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Fracture of nasal bone
Etiology
Traffic accident
Physical combat.
Sports injury
Nasal bone---
Upper end: thick
Lower end: thin
Symptoms & Signs：Pain, epistaxis,
nasal deformity or deviation, bruising.
Diagnosis：X-ray in lateral view.
Septal hematoma?——puncture
Treatment：Hemostasia, cleaning &
suturing wound, restoring alignment
Reduction of nasal bone
•Before soft tissue edema
•5—7 days after injury
•Walshan forceps
•Nasal packing for 2-3d
Deal with septal hematoma & abscess
•Septal hemotoma drainage as early as
possible.
•“L” incision on septum.
• Postoperative nasal packing.
• Adequate antibiotics.
Fracture of frontal bone
Pathology：Often combine with fracture of
naso-fronto- ethmoido-orbital complex.
Front wall
Front & back wall
Base fracture (frontonasal fracture)
Stringy, sunken and smashed fracture
Symptoms & Signs：
Epistaxis, edema or sunken front.
Diagnosis：Frontal palpation, X-ray, CT scans
front wall fracture
(sunken fracture凹陷型)
front & back wall fracture
(smashed fracture 粉碎型)
Treatment：According to the situation:
1、 stringy fracture
2、 sunken fracture
3、 smashed fracture
4、 front & back wall fracture
5、base fracture (frontonasal fracture): restore
the function of frontal sinus.
Principle：To isolate the communication
between frontal sinus and cranial cavity,
to prevent rhinogenic complications,
to keep the frontal part from deformation.
Fracture of ethmoidal bone
Pathology：Often combine with fracture
of naso-fronto- ethmoido-orbital complex.
Fracture of naso-fronto- ethmoido-orbital complex
Symptoms & Signs：
Edema of eyelid or nasal root, increase in the
intercanthal distance.
sunken front ，
vision disorder,
Diagnosis：
X-ray film,
CT scan
Treatment：
Vision disorder——depression of optic canal
Nosebleed——nasal pack or arterial ligation
(ligation of ethmoidal artery)
Cerebrospinal fluid rhinorrhea (CSF) ——
surgical reparation
Blow-out fracture
Symptoms & Sign：
Swelling and bruising involving
all eyelids, lid and infraorbital
emphysema. diplopia，restricted
movement of the eyes； vision
disorder.
击出性骨折
(眶底暴折)
Diagnosis：
Clinical manifestation, X-ray, CT scans
Treatment：
Reduction after 7—10d post-wound.
Operation approach: via infraorbit, via
maxillary sinus and external ethmoidectomy
Blow-in fracture
Relatively rare.
Symptoms & Sign：
Protruding eye, swelling eyelids and zygoma,
Palpation: infraorbital edge---“stairs-like”.
Diagnosis：
Clinical manifestation, X-ray, CT scans
Treatment：
Reduction after 7—10d post-wound.
Midface fracture
Le Fort , Le Fort , Le Fort 
Cerebrospinal fluid rhinorrhea
(CSF)
Etiology：
Traumatic: Iatrogenic, and external trauma.
Intracranial or extracranial surgery.
Cribriform plate, sphinoid, frontoethmoidal
complex.
Nontraumatic: Spontaneous (or primary),
direct erosion or increased intracranial pressure
(tumors, congenital or acquired hydrocephalus,
or infections.
Diagnosis：History, laboratory test,
endoscopic examination, ascertain the nature,
fix the precise location
Treatment：
1、Conservative treatment：
To prevent from infection, to prevent from
high cranial pressure
2、Surgery：
Intracranial approach ：
Extracranial approach ：
nasal external approach
nasal endoscopic surgery
Vestibulitis of nose
Etiology：
Irritation of rhinorrhea and dust；
secondary to skin infection
Symptoms & Sign：
Red, swelling and ulcerative skin，crusting inside
the vestbule, tenderness of the nasal tip or alae.
Treatment：
Acute——thermotherapy or infrared
Chronic——3%H2O2, antibiotic ointment
Furuncle of nose
Etiology：
Secondary to chronic vestibulitis. Diabetics and
weaklings will be subject to the disease.
Symptoms & Sign：
Redness, swelling, heat, and pain；
mature—ulcerate. Serious cases: Phlegmon
Complications：Thrombosis of cavernous
sinus and cranial infection
Treatment：
Unmature：antibiotic，physiotherapy
Mature：drainage，D’not crash and press
Ulcerate：drainage，antibiotic
Complications：antibiotics，call
ophthalmologist and neurologist for assistance
Acute & chronic inflammations
of the nasal cavities
Acute rhinitis
Etiology：Rhinoviruses, adenoviruses,
coronaviruses, influenza & parainfluenza
viruses.
Common cord (coryza)
Causes: general factors, local factors
Symptoms & Sign：Sneezing, nasal
obstruction, malaise, fever. Nasal mucosa
congestion, swelling, secretion in meatus.
Complications：
1、Sinusitis
2、Acute ototitis media infection pass through the
Eustachian tube to middle ear
3、Acute pharyngolaryngitis, trachitis & bronchitis
Differential Diagnosis：
1、Influenza
2、Allergic rhinitis
3、Vasomotor rhinitis
4、Acute infectious disease
Treatment：
General treatment
Local treatment
Chronic rhinitis
Etiology：
Local causes：1、Acute—→chronic，
2、Chronic diseases of nose & sinus，
3、Infective focus around nasal cavity，
4、 Iatrogenic: misuse nasal drops
Professional and environmental causes：dusts，
harmful chemical gas，physical changes
General factors：1、chronic diseases，
2、malnutrition，
3、endocrinic dysfunction，
4、cigarette and alcohol
Pathology：
Simple chronic rhinitis——no hyperplasia
Hypertrophic chronic rhinitis——nasal mucosa,
submucosa, even periosteum & os: limited or
extensive hypertrophy
Symptoms & Sign：
Nasal obstruction, rhinorrhea, hypertrophied inferior
turbinate
Treatment：
1、Pathogenic treatment
2、Local treatment
1) Simple chronic rhinitis：
Vasoconstrictor sympsthomimetics,
acupuncture
2) Hypertrophic chronic rhinitis：
Vasoconstrictor sympsthomimetics,
electric coagulation, laser, microwave,
radiofrequancy. Partial inferior
turbinectomy.
单纯性鼻炎
肥厚性鼻炎
鼻塞
间歇性
持续性
鼻涕
黏液性
多，黏液性或粘
脓性,不易擤出
闭塞性鼻音
无
有
前鼻镜检查
下甲黏膜肿胀,表 下甲黏膜肥厚,表
面光滑
面可呈结节状
下鼻甲探针触诊 柔软,有弹性
硬实感
对麻黄素反应
黏膜收缩明显
黏膜收缩不明显
治疗
非手术治疗
宜手术治疗
Atrophic rhinitis
Etiology：
Primary：Endocrine imbalance, functional
disorders of autonomic nerve, infection,
（coccobacillus foetidus ozena, diphtheroid
bacilli）, poor nutrition, hereditary factors,
autoimmunophathy？
Secondary：1)Infection:chronic
inflammation; 2)Iatrogenic: excessive surgical
destruction of mucosa (empty nose syndrome);
3)Irritant:
4)Special infection: tuberculosis, syphilis.
Pathology：Endarteritis and periarteritis of
terminal arterioles, metaplasia of the epithelium,
atrophy of the mucosa, glands, periosteum.
Symptoms & Sign：
1)Nose, nasopharynx is dry
2)Nasal obstruction (detached crusts)
3) Epistaxis
4) Anosmia
5) Foul or fetid odor
6) Headache
Treatment：
1、Local management：nasal irrigation by
worm water, liquid paraffin
2、
General management：vitaminB2、C、E 3、
Surgery：