The Nose

Nasal Septum
Paranasal Sinus Anatomy
Paranasal Sinus Anatomy
Paranasal Sinus Anatomy
Paranasal Sinus Anatomy
Adenoids
Deviated Nasal Septum
(Caudal Dislocation)
Investigations:
• CT scan PNS to see
if there is sinusitis
• Acoustic rhinometry
 Deviated Nasal Septum
(Caudal Dislocation)

Treatment: Septoplasty Operation

Deviated Nasal septum
Deviated Nasal septum
Deviated Nasal septum
Fracture Nasal Bones

Investigation:
Plain X-ray nasal bones
Fracture Nasal Bone
Treatment:
• If presenting early:
– If there is no edema:
Immediate reduction
by Walsham’s
forceps under G.A.
– If there is edema:
anti-edema measures
till edema subsides
then reduction
• If presenting late:
(more than 3 weeks):
Rhinoplasty operation
Fracture Nasal Bone
Nasal Polyp

Investigations:
• CT scan PNS
• Biopsy
• Tests for allergy
e.g. skin sensitivity
test or serum Ig E
 Nasal Polyp

Treatment: Excision via Functional Endoscopic

Sinus surgery (FESS)
Nasal Polyp
Nasal Polyp
Nasal Polyps
Nasal Polyp
 Antro-Choanal Polyp

Investigations: CT scan PNS & Biopsy

Treatment: Endoscopic Excision
or Radical antrostomy operation “if recurrent”.
Septal perforation
Investigations:
• CT scan PNS
• Investigations to diagnose
the cause e.g. for Syphilis
TPI, FTA or Tuberclin test
for TB
Treatment:
• Alkaline nasal wash for
removal of the Crusts.
• Oily drops to moisture the
nose for dryness
• Closure by Silastic Septal
button.
• Closure by mucosal flaps.
 Septal Button

Use: To close Septal perforation

Orbital complication of sinusitis
Investigations:
• CT scan PNS &
orbit
• Eye assessment
• C&S of discharge
Treatment:
External or
endoscopic
Drainage of the
affected sinus
Orbital complication of sinusitis
Orbital complication of sinusitis
Orbital complication of sinusitis
 Maxillary Sinus Tumour

Investigations: Treatment:
• CT scan PNS •Excision (Maxillectomy)
• Biopsy for histopathology •Radio &/or Chemotherapy
Rhinoscleroma
Investigations:
• Biopsy for histopathology
• Swab for C&S for bacillus
of Frish.
Treatment:
In granulomatous stage:
Antibiotics as Rifampicine
or Quinolones
In stage of fibrosis:
Recanalization of nose by
laser or scalpel
Oro-antral Fistula
Investigations:
• CT scan PNS
• C&S for discharge if
infected
Treatment:
• Presenting early:
1. Conservative
2. 1ry sutures
• Presenting late:
1. Radical antrostomy
2. Closure by palatal or
buccal flap
 Rigid Nasal Endoscope
(Sinoscope)

USES:
– Nasal examination
– Endoscopic sinus surgery ESS
 Flexible Fibro-optic
NasoPharyngoLaryngoscope

USES: To examine:
• Nasal cavity
• Pharynx
• Larynx
 Nasal dressing forceps

Uses:
– To do anterior nasal pack
– Remove F.B. or crusts from the nose
– Apply packs soaked with local anaesthesia in nose
Nasal dressing forceps
 Nasal speculum

• Uses:
1. Anterior rhinoscopy
2. Used during nasal surgery
Nasal speculum
Posterior rhinoscopy mirror
Use:
Posterior rhinoscopy
to examine:
3. The nasopharynx
4. Posterior part of
the septum & nose
 Nasal packs
Anterior nasal pack Anterior & posterior
nasal pack
Anterior and Posterior nasal pack

Uses:
Nasal packing in:
– Epistaxis
– Post operative
Epistaxis Balloon (Nasal Tampons)
For anterior & posterior nasal packing

• Uses: Nasal packing in:

• Epistaxis
• Post operative after nasal surgery
Epistaxis Balloon (Nasal Tampons)
For anterior nasal packing
The Larynx
Laryngeal Anatomy
Indirect Laryngoscopy
 Laryngeal Mirror

Uses: Indirect laryngoscopy to:

1. Asses vocal folds mobility
2. Diagnose laryngeal & hypopharyngeal lesions
Laryngeal Telescope

Uses: To examine:
1. Larynx
2. hypopharynx
Normal Larynx
Vocal Fold Polyp
Treatment:
Excision via micro-
laryngeal surgery
“MLS”
Vocal Fold Polyp
Vocal Fold Polyp
Vocal Fold Polyp
Vocal Fold Polyp
Vocal Fold Nodules

Treatment:
• Voice therapy
• If failed
Removal by laser
or MLS
Vocal Fold Nodules
Vocal Fold Nodules
Vocal Fold Nodules
Vocal Fold Nodules
 Vocal Fold Cyst

Treatment: Excision by MLS

Vocal Fold Cyst
Vocal Fold Cyst
Vocal Fold Cyst
Vocal Fold Cyst
Reinke’s Oedema
Treatment:
• Voice therapy and
stopping of smoking
“in early cases
“

• Excision via MLS

“in advanced cases”
Reinke’s Oedema
Leucoplakia of the Vocal Folds

• Investigations: Treatment:
• DL & biopsy • Excision via MLS (stripping
of the VF) &Histopathology
• Stroboscopy
• Constant follow up
Cancer Larynx
Investigations:
2. CT scan neck
3. DL & biopsy
Treatment:
According to stage:
Partial or total
laryngectomy &/or
Radiotherapy
Cancer Larynx
Cancer Larynx
Cancer Larynx
Cancer Larynx
Cancer Larynx
Cancer Larynx
Acute Epiglottitis
Investigations
Plain X-ray lateral view
neck “swollen epiglottis”
Treatment:
• Ensure patent air way:
– Corticosteroids
– If severe stridor do
endotracheal tube or
tracheostomy
• Antibiotics against H.
influenza
 Laryngeal Papilloma

Treatment:
Excision by MLS, better with LASER
Laryngeal Papilloma
Right Vocal Fold Paralysis
Investigations:
• CT scan neck from
base of skull down to
upper chest.!!
• Laryngeal
photography &
Stroboscopy
Laryngeal Web
Investigations:
• DL
• Laryngeal
photography
Treatment:
• Excision by LASER
through MLS
Laryngeal Web
Laryngeal Web
Laryngomalacia
Investigation:
• DL
• Laryngeal
photography
Treatment:
• Conservative (prone
position)
• Rarely tracheostomy
in cases of severe
stridor
Laryngomalacia
The Pharynx
 Tongue Depressor

Uses:
– Examine the oral cavity and the oropharynx
– The metallic is used in Cold mirror test
Acute Follicular Tonsillitis

Investigations:
– Tonsillar swab for C&S
– C.B.C.
 Acute Follicular Tonsillitis

• Treatment:
– Rest, antipyretics & analgesics
– Broad spectrum Antibiotic (e.g.amoxicillin + clavulinic acid)
for 10 days
Acute Follicular Tonsillitis
Acute Follicular Tonsillitis
Acute Follicular Tonsillitis
Acute Follicular Tonsillitis
Chronic Tonsillitis
Invetstigations:
• Pre-operative
investigations (POI )
e.g. CBC, PT,PTT, BT.

• ESR
Treatment:
• Tonsillectomy
Chronic Tonsillitis
(Kissing Tonsils)
Chronic Tonsillitis
(Kissing Tonsils)
Oral Moniliasis
Investigations:
• Swab for fungal
culture
• Investigations for the
cause e.g. CBC, Blood
sugar
Treatment:
• Stop the antibiotics,
good diet and vitamins.
• Local antifungal
(nystatin or Daktarin)
• Systemic antifungal in
severe cases
Post-Tonsillectomy Membrane
Post-Tonsillectomy Membrane
Peritonsiller Abscess
(Quinsy)
Peritonsiller Abscess
(Quinsy)
Investigation:
• C&S for the pus
during drainage
Treatment:
• Antibiotics
• Incision and drainage
with Quinsy knife or
guarded scalpel
• Tonsillectomy later on
(after 4 - 6 weeks)
Peritonsiller Abscess
(Quinsy)
Peritonsiller Abscess
(Quinsy)
 Aphthous Ulcer

Treatment:
2. Analgesics
3. Analgesic, antiseptic paints
Aphthous Ulcer
Aphthous Ulcer
 Herpes Simplex

Treatment: 1. Acyclovir systemically and locally.

2. Local analgesics& antiseptic paints.
Ludwig's Angina
Treatment:
• Antibiotics
• Incision and
drainage through
submental incision
• If respiratory
obstruction: do
tracheostomy
• Control source of
infection (carious
tooth)
Ludwig's Angina
Direct Laryngoscope
Uses:
Direct Laryngoscopy:
– Diagnostic for
laryngeal &
hypopharyngeal
lesions
– Biopsy
Laryngeal surgery:
– MicroLaryngeal
surgery (MLS) or
LASER surgery
Direct Laryngoscope
Direct Laryngoscope
Direct Laryngoscope
 Flexible Fibro-optic
NasoPharyngoLaryngoscope
 Flexible Fibro-optic
NasoPharyngoLaryngoscope
Tracheostomy Tube
Uses:
• Bypass upper
airway obstruction:
– Cancer larynx
– Bilateral VF
paralysis
• Allows easy
bronchial suction
e.g. comatosed
patient