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Rhinology

Rhinology. Teaching Topics for Mary’s Medics Steve Lewis 2003/4. Filtration (hairs/mucus/cilia) Warming (30C) Humidification Olfaction Vocal resonance. Physiology. Bony upper 1/3 Cartilage lower 2/3 Alar L Lat U Lat. Anatomy (outside). Septum Turbinates (x3)

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Rhinology

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

  2. Filtration (hairs/mucus/cilia) Warming (30C) Humidification Olfaction Vocal resonance Physiology

  3. Bony upper 1/3 Cartilage lower 2/3 Alar L Lat U Lat Anatomy (outside)

  4. Septum Turbinates (x3) Ciliated epithelium Sinus drainage to around middle turbinate Anatomy (cavity)

  5. Use of the bony septum!

  6. Anterior drain to middle meatus Frontal Maxillary Ant Eth Posterior drain superior meatus/sphenoethmoidal recess Post Eth Sphenoidal Anatomy (sinuses)

  7. Anatomy (sinuses)

  8. Anatomy (sinuses)

  9. Anatomy (sinuses)

  10. Anatomy (sinuses)

  11. Very extensive anastamoses Int Carotid & Ext Carotid branches Ethmoidal arteries above MT Sphenopalatine/Palatine/Labial below MT Little’s Area Kiesselbach’s plexus Blood Supply

  12. Point to yourself! Rigid scope (0/30/90) Flexi ‘scope Examination

  13. ABC Hx Ex Ix as you go Basic first aid Bloods (FBC/G&S/INR/U) Fluids Consider co-morbidity in the elderly Epistaxis

  14. Beavis and Butthead Epistaxis

  15. 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 Epistaxis

  16. # Nasal bones (not urgent) see in 1/52 MUA in 2/52 Rhinoplasty >3/52 Septal haematoma (URGENT) prompt drainage poor cosmetic result possible Trauma

  17. Congenital/Acquired Deviated septum Rhinitis Polyps Foreign body Neoplasia Obstruction

  18. Rhinitic Mucosa

  19. 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 Rhinitis

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

  21. Medicamentosa OTC decongestants are usually designed for short term use Like heroin Very difficult vicious circle to break free from Rhinitis

  22. Inflammatory origin most common neoplastic CF idiopathic Aspirin/Asthma/Obstruction Hx Ex Ix Steroids/Surgery Recurrence Polyps

  23. Polyps

  24. 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 Acute Sinusitis

  25. Retained secretions blocked nose frequent acute episodes sinofacial pain Take careful pain history before diagnosis Visualise drainage system by CT FESS Chronic Sinusitis

  26. 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) Nasopharyngeal Carcinoma

  27. Pictures of FBs Foreign Bodies

  28. Pictures of septorhinoplasty Pictures of facial proportions Grades of uglyness Cosmetics

  29. The End

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