Septal Deviation / orthodontic courses by Indian dental academy

A congenital or traumatically acquired bending or bowing of the nasal septum

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Mild forms do not causesymptoms and have no pathologic significance


More pronounced degrees of septal curvature can obstruct nasal breathing and may also cause olfactory impairment due to inadequate ventilation of the olfactory groove.

Deficient nasal airflow can also lead to

paranasal sinus sequelae such as headaches and recurrent sinusitis.

A large septal spur that comes into contact with the nasal turbinates

can cause epistaxis


Septal subluxation is a special form in which the anterior septal margin is displaced from the median plane. This condition is readily identified by external inspection of the nasal base.

Further clinical examination consists of anterior rhinoscopy or endoscopy.

The degree of nasal obstruction can be objectively evaluated by rhinomanometry.

For medicolegal reasons, olfactory testing should always be done prior to surgical treatment


The treatment of choice is surgical straightening of the deviated septum (septoplasty)


Deformities may be congenital or traumatically acquired

The most common deformities are a crooked nose, humped nose, saddle nose, and broad nose, which may occur separately or in combinations



Inspection

Anterior rhinoscopy Endoscopy


The treatment of choice is “functional septorhinoplasty,” with correction of the nasal septum and external nose


Nosebleed is a relatively common, usually harmless symptom that may reflect a number of diseases of variable severity


1. Perforation2. traumatic3. iatrogenic4. Inflammatory5. spurs or ridges 6. Foreign bodies7. rhinoliths8. trauma (including

nose picking)

1. allergy 2. acute rhinitis 3. Traumatic

aneurysm of the internal carotid

4. Benign neoplasms

5. malignant neoplasms


1. Atherosclerosis2. Infection3. Pregnancy4. Diabetes mellitus5. Congenital: e.g.,

hemophilia A and B, Willebrand disease

6. Acquired: e.g., anticoagulant therapy,

7. Hepatocellular insufficiency

1. Platelet disorders Congenital Acquired: uremia,

dysproteinemia, adverse effects of dextrann and acetylsalicylic acid (ASA) therapy Schönlein–Henoch purpura

1. Osler diseasewww.indiandentalacademy.com

Nosebleed requires a simultaneous, coordinated protocol of diagnostic and therapeutic actions


The diagnostic work-up begins with blood pressure measurement.

Except in very minor cases, the Hb should also be determined, and a coagulation disorder should be excluded by determining the platelet count, bleeding time, thromboplastin time, partial thromboplastin time (PTT), and thrombin time


The nasal cavity is inspected by anterior rhinoscopy or endoscopy following decongestion and local anesthesia of the mucosa.

In most cases the bleeding site is in Kiesselbach’s area


General measures:1.The nostrils are compressed against the

nasal septum2.the patient is told not to swallow blood

running down the pharynx.3.The patient is kept in an upright posture 4.An ice bag can be placed on the back of

the neck to induce reflex vasoconstriction

5.An intravenous line should be placed if bleeding is severe


Mild epistaxis from Kiesselbach’s area can often be controlled by selective local cauterization


For severe epistaxis, the anterior nasal cavity can be packed with ointment-impregnated gauze strips


The most common source of bleeding from the posterolateral part of the nasal cavity is the sphenopalatine artery (branch of the maxillary artery), which can be coagulated or clipped under endoscopic control


The main indications for surgery are changes in the nasal septum such as septal spurs, ridges, and perforations.

Treatment consists of straightening the

nasal septum (septoplasty or closing the septal perforation (e.g., by implanting an auricular cartilage graft and using local mucosal flap advancement



The nasal pyramid is predisposed to fractures because of its exposed location.


Inspection


Crepitus noted on palpation confirms the suspicion of a fracture


Further diagnostic measures include radiographs of the nose in the lateral projection

Standard sinus projections to exclude bony involvement of the lateral midface


1. Subperichondrial hemorrhage with hematoma

2. Septal Abcess


Lateral midfacial fractures are usually caused by blunt trauma to the side of the face.

Affected structures of the bony facial

skeleton are the maxillary sinus, orbit, and the zygoma or zygomatic arch


An isolated fracture of the orbital floor with a partial herniation of the orbital contents into the maxillary sinus is a special type of lateral midfacial fracture called a blow-out fracture


Facial asymmetryLimited mouth openingDiplopiaSensory disturbances


Inspection

1.Swelling2.subcutaneous hemorrhage3.Asymmetry of the affected facial4.Enophthalmos


Palpation:

Concomitant soft-tissue swelling can make it difficult or impossible to palpate sites of bony discontinuity or displacement


Sensory testing

Wisps of cotton can be used to test sensory function on the healthy and affected sides


Radiographs

Whenever a lateral midfacial fracture is suspected, standard sinus radiographs should be obtained (occipitomental and occipitofrontal projections to define the extent of the bony discontinuity or displacement


The zygomatic arches may be poorly visualized in standard projections, and so a “bucket handle” view should be added when a concomitant zygomatic arch fracture is suspected


CT Scans

be helpful to obtain a more discriminating view of the fracture and also to exclude an involvement of the anterior skull base





Surgical treatment

is unnecessary for undisplaced, asymptomatic fractures

is indicated for displaced fractures or fractures that are causing symptoms such as sensory deficits in the distribution of the infraorbital nerve, diplopia on upward gaze, enophthalmos, restricted jaw opening, or facial asymmetry.

Treatment consists of reduction and fixation of the bone fragments using miniplates, interosseous wiring, or both




Central midfacial fractures (Le Fort I-III)

Frontobasal fractures (Escher classification)




Frontobasal fractures occupy a special place among skull fractures because they are usually an “indirectly open” injury that creates a communication between the cranial cavity and the environment lead to life-threatening intracranial complications (e.g., meningitis, brain abscess)


Unilateral or bilateral periorbital hematoma

Dish face: the midface has been separated from the skull base and displaced inward

Cerebrospinal fluid (CSF) rhinorrhea Vision loss Diplopia Cerebral prolapse Anosmia




Glucose test

β2-transferrin


Computed tomographyAxial scans are for evaluating the

anterior and posterior walls of the frontal sinuses and sphenoid sinus

Coronal scans more clearly define the ethmoid roof and cribriform plate


Testing of hearing and balance

Olfactory testing


Every confirmed fracture of the anterior skull base should be treated surgically in operable patients, regardless of whether or not a CSF leak has been detected



Life-threatening rise of intracranial pressure due to intracranial hemorrhage

Bleeding from the nose or sinuses that is refractory to conservative treatment

Bleeding from an open skull injury that is refractory to conservative treatment


Open brain injury Dural tear from an indirectly open

head injury Penetrating foreign bodies and

impalement injuries Early complications (e.g., meningitis,

encephalitis, brain abscess) Late complications (e.g., meningitis,

brain abscess, osteomyelitis) Orbital complications


Displaced bone fragments Fractures involving the drainage

tracts of the paranasal sinuses (“ostiomeatal unit”)

Acute or chronic sinusitis at the time of the injury

Post-traumatic sinus inflammation, mucopyocele formation

Supraorbital nerve injury due to an adjacent fracture


1. Define the paradoxical cyanosis.2. Name four common nasal

deformity.3. Where is the common site of

epistaxis in old age?4. What is the most definitive sign

for nasal fracture?5. Name six common symptoms for

frontobasal fracture.www.indiandentalacademy.com

Inflammations of the External Nose, Nasal Cavity,and Facial Soft Tissues


Folliculitis: the disease is confined to the hair follicles.

Furuncle: the infection spreads to deeper tissues and forms a central core of purulent liquefaction.


Nasal furuncles present as painful, tender, erythematous swellings about the nasal tip and nares


Antibiotic that is active against staphylococci:

1.Dicloxacillin sodium , Cephalexin and so on

2.Combined with the local application of an antibiotic-containing ointment


Inadequate treatment or manipulations of the nasal furuncle itself can result in:

Hematogenous spread to intracranial structures


Causative organisms are beta-hemolytic group A streptococci

Less common pathogens are streptococci of other groups, Staphylococcus aureus, and gram-negative rods (e.g., Klebsiella pneumoniae)


High fever Feeling of tension in the soft

tissuesRapidly by broad areas of erythema

and swelling, which are sharply demarcated from unaffected skin

The tissue is warm to the touch, and small blisters occasionally form


The treatment of choice is the parenteral administration of penicillin



Acute rhinitis (common cold) is the most prevalent infectious disease

Rhinoviruses and coronaviruses comprise almost half of the causative organisms of acute viral rhinitis


Dry stage Malaise (lethargy, headache, fever) and

local discomfort in the nose and nasopharynx (burning, soreness).

Catarrhal stage Watery, initially serous nasal discharge

and nasal obstruction due to mucosal swelling, which mainly involves the turbinates.


Viral damage to the epithelium promotes bacterial colonization, which alters the consistency of the clear nasal discharge, causing it to become mucopurulent.


Treatment consists of supportive measures to relieve nasal obstruction and prevent sinusitis and other sequelae by the use of decongestant nose drops

Antibiotics may also be prescribed in patients with bacterial superinfection or paranasal sinus involvement


Nonspecific chronic rhinitis can develop due to anatomic changes (e.g., marked septal deviation, septal spur) or other lesions of the nasal cavity (polyps, tumors) and nasopharynx (adenoids)

Environmental factors such as sustained extreme temperatures or air pollutants can also bring on this condition


Patients present clinically with:

1. Obstructed nasal breathing 2. Mucous nasal discharge3. Frequent throat clearing and

occasional hoarseness


The most important step is to eliminate the cause by removing chronic irritants from the environment or by surgically correcting any intranasal pathology (e.g., septoplasty)


Tuberculosis Sarcoidosis Rhinoscleroma Actinomycosis Syphilis Wegner

Granulomatosis

Fungal infections

1.Aspergillosis2.Mucormycosis3.Rhinosporidiosis


Triggered by an immediate, IgE-mediated reaction of the immune system to any of a number of foreign substances, particularly pollens and animal allergens.


Mainly by pollens

Disappear at the end of the pollen season


Is caused by year-round allergen exposure

The predominant causative allergens are house dust, pet dander, and molds

The disease may also be caused by certain foods (e.g., strawberries, nuts, eggs, fish) as well as occupational exposure to allergens (e.g., bakers and hairdressers)


The clinical manifestations:

1.Obstructed nasal breathing2. Sneezing attacks3. Watery nasal discharge4. Itching of the nose and eyes

(conjunctivitis)


Detailed allergy history (do the symptoms present year-round or only during contact with certain animals or plants).

Seasonal allergic rhinitis, a bluish-purple discoloration of the mucosa.

Perennial rhinitis, the mucosa is bright red and shows inflammatory changes.

Careful allergy testing is necessary to identify the antigens involved.



The best treatment strategy is to avoid contact with the allergen or eliminate allergenic irritants

Pharmacologic treatment1. Mast-cell stabilizers2. Local and systemic H1 antihistamines3. Local steroids

Immunotherapy or hyposensitization therapy

Surgical options


Resembles allergic rhinitis in its clinical features, but there is no evidence that the patient has been previously sensitized.

Neurovascular autonomic disturbances in regulating the tonus of the nasal mucosal vessels


Obstructed nasal breathingWatery nasal dischargeSneezing

The history shows that the symptoms are related to a temperature change, the consumption of hot liquid or alcohol, or less specifically to “emotional stress.”


Medical therapy includes

Antihistamines corticosteroid-containing nasal sprays

In the Kneipp system of therapy, ice-cold water is sniffed up the nose as a way of “training” the neuroautonomic regulation of the blood supply to the nasal mucosa


For intractable vasomotor rhinitis is surgical reduction of the turbinates a septoplasty should be performed.


Characterized by pronounced dryness of the nasal mucosa.

Severe cases, especially with secondary bacterial colonization, are marked by a fetid nasal odor that is not perceived by the patient due to degeneration of the olfactory epithelium.


Primary atrophic rhinitis is unknown

Secondary forms1.Extensive prior tumor resection2.Excessive use of nose drops drug

abuse (cocaine)3.Previous radiotherapy for nasal and

sinus tumors


Conservative: Symptomatic measures (saline

“nasal douche,” soothing mucosal ointments).

Surgery : reduce the nasal cavity by the

submucous implantation of cartilage grafts.


Occurs mainly during pregnancy and is believed to be caused by estrogen-induced swelling of the mucosa with nasal airway obstruction.


This disease occurs mainly as a side effect from the long-term use of decongestant nose drops


Antihypertensive drugs Beta-blockers, Angiotensin-converting enzyme (ACE)

inhibitors

Oral contraceptive

Clinical symptoms consist of obstructed nasal

breathing, dry mucosa, and occasional olfactory disturbances.


Intranasal anatomic changes such as: Septal deviation Septal spursChronic inflammation Allergy TraumaNeoplasms

The common pathogenic mechanism is impaired ventilation of the ostiomeatal unit


Chronic sinusitis frequently affects the maxillary sinus and ethmoid cells


Pain (from feeling of pressure to persistent or recurrent headaches)

Nasopharyngeal drainage (postnasal drip)

Obstructed nasal breathingwww.indiandentalacademy.com

Rhinoscopy Endoscopy Imaging studies



Conservative treatment options

Appropriate antiallergic therapy

Sinus surgery


The modern surgical treatment of chronic sinusitis is performed intranasally under endoscopic or microscopic control.


Genetic causesChronic irritation of the mucosa,

like that occurring in chronic rhinitis or sinusitis

In response to allergic rhinitis and acetylsalicylic acid (ASA) intolerance



Nasal polyps are rarely observed in children.

Most occur in a setting of cystic fibrosis.


Obstructed nasal breathing Hyposmia or anosmia Headache Snoring Rhinophonia clausa Frequent throat clearing

Spread to the lower airways can lead to laryngitis with hoarseness and bronchitic symptoms.


Rhinoscopic or endoscopic evaluation

Computed tomographyAllergy testsOlfactory testing


Conservative measures Use of corticoid containing nasal

sprays Systemic antihistamines Systemic steroids

Surgical treatment


The prognosis is guarded even with modern surgical techniques most meticulous ablative sinus surgery cannot prevent a recurrence


Adhesions due to Postinflammatory Post-traumatic Postoperative

The most common site of occurrence is the frontal sinus, followed by the ethmoid cells, maxillary sinus, and sphenoid sinus.


Presents as an isolated, tense swelling over the anterior wall of the frontal sinus

It may also cause inferolateral displacement of the orbital contents


Swelling in the cheek area with upward displacement of the orbital contents


Proptosis, limited ocular movements, and diplopia may also occur, depending on the location of the mass.


Computed tomography

MRI


The treatment of choice is surgical removal of the mucocele



They occur with highest frequency in children under 6 years of age

1.Orbital edema 2.Periosteitis 3.Subperiosteal abscess4.Orbital cellulitis5.Orbital apex syndrome6.Cavernous sinus thrombosis




Osteomyelitis occurs mainly as a complication of frontal sinusitis


The patient presents clinically with a tender, doughy, erythematous swelling over the forehead


Cranial CT scans


The treatment of choice is surgical eradication of the affected bone under antibiotic coverage


Epidural, subdural and intracerebral abscesses

MeningitisSinus Thrombosis and

Thrombophlebitis


1. What is so serious regarding nasal foliculitis?

2. Name the common symptoms of sinusitis.

3. When orbit shift to the inferolateral the mucocel perhaps is located in …. sinus.

4. Name the causes of sinonasal polyposis.

5. Subdural abscess is more common when the ….. Sinus is involved.


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Septal Deviation / orthodontic courses by Indian dental academy