Transcript Фурункул носа

Current challenges and
achievements of
otolaryngology. Acute
and chronic diseases of
the nose and paranasal
sinuses
Department of ENT
diseases of Tashkent
Medical Academy
www.tma.uz
ANATOMY OF EXTERNAL
NOSE
The nasal septum
Lateral wall of the SASP
Functional areas of the
nasal cavit
Regio olfactoria olfactory area
Regio respiratoria breathing zone
The functions of the nose
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Respiratory;
Protection;
Olfactory;
Cavity;
Neuro-reflex;
Protective functions of the
nose
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Warming and cooling the inhaled air;
Detention of micro-and
microparticles, enveloping mucous;
Neutralization of microbial particles
(lysozyme);
Types of smell
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Anosmatiki - Dolphins;
Mikrosmatiki - man;
Makrosmatiki - carnivores and
rodents;
Types of disorders of smell
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hyposmiya;
anosmiya;
hyperosmiya;
kokosmiya;
Sinuses
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Maxillary;
Frontalis;
Ethmoidal labyrinth cells;
Sphenoidalis;
Anatomy of the paranasal
sinuses
Methods of investigation of
the nose
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Rhinoscopy: front, middle and rear;
Endomikrorinoskopiya;
Rinopnevmometriya;
Definition mukotsilliarnogo
clearance;
olfactometer;
Saharinovaya sample;
Methods of investigation of
paranasal sinuses
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Palpation;
R-graphy;
Computer magnetic resonance imaging;
Thermography;
Sonography;
Transillumination;
Catheterization;
Puncture the top jaw and
trepanopunktsiya frontal sinus;
Congenital anomaly of nose
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Double nose;
Splitting of the nose;
Formation of the nose in one or two
of the trunk;
Fistulas and cysts of the nose;
Malformations of the nasal cavities;
Choanal atresia;
Acute and chronic diseases
of the nose and paranasal
sinuses
Diseases of external nose
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Furuncle of the nose;
Sycosis;
Eczema;
Erysipelas;
Acne rosacea;
Furuncle of the nose
Cone-shaped infiltrate covered
hyperemic skin on top of which is
usually 3-4 days appears
yellowish-white head - the
abscess. Inflammation extended
to the upper lip, cheek and soft
tissue.
Local adverse boil over: the development of carbuncle, accompanied by
low-grade or febrile temperature, increased sedimentation rate,
leukocytosis, increased morbidity and lymph nodes.
Clinical forms of acute cold
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acute catarrhal rhinitis (rhinitis cataralis
acuta);
acute catarrhal nasopharyngitis, usually in
childhood (rhinitis cataralis neonatorum
acuta);
acute traumatic rhinitis (rhinitis traumatica
acuta);
Stage of acute rhinitis
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dry phase of stimulation;
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stage serous discharge;
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stage of muco-purulent discharge
(permit);
Rhinoscopy in the initial
stages (1 - 2), acute coryza
Hyperemic mucosa,
dry, and she gradually
swells, and nasal
passages are
narrowed, breathing is
difficult. In the future
there are abundant
mucus
Rhinoscopy in the third
stage of acute rhinitis
Characterized by the
appearance of
mucopurulent, first
gray, then yellow and
greenish discharge,
crusts are formed. In
the next few days of
discharge is reduced,
swelling of the mucous
membrane disappears.
The principles of treatment
of acute rhinitis
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Drug therapy;
Antimicrobials;
Physiotherapy;
Distraction therapy;
The main forms of chronic
rhinitis
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Bluetongue;
Hypertrophic;
Atrophic;
Rhinoscopy in chronic
catarrhal rhinitis
Pastoznost and swelling of
the mucous membrane, often
with cyanotic hue, and slight
thickening of her mostly in
the lower shell and the front
end of the middle shell, while
the walls of the nasal cavity is
usually covered with mucus
Rhinoscopy in chronic
hypertrophic rhinitis
The mucosa is usually
flushed, full-blooded,
slightly cyanotic, or
purple-bluish, grayishred, covered with
slime. Greatly
increased the lower
turbinate, which has
various forms of
structure.
Pharyngorrhinoscopy in
chronic hypertrophic rhinitis
The rear ends of the
lower shell is usually
thickened, often
compressing the mouth
of the pharyngeal
eustachian tubes,
causing the Eustachian
Rhinoscopy in chronic
atrophic rhinitis
Marked pallor of the
nasal mucosa,
atrophic turbinates.
There is scant,
viscous, mucous or
muco-purulent
discharge, which
usually adheres to
the mucosa and dries
to form crusts.
Causes of atrophic rhinitis
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Adverse weather conditions;
Occupational hazard;
Frequent coryza;
Infectious diseases;
Surgical intervention in the nose;
Rinoscopy picture at Ozen
Brown or yellowgreen, dark crust,
which covers the
nasal mucosa, and
often performs nearly
all of its cavity. After
removing the crusts
nasal cavity is
extended, sometimes
on the mucous
membrane is sticky
yellow-green exudate.
Causes of ozeny
Klebsiella ozeny (Abel-Levenberg
in 80% of cases);
 Metabolic disorders;
 Iron-deficiency anemia
defetsitnaya;
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Rinoscopy symptoms of
vasomotor rhinitis
Swelling and
pallor of the
mucous
membrane,
glaucous (bluish)
or white spots on
it
The triad of symptoms
accompanying vasomotor
rhinitis
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paroxysmal sneezing;
gidroreya nose;
difficulty of nasal breathing;
Adrenaline test
For the differential diagnosis of catarrhal
rhinitis from true hypertrophy applied
adrenaline test.
Reduce swelling of the mucous membrane
indicates the absence of true hypertrophy. If
the reduction of mucosa expressed little or she
is not reduced, it indicates the nature of
hypertrophic swelling.
Treatment of various forms
of chronic rhinitis
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elimination of possible endo-and
exogenous factors that cause a runny
nose and support;
drug therapy for each form of
rhinitis;
surgical intervention if indicated;
physiotherapy and climatotherapy;
Various
forms of
distortion of
the nasal
septum
Types of deviated septum
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Physiological;
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Abnormal: traumatic, compensatory;
Treatment deviated septum
- surgical
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Indications for surgery:
Difficulty in nasal breathing;
Secondary pathological changes;
Cosmetic damage;
Epistaxis
Reasons:
Local
General
Zone Kisselbaha
Criteria for the severity of
epistaxis
 Slight
- in the form of
droplets;
 Moderate-20 to 200 ml;
 Bleeding-from 200 ml or
more;
Principles stop minor
nosebleeds
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The introduction of sterile cotton
wool moistened with 3% hydrogen
peroxide solution;
Infiltration of the bleeding area of
1% novocaine solution;
Cauterization of bleeding areas lapis,
10-30% solution of AgNO3, 3%
solution of trichloroacetic acid;
Principles of nasal bleeding
At moderate - front tamponade;
 With strong - back tamponade,
ligation of common carotid
artery;
 Medications - increase blood
clotting, blood transfusions,
oxygen therapy
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The front nose tamponade
Plugging produce orderly laying
loops turundy impregnated with an
ointment to the bottom of the nose
of his entry to the posterior nares.
Stages of the back of the
nose tamponade
Holding the catheter at the
bottom of the nose into the
nasopharynx and removal of
the distal end through the
mouth
Fixation pad to the distal end of
the catheter
Stages of the back of the
nose tamponade
Summing up the pad to the
choanal and pressing a
finger
Fixation pad at the front
edge of the nose
Clinical forms of sinusitis
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acute;
chronic;
Classification of sinusitis
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Exudative form: Bluetongue, serous,
purulent;
Productive: wall-hyper-plastic, polypous,
cystic;
Alternative - holesteotomnaya, caseous,
necrotic, atrophic;
Mixed forms - purulent polypous, senoznocatarrhal, sero-polopoznaya;
Vasomotor and allergic form;
Diagnosis of sinusitis...
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Complaints and history;
Palpation and percussion;
rhinoscopy;
radiography;
Computer-tomography;
Puncture of the maxillary sinus;
Trepanopunktsiya frontal sinus;
Radiographs of the
paranasal sinuses with sinus
The decrease in the
transparency of the
projection of the
maxillary sinus
Computer tomography of
the paranasal sinuses with
sinus
Puncture of the maxillary
sinus
After preliminary adrenalizatsii
and anesthesia of the lower
nasal passage, the needle
puncture produce 2.5 cm away
from the front edge of the
inferior turbinate. The needle is
introduced towards the lateral
corner of the eye.
Minimally invasive
treatments for sinusitis
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Sinus catheterization;
Rinsing the sinuses on Proytsu
(displacement method);
Sinus-catheter "YAMIK";
Washing on the paranasal
sinuses by Proyts
After preliminary adrenalizatsii nasal passages, the patient is laid on
the couch threw back his head back. In one nostril entered a drug from
another - is removed from the liquid contents by means of pathologic
surgical suction.
Besunksion way to treat
sinusitis
Unit Overview
"YAMIK catheter"
Exhaustion of pathologists-cal
content and administration of
the drug
X-ray picture of acute
sinusitis
The decrease in the transparency of the
projection of the frontal sinus.
Puncture of frontal sinus
Layout for trepanopunction
frontal sinus
Trepanopunction
Stages of the operation by
the method of Caldwell-Luc
Mucosal incision
under the lip of 3.4 as
a painter.
Exposing the canine
fossa and sinus is
opened with the
removal of pathological
tissues.
Performed with nasal
sinus post-Tew bands
on the inferior course.
Operation Ritter-Janssen
1-incision brow with the
transition to a side slope
of the nose
2-placental
tissue
3-opened the
front wall of
the frontal
sinus
4-post of the
frontal sinus from
the nasal cavity
Thank you for your
attention!
Department of ENT
diseases of Tashkent
Medical Academy
www.tma.uz