Dr. Ramesh Parajuli,MS
Chitwan medical college teaching hospital, bharatpur-10,chitwan Nepal
Differential Dx of nasal obst...
Differential diagnosis of nasal obstruction
1.Structural: DNS, inf.turbinate
hypertrophy,concha bullosa
2.Infection: Unila...
Neoplasms of Nose and PNS
Benign
1. Papilloma
2. Ossifying Fibroma
3. Osteoma
4. Haemangioma
5. Neurofibroma
Intermediate
...
Frontal sinus osteoma
Normal medullary bone is replaced by abnormal proliferation
of fibrous tissue, resulting in distortion & expansion of bone...
•Locally aggressive sino-nasal tumour
•Synonyms: Ringertz or Schneiderian papilloma
•Common in males between 50-70 years
•...
Treatment:
•Medial maxillectomy (& ethmoidectomy)by lateral rhinotomy approach
•Tendency to recur after surgical removal
•...
Lateral rhinotomy
Epidemiology
•Maxillary sinus>ethmoid>frontal>sphenoid
•>80% are squamous cell carcinoma
•Male : female = 2:1
•Commonly se...
1. Hardwood dust (adenocarcinoma)
2. Softwood dust (squamous carcinoma)
3. Nickel refining; chromium workers
4. Boot, shoe...
Carcinoma Maxillary Sinus(Maxilla)
Early symptoms
•Mimic maxillary sinusitis
•Nasal blockage
•Blood-stained nasal discharg...
Spread
Medial spread:
Unilateral nasal obstruction
Unilateral purulent nasal
discharge
Epistaxis
Unilateral, friable, nasal mass
...
Posterior spread:
Pterygoid muscle involvement  trismus
Intracranial spread via:
Ethmoids, cribriform plate or foramen la...
Initial presentation 7 months 11 months
Diagnostic nasal endoscopy
C.T. Scan Nose & Paranasal sinus: expansion & destruction of bony wall
Biopsy
Diagnosis
C.T. Scan
Ohngren’s Classification
Lederman’s Classification
TNM Staging
T1 = Tumor confined to antral mucosa
T2 = Bone destruction of hard palate / middle meatus
T3 = Involvement of ...
Treatment
• T1 & T2 = Surgery or Radiotherapy
• T3 = Surgery + Radiotherapy
• T4 = Surgery + Radiotherapy + Chemotherapy
•...
Surgical Options
1.Total maxillectomy:
Weber Fergusson incision
Malignancy limited to maxilla
2.Radical maxillectomy (with...
Weber Fergusson incision
Osteotomy cuts
Total maxillectomy done & incision
closed
Palatal defect & prosthesis
Orbital exenteration indications
• Involvement of orbital apex
• Involvement of extra-ocular muscles
• Involvement of bulb...
Orbital exenteration
Post-operative defect & prosthesis
Cranio-facial resection
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Nasal obstruction

causes of unilateral and bilateral nasal obstructions (for undergraduates)
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Nasal obstruction

  • 1. Dr. Ramesh Parajuli,MS Chitwan medical college teaching hospital, bharatpur-10,chitwan Nepal Differential Dx of nasal obstruction & Neoplasms of Nose and PNS
  • 2. Differential diagnosis of nasal obstruction 1.Structural: DNS, inf.turbinate hypertrophy,concha bullosa 2.Infection: Unilateral sinusitis 3.Polyp: Antrochoanal polyp 4.FB 5.Neoplasms 6.Congenital:choanal atresia 7.Trauma 8.Granulomatous Dx:Rhinoscleroma 1.Infection: -Acute rhinitis -CRS, Atrophic rhinitis 2.Allergy:Allergic rhinitis 3.Non allergic,non infective: Vasomotor rhinitis 4.Adenoid hypertrophy 5.Structural: DNS 6.Trauma:Septal hematoma 7. Ethmoidal polyposis 8.Neoplasms 9.Rhinitis medicamentosa Causes of unilateral nasal obstruction Causes of Bilateral Nasal obstruction
  • 3. Neoplasms of Nose and PNS Benign 1. Papilloma 2. Ossifying Fibroma 3. Osteoma 4. Haemangioma 5. Neurofibroma Intermediate Inverted papilloma Malignant 1. Squamous cell carcinoma 2. Adenocarcinoma 3. Anaplastic carcinoma 4. Transitional cell carcinoma 5. Malignant melanoma 6. Salivary gland tumours 7. Rhabdomyosarcoma Classification
  • 4. Frontal sinus osteoma
  • 5. Normal medullary bone is replaced by abnormal proliferation of fibrous tissue, resulting in distortion & expansion of bone C.T. scan: ground - glass appearance Treatment: complete surgical excision Fibrous dysplasia
  • 6. •Locally aggressive sino-nasal tumour •Synonyms: Ringertz or Schneiderian papilloma •Common in males between 50-70 years •It arises from the lateral wall of nose •Presents as unilateral, friable, pink mass •Diagnosis made by punch biopsy Inverted papilloma
  • 7. Treatment: •Medial maxillectomy (& ethmoidectomy)by lateral rhinotomy approach •Tendency to recur after surgical removal •Squamous cell ca is present in 1015% cases •Radiotherapy is avoided
  • 8. Lateral rhinotomy
  • 9. Epidemiology •Maxillary sinus>ethmoid>frontal>sphenoid •>80% are squamous cell carcinoma •Male : female = 2:1 •Commonly seen in 45-60 years Sinonasal malignancy
  • 10. 1. Hardwood dust (adenocarcinoma) 2. Softwood dust (squamous carcinoma) 3. Nickel refining; chromium workers 4. Boot, shoe and textile workers 5. Mustard gas exposure 6. Human papilloma virus Risk factors
  • 11. Carcinoma Maxillary Sinus(Maxilla) Early symptoms •Mimic maxillary sinusitis •Nasal blockage •Blood-stained nasal discharge •Facial paraesthesia or pain •Epiphora
  • 12. Spread
  • 13. Medial spread: Unilateral nasal obstruction Unilateral purulent nasal discharge Epistaxis Unilateral, friable, nasal mass Anterior spread: Cheek swelling Invasion of facial skin Late Clinical features Inferior spread: Expansion of alveolus with dental pain Loosening of teeth, poor fitting of dentures Swelling in hard palate or alveolus Superior spread: Proptosis Diplopia Ocular pain
  • 14. Posterior spread: Pterygoid muscle involvement  trismus Intracranial spread via: Ethmoids, cribriform plate or foramen lacerum Lymphatic spread: Neck node metastases in late stages Systemic spread: Lungs, bone
  • 15. Initial presentation 7 months 11 months
  • 16. Diagnostic nasal endoscopy C.T. Scan Nose & Paranasal sinus: expansion & destruction of bony wall Biopsy Diagnosis
  • 17. C.T. Scan
  • 18. Ohngren’s Classification
  • 19. Lederman’s Classification
  • 20. TNM Staging T1 = Tumor confined to antral mucosa T2 = Bone destruction of hard palate / middle meatus T3 = Involvement of skin of cheek, floor or medial wall of orbit, ethmoid sinus, posterior antral wall, pterygoid plates, infratemporal fossa T4 = Involvement of orbital contents, cribriform plate, frontal or sphenoid sinus, skull base, nasopharynx
  • 21. Treatment • T1 & T2 = Surgery or Radiotherapy • T3 = Surgery + Radiotherapy • T4 = Surgery + Radiotherapy + Chemotherapy • Surgery  post-operative Radiotherapy after 4-6 weeks
  • 22. Surgical Options 1.Total maxillectomy: Weber Fergusson incision Malignancy limited to maxilla 2.Radical maxillectomy (with orbital exenteration): Involvement of orbital fat 3. Anterior Cranio-Facial Resection: Involvement of cribriform plate, frontal sinus
  • 23. Weber Fergusson incision
  • 24. Osteotomy cuts
  • 25. Total maxillectomy done & incision closed
  • 26. Palatal defect & prosthesis
  • 27. Orbital exenteration indications • Involvement of orbital apex • Involvement of extra-ocular muscles • Involvement of bulbar conjunctiva or sclera • Lid involvement beyond a reasonable hope for reconstruction • Non-resectable full thickness invasion through periorbita into retrobulbar fat
  • 28. Orbital exenteration
  • 29. Post-operative defect & prosthesis
  • 30. Cranio-facial resection

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