1
6TEL. 22781169, 88825513 M, 84316459 C 8
"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$e.
8/17/2019 Aerodinámica Nasal.ppt
9/52 3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 9
8/17/2019 Aerodinámica Nasal.ppt
10/52 3 0
/ 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 10
8/17/2019 Aerodinámica Nasal.ppt
11/52 3 0
/ 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 11
8/17/2019 Aerodinámica Nasal.ppt
12/52 3 0
/ 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 12
8/17/2019 Aerodinámica Nasal.ppt
13/52 3 0
/ 0 4 / 1
6TEL. 22781169, 88825513 M, 84316459 C 13
%hysiologic function of the nose
The "asal physiologi# %$"#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 '$#osa 'ai"ai"s
he "asal #a*iy a a ra"ge o% 3137 C.-1
8/17/2019 Aerodinámica Nasal.ppt
14/52
CONGESTION NASAL TIP…
In a#)'s, nasa resis'an"e "an "on'ri*)'e )( 'o +a o 'o'a air-a$. [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 $in%8ian% , LI34
3 0 / 0 4 / 1
6TEL. 22781169, 88825513 M, 84316459 C 14
8/17/2019 Aerodinámica Nasal.ppt
15/52 3 0
/ 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 15
8/17/2019 Aerodinámica Nasal.ppt
16/52
MECANISMO CONTRACORRIENTE PARAEN3RIAR O CALENTAR EL AIRE.
One %her# re"/rdin" %he e45ien5# ' he/% e&5h/n"e re!/%e6 % %he!5/%in ' %he 67hen7/!/%ine /r%er#.
The 67hen7/!/%ine /r%er# 5*r6e6 /n%erir!# in %he n/6/! 5/8i%# 8er%he %*r9in/%e6, +here/6 /ir :+6 in / 76%erir dire5%in 'rin" /5*n%er5*rren% e&5h/n"e.[1]
Th*6, %he ; 776in" %in6 5re/%e / re e45ien% he/% e&5h/n"e7r5e66. -+e8er, %hi6 7r5e66 re/in6 i7er'e5%, /nd /6 *5h /61
8/17/2019 Aerodinámica Nasal.ppt
17/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 17
8/17/2019 Aerodinámica Nasal.ppt
18/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 18
8/17/2019 Aerodinámica Nasal.ppt
19/52
3 0 / 0 4 /
1 6TEL. 22781169, 88825513 M, 84316459 C 19
*umidification is another important process
of nasal physiology.'() as#$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.'()
8/17/2019 Aerodinámica Nasal.ppt
20/52
3 0 / 0 4 /
1 6TEL. 22781169, 88825513 M, 84316459 C 20
"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"$ses.-2
8/17/2019 Aerodinámica Nasal.ppt
21/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 21
8/17/2019 Aerodinámica Nasal.ppt
22/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 22
8/17/2019 Aerodinámica Nasal.ppt
23/52
3 0 / 0 4 /
1 6TEL. 22781169, 88825513 M, 84316459 C 23
Nasal air(ay resisa"#e a##o$"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
8/17/2019 Aerodinámica Nasal.ppt
24/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 24
8/17/2019 Aerodinámica Nasal.ppt
25/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 25
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
8/17/2019 Aerodinámica Nasal.ppt
26/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 26
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".
8/17/2019 Aerodinámica Nasal.ppt
27/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 27
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 $ith the administration of
histamine.'4)
8/17/2019 Aerodinámica Nasal.ppt
28/52
3 0 / 0 4 /
1 6
TEL. 22781169, 88825513 M, 84316459 C 28
The Cottle's test
' @ :hi"ol. 2007 @$l$gA214;4569.
Effects of the 2ottle5s maneu#er on the nasal #al#e as
assessed y acoustic rhinometry.
Tia"o @1
, irilB T.
https://www.youtube.com/watch?v=ZfFxUBZBW1ohttps://www.youtube.com/watch?v=ZfFxUBZBW1o
8/17/2019 Aerodinámica Nasal.ppt
29/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 29
The "asal #a*$' 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 $r&i"ae! regio"s o% he "asal
passage ha*e relai*ely large #rossse#io"al areas.-1
8/17/2019 Aerodinámica Nasal.ppt
30/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 30
E*al$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
8/17/2019 Aerodinámica Nasal.ppt
31/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 31
8/17/2019 Aerodinámica Nasal.ppt
32/52
RINOMANOMETRIA ANTERIOR
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 32
8/17/2019 Aerodinámica Nasal.ppt
33/52
RINOMANOMETRIA POSTNASAL
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 33
8/17/2019 Aerodinámica Nasal.ppt
34/52
CAUSAS DE O)STRUCCION NASAL
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 34
8/17/2019 Aerodinámica Nasal.ppt
35/52
RINOMANOMETRIA POSTERIOR
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 35
&sr$#io"
8/17/2019 Aerodinámica Nasal.ppt
36/52
Se7%/! de8i/%in
T*r9in/%eh#7er%r7h#
Rhin7!/6%#
Se7%/!7er'r/%in
>/!8*!/r 5!!/76e
Ch/n/! /%re6i/Neo(asm
9o$(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
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 36
8/17/2019 Aerodinámica Nasal.ppt
37/52
:D?NL=T N> N=L E:>NM?C=
4 #e os (a"ien'es 'ienen o*s'r)""i
8/17/2019 Aerodinámica Nasal.ppt
38/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 38
8/17/2019 Aerodinámica Nasal.ppt
39/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 39
8/17/2019 Aerodinámica Nasal.ppt
40/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 40
8/17/2019 Aerodinámica Nasal.ppt
41/52
RAMAS O3TÁLMICA ? MA@ILARES, >1,>;
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 41
T+e'ri%emina
ner&einner&a'e
s '+e(os'erior
nasa"a&i'$ 'o
#e'e"'no>io)ss'im)i.
8/17/2019 Aerodinámica Nasal.ppt
42/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 42
8/17/2019 Aerodinámica Nasal.ppt
43/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 43
8/17/2019 Aerodinámica Nasal.ppt
44/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 44
8/17/2019 Aerodinámica Nasal.ppt
45/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 45
8/17/2019 Aerodinámica Nasal.ppt
46/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C 46
8/17/2019 Aerodinámica Nasal.ppt
47/52
3 0 / 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 47
8/17/2019 Aerodinámica Nasal.ppt
48/52
)I)LIOGRA3A
A'as Ne''er III e#i"i
8/17/2019 Aerodinámica Nasal.ppt
49/52
3 0 / 0 4
/ 1 6
TEL. 22781169, 88825513 M, 84316459 C
49
8/17/2019 Aerodinámica Nasal.ppt
50/52
Fa&or eer no'as
a (ie #e(%ina2..
9rima "+ara
22 …..
…..
….. @ra"ias
3 0 / 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 50
ANATOMA ? 3ISIOLOGA
8/17/2019 Aerodinámica Nasal.ppt
51/52
)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...
3 0 / 0 4 / 1 6
TEL. 22781169, 88825513 M, 84316459 C 51
8/17/2019 Aerodinámica Nasal.ppt
52/52
@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
4/1 6