The document discusses various topics related to nasal and sinus disorders. It covers deformities of the nasal septum such as deviations which can range from mild and asymptomatic to more severe forms that cause nasal obstruction and other issues. It describes evaluating such conditions through inspection, anterior rhinoscopy, endoscopy, and rhinomanometry. Surgical straightening of the septum (septoplasty) is usually the treatment for more significant deviations. The document also discusses epistaxis (nosebleeds), their causes, evaluation, and treatments including cauterization, packing, and finding and treating the source of bleeding.
Dental tissues and their replacements/ oral surgery courses
Septal deviation /certified fixed orthodontic courses by Indian dental academy
1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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A congenital or traumatically acquired bending or bowing of the nasal
septum
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2. Mild forms do not cause
symptoms and have no
pathologic significance
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3. 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
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4.
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
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5.
The treatment of choice is surgical straightening
of the deviated septum (septoplasty)
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6. 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
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9. The treatment of choice is “functional
septorhinoplasty,” with correction of the
nasal septum and external nose
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10. Nosebleed is a relatively common, usually
harmless symptom that may reflect a
number of diseases of variable severity
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13. Nosebleed requires a simultaneous,
coordinated protocol of diagnostic and
therapeutic actions
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14.
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
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15.
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
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16. General measures:
The nostrils are compressed against the nasal
septum
2. 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
1.
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17.
Mild epistaxis from Kiesselbach’s area can often
be controlled by selective local cauterization
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18. For severe epistaxis, the anterior nasal
cavity can be packed with ointmentimpregnated gauze strips
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19.
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
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20.
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
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24. Crepitus noted on palpation confirms the
suspicion of a fracture
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25. Further diagnostic measures
include radiographs of the
nose in the lateral projection
Standard sinus projections to
exclude bony involvement of
the lateral midface
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27.
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
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28. 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
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31. Palpation:
Concomitant soft-tissue swelling can make it
difficult or impossible to palpate sites of bony
discontinuity or displacement
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32. Sensory testing
Wisps of cotton can be used to test sensory
function on the healthy and affected sides
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33. 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
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34.
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
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35. CT Scans
be helpful to obtain a more discriminating view of
the fracture and also to exclude an involvement of
the anterior skull base
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39.
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
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45.
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)
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46. 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
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50. Computed tomography
Axial 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
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51. Testing of hearing and balance
Olfactory testing
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52.
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
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54. 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
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55. 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
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56. 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
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57. 1.
2.
3.
4.
5.
Define the paradoxical cyanosis.
Name four common nasal deformity.
Where is the common site of epistaxis in
old age?
What is the most definitive sign for nasal
fracture?
Name six common symptoms for
frontobasal fracture.
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58. Inflammations of the External Nose, Nasal Cavity,
and Facial Soft Tissues
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59. Folliculitis: the disease is confined to the
hair follicles.
Furuncle: the infection spreads to deeper
tissues and forms a central core of purulent
liquefaction.
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60.
Nasal furuncles present as painful,
tender, erythematous swellings
about the nasal tip and nares
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61.
Antibiotic that is active against staphylococci:
Dicloxacillin sodium , Cephalexin and so on
2. Combined with the local application of an
antibiotic-containing ointment
1.
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62.
Inadequate treatment or manipulations of the
nasal furuncle itself can result in:
Hematogenous spread to intracranial structures
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63. 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)
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64. High fever
Feeling of tension in the soft tissues
Rapidly 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
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65. The treatment of choice is the parenteral
administration of penicillin
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67. Acute rhinitis (common cold) is the most
prevalent infectious disease
Rhinoviruses and coronaviruses comprise
almost half of the causative organisms of
acute viral rhinitis
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68. 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.
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69.
Viral damage to the epithelium promotes bacterial
colonization, which alters the consistency of the clear
nasal discharge, causing it to become mucopurulent.
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70.
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
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71.
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
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73. 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)
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75.
Triggered by an immediate, IgE-mediated
reaction of the immune system to any of a
number of foreign substances, particularly pollens
and animal allergens.
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76. Mainly by pollens
Disappear at the end of the pollen season
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77.
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)
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78. The clinical manifestations:
Obstructed nasal breathing
2. Sneezing attacks
3. Watery nasal discharge
4. Itching of the nose and eyes (conjunctivitis)
1.
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79.
Detailed allergy history (do the symptoms present yearround 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.
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81.
The best treatment strategy is to avoid contact
with the allergen or eliminate allergenic irritants
Pharmacologic treatment
1.
3.
Mast-cell stabilizers
Local and systemic H1 antihistamines
Local steroids
Immunotherapy or hyposensitization therapy
Surgical options
2.
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82. 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
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83. Obstructed nasal breathing
Watery nasal discharge
Sneezing
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.”
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84. 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
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85. For intractable vasomotor rhinitis is
surgical reduction of the turbinates a
septoplasty should be performed.
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86. 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.
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87. Primary atrophic rhinitis is unknown
Secondary forms
Extensive prior tumor resection
2. Excessive use of nose drops drug abuse (cocaine)
3. Previous radiotherapy for nasal and sinus tumors
1.
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88. Conservative:
Symptomatic measures (saline “nasal douche,”
soothing mucosal ointments).
Surgery :
reduce the nasal cavity by the submucous
implantation of cartilage grafts.
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89. Occurs mainly during pregnancy and is
believed to be caused by estrogen-induced
swelling of the mucosa with nasal airway
obstruction.
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90. This disease occurs mainly as a side effect
from the long-term use of decongestant
nose drops
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92. Intranasal anatomic changes such as:
Septal deviation
Septal spurs
Chronic inflammation
Allergy
Trauma
Neoplasms
The common pathogenic mechanism is impaired
ventilation of the ostiomeatal unit
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93. Chronic sinusitis frequently affects the
maxillary sinus and ethmoid cells
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94. Pain (from feeling of pressure to persistent
or recurrent headaches)
Nasopharyngeal drainage (postnasal drip)
Obstructed nasal breathing
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98. The modern surgical treatment of chronic
sinusitis is performed intranasally under
endoscopic or microscopic control.
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99. Genetic causes
Chronic irritation of the mucosa, like that
occurring in chronic rhinitis or sinusitis
In response to allergic rhinitis and
acetylsalicylic acid (ASA) intolerance
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101. Nasal polyps are rarely observed in
children.
Most occur in a setting of cystic fibrosis.
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102. 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.
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105. The prognosis is guarded even with modern
surgical techniques most meticulous
ablative sinus surgery cannot prevent a
recurrence
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106. 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.
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107. Presents as an isolated, tense
swelling over the anterior wall
of the frontal sinus
It may also cause inferolateral
displacement of the orbital
contents
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108. Swelling in the cheek area
with upward displacement of
the orbital contents
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109. Proptosis, limited ocular
movements, and diplopia may
also occur, depending on the
location of the mass.
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113.
They occur with highest frequency in children
under 6 years of age
Orbital edema
2. Periosteitis
3. Subperiosteal abscess
4. Orbital cellulitis
5. Orbital apex syndrome
6. Cavernous sinus thrombosis
1.
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119. The treatment of choice is surgical
eradication of the affected bone under
antibiotic coverage
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120. Epidural, subdural and
intracerebral abscesses
Meningitis
Sinus Thrombosis and
Thrombophlebitis
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121. 1.
2.
3.
4.
5.
What is so serious regarding nasal
foliculitis?
Name the common symptoms of sinusitis.
When orbit shift to the inferolateral the
mucocel perhaps is located in …. sinus.
Name the causes of sinonasal polyposis.
Subdural abscess is more common when
the ….. Sinus is involved.
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122. Thank you
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