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Transcript
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: