epistaxis (nosebleed) etiology : 1 、 local causes : 1 ) trauma : mucosa laceration blood...
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Epistaxis (nosebleed)
Etiology :
1 、 Local causes :1 ) Trauma : mucosa laceration blood vessel injury
2 ) Inflammation of nose and sinus
3 ) Diseases of septum
4 ) Tumor : nasal cavity tumor sinus tumor angiofibroma of nasopharynx
2 、 General factors
Systematic disease——
Ascension of arterial pressure and venous pressure ,
Dysfunction of coagulation,
Change of blood vessel tension.
1 ) Acute epidemical diseases
2 ) Cardiovascular diseases
3 ) Hemological diseases
4 ) Nutrition defect : VitC 、 K 、 P or calcium
5 ) Liver, kidney diseases and rheumatic fever
6 ) Poison : phosphorus, mercury, arsenic, benzene
7 ) Osler’s disease hemorrhagic familial telangiectasia
8 ) Endocrinic imbalance
Treatment :
1 、 Fundamental treatment Emergency: sedation estimate the bleeding amount keep proper posture No blood ingest
2 、 Hemostatic methods
1 ) Identify the bleeding site pinch the nostrils
2 ) Cautery techniques• chemical• electrical• laser• radiofrequency• microwave3 ) Nasal packing
• resorbable material, gel foam.• anterior• postorior• water or air balloon
3 、 Artery ligation
anterior ethmoid artery
posterior ethmoid artery
internal maxillary artery
external carotid artery 4 、 Angiography and embolization
submucous resection
endoscopic cautery and ligation
5 、 Systematic management.1 ) sedative2 ) hemostatic agent3 ) Vitamine C, K.4 ) sclerosant5 ) anti-shock management
6 ) Traditional Chinese Medicine
Foreign body in the nose
Endogenic
Dead bone, blood clot, rhinolith
Extrogenic
Plant seeds, insect, metals, stone, woods…
Biologic
Nonbiologic
Diagnosis :Unilateral purulent drainage with foul smell in
children ——Foreign body in the nose?
History ; nasal examination ; plain X-ray;
CT scan
Treatment :
Remove foreign body in different ways
Prevent foreign body in the nosein bronchi
Cyst of nasal vestibule
• Vestibule, maxillary dental alveoli, unilateral round/oval cyst
• Diagnosis:
palpation, punction
X-ray
• Treatment:
resection of cyst
Mucocele
Benign neoplasms: Obstruction of sinus ostia and
accumulation of fluid
Etiology: chronic inflammation, allergic sinona
sal disease, trauma, and previous surgery
Pathology : retention of intrasinus secretion,
progressive augmentation of internal pression, bo
ny remodeling and erosion.
Morbidity: China: ethmoid > frontal > sphenoid > maxillaryAbroad: frontal > ethmoid > sphenoid > maxillarySymptoms & Sign :Orbital apex syndromeFacial protrude Rhinorrhea, nasal obstruction, hyposmia Diagnosis:History, symptoms and signPunction, X-ray/CT scanTreatment:Operation: “open surgery”, marsupialization
Diagnosis :
X-ray and CT scanner.
Treatment : surgical treatment: drainage, creatio
n of vast communication with nasal cavity
Tumor of nose and skull base
Benign tumor in the nose— 40 kinds of benign tumor
— nasal organ is small, difficult to identify the origin.
—recurrence and malignant transformation
Hemangioma
Capillary hemangioma——nasal septum & anterior inferior turbinate
Cavernous hemangioma——maxillary & nasal bone
Papilloma in the nose
Pathogenesis
— unclear
— humon papilloma virus (HPV)Pathology:1) Keratotic papilloma simple cutaneous wart, exophytic with broad base, in the nasal vestibule or nasal septum.
2) Inverted papilloma
Age>40ys , high morbidity: 50—60ys;
M: F=3:1Features : Hyperplastic epithelia with inverting pattern of growth. Epithelial inversion into underlying stroma. Basal membrane is intact. Malignant transformation : 5-15% .
squamous cell carcinoma, adenocarcinoma.
Symptoms & Signs :
Nasal obstruction, rhinorrhea with blood staining,
sometimes with headache and abnormalities of sm
ell.
Firm red or grey masses, unilateral, arising from lateral wall of the nose, extension into the ethmoid and maxillary sinuses.
Treatment
Complete excision
Some times it is difficult.
Recurrence: 28-74%
Lateral rhinotomy.
Endoscopic excision,
with reasonable recurrence rates.
Malignant transformation--radiotherapy
Malignant tumor of
nasal cavity and paranasal sinusesMorbidity in China:
2.05-3.66% of malignant tumors in all
21.74%-49.22% of malignant tumors in ORL
Carcinoma:cancer=8.5:1
M: F=1.5-3.0:1
Cancer:---40-60ys , Sarcoma---younger
— 2 ~ 4% of whole body carcinorna.
— more frequently in sinus than nasal cavity
maxillary 60 ~ 80%
ethmioid 3.8%
frontal 2.5%
— for advanced case difficult to identify the original site.
Squamous: 70 ~ 80% more in maxillary sinus
Adenocarcinoma: 4 ~ 8% more in ethmoid sinus
Adenoid cystic carcinoma 4% more in ethmoid sinus
Sarcoma: 10-20% malignant tumors in ORL
More in nasal cavity and maxillary sinus.
Malignant lymphoma>60% ;
— Malignant epithelia tumor.
Carcinoma of nasal vestibule and Septum
Carcinoma of the paranasal Sinus
Melanoma
Esthesioneuroblastoma
— Malignant nonepithelial tumor.
Rhabdomyosarcoma.
Hemangiopericytoma
lymphoma
Extramedullary plasmacytoma.
Paranasal sinus:
— purulent drainage with blood
— nasal obstruction (unilateral, progressive)
— extrusion of cheek
— extrusion of hard palate
— Ophthalmologic symptoms: proptosis,
epiphora, visual acuity decrease,
orbital apex syndrome
— cranial involvement
Diagnosis:
Caution! >40yrs, unilateral, progressive symptoms
— increase doctor’s index of suspicion
— nasal examination
— nasal endoscopic examination
— biopsy
— CT 、 MRI
— PET (positron emission tomograph)
Treatment:
1. Radiotherapy: 5000-6000rad within 4-8w ,6w after radiotherapy --- surgery
2. Surgery --- cornerstone
-lateral rhinotomy.
-midfacial degloving
-Maxillectomy
-Maxillectomy+orbital contents exenteration
-Craniofacial resection.
3. Chemotherapy --- unwilling or unsuitable
for surgery
Prognosis :
—Survival advantage
radiation and surgery.
—The value of the chemotherapy
undetermined.
5yr survival rate: 30-40% for maxillary sinus MT
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