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DISEASES OF THE NOSE AND PARANASAL SINUSES RYAN DUNCAN, MD PGY-4 RESIDENT OTOLARYNGOLOGY-HEAD AND NECK SURGERY February 6, 2006

Ethmoid Maxilla Palatine Lacrimal Pterygoid plate of Sphenoid Nasal Inferior Turbinate Bony Structure

7 bones 4 paired sinuses 4 turbinates 3 meati Drainage system Nervous supply Vascular supply Related structures Sinus Anatomy Overview

Arterial Supply External Carotid Maxillary A. Sphenopalatine Internal Carotid Ophthalmic A. Ant. Ethmoid Post. Ethmoid Supraorbital Supratrochlear

VIRAL RHINITIS ,[object Object],[object Object],[object Object]

VIRAL RHINITIS-TREATMENT ,[object Object],[object Object],[object Object],[object Object]

Function of Paranasal Sinuses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rhinosinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Rhinosinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rhinosinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Septum MT remnant MSO CRS -”Empty nose”-Pseudomonas, Staph. aureus

Rhinosinusitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rhinosinusitis ,[object Object],[object Object],[object Object],[object Object]

Rhinosinusitis ,[object Object],[object Object],[object Object]

Techniques of Functional Endoscopic Sinus Surgery Uncinectomy LNW MT MT LNW

Techniques of Functional Endoscopic Sinus Surgery 0 degree telescope 45 degree telescope Maxillary Antrostomy MSO Accessory ostium

Why bleeding from the nose ? ,[object Object],[object Object],[object Object],[object Object]

EPISTAXIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Kesselbach’s Plexus/Little’s Area: -Anterior Ethmoid (Opth) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX ) Woodruff’s Plexus: -Pharyngeal & Post. Nasal AA of Sphenopalatine A (IMAX)

Anterior vs. Posterior ,[object Object],[object Object],[object Object]

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Etiology ,[object Object],[object Object],[object Object],[object Object]

Local Factors -- Vascular ,[object Object],[object Object],[object Object]

Local Factors - Infection/Inflammation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Local Factors - Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nasal Fracture with Septal Hematoma

Local Factors - Iatrogenic nasal injury ,[object Object],[object Object],[object Object]

Local Factors - Neoplasm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Local Factors – Dessication ,[object Object],[object Object],[object Object],[object Object],[object Object]

Local Factors - Other ,[object Object],[object Object],[object Object],[object Object]

Systemic Factors -- Vascular ,[object Object],[object Object]

Epistaxis Osler-Weber- Rendu (HHT) R L

Systemic Factors – Infection/Inflammation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Systemic Factors – Coagulopathies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Etiology and Age ,[object Object],[object Object],[object Object],[object Object]

Initial Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

suction good light anesthetic silver nitrate merocels gelfoam bacitracin endoscopes suction bovie/bipolar Afrin T.C.A. surgicel epistat bayonet forcepts vaseline gauze

Non-surgical treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Non-surgical treatments – on d/c ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Nasal packs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TSS—Nugauze vs. Merocel Electron microscopy

Posterior Packs – Admission ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications for surgery/embolization ,[object Object],[object Object],[object Object],[object Object],[object Object]

Selective Angiography/embolization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transmaxillary IMA ligation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Intraoral IMA ligation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ant./Post. Ethmoidal ligation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transnasal Endoscopic Sphenopalatine Artery ligation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Transnasal Spheno-palatine Artery ligation

ECA ligation ,[object Object],[object Object],[object Object],[object Object]

Septodermoplasty/Laser ,[object Object],[object Object],[object Object],[object Object],[object Object]

Statistically speaking,…. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Neoplasms of Nose and Paranasal Sinuses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Neoplasm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MRI demonstrating right nasal mass with no intracranial involvement Nasal mass

Neoplasms of Nose and Paranasal Sinuses ,[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Location ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Radiography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Benign Lesions ,[object Object],[object Object],[object Object],[object Object],[object Object]

NASAL POLYPS ,[object Object],[object Object],[object Object],[object Object]

Papilloma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Inverted Papilloma ,[object Object],[object Object],[object Object],[object Object]

Inverted Papilloma Resection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Osteomas ,[object Object],[object Object],[object Object],[object Object],[object Object]

Fibrous dysplasia ,[object Object],[object Object],[object Object],[object Object]

Neurogenic tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Malignant lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Squamous cell carcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object]

Adenoid Cystic Carcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mucoepidermoid Carcinoma ,[object Object],[object Object]

Adenocarcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hemangiopericytoma ,[object Object],[object Object],[object Object]

Melanoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Olfactory Neuroblastoma Esthesioneuroblastoma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sarcomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rhabdomyosarcoma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Lymphoma ,[object Object],[object Object],[object Object]

Sinonasal Undifferentiated Carcinoma (SNUC) ,[object Object],[object Object],[object Object]

Metastatic Tumors ,[object Object],[object Object]

Staging of Maxillary Sinus Tumors

Staging of Maxillary Sinus Tumors ,[object Object],[object Object],[object Object],[object Object]

Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]

Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of the Orbit ,[object Object],[object Object],[object Object]

Current indications for orbital exenteration ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object]

REFERENCES ,[object Object],[object Object],[object Object]

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