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Rhinologist
Assistant Professor of Mashad University of Medical Sciences
Four sessions:
1.
2.
History and Clinical Examination of the Nose; Tumors of the External Nose
and Face
3.
4.
Inflammations of the External Nose, Nasal Cavity, and Facial Soft Tissues
Including:
1.Initial assessment: 10 min
2.Lesson delivery: 60 min
3.Discussion: 15 min
4.Question and problems of previous
session: 10 min
5.A brief talking on next session: 5
min
The
relaxed skin
tension lines (RSTLs):
Scars can be made less
conspicuous by taking
these tension lines into
account
The
aesthetic units of
the face:
an important
consideration in the
treatment larger softtissue defects
Nasal Vestibule
Nasal Septum
Nasal Valve
Lateral nasal Wall
Choana
Bony Structure:
1.Maxilla
2.Ethmoid
3.Palatine
4.Inferior Turbinate
5.Sphenoid
Functional apparatus:
1.Turbinate
2.Meatus
3.Sinus ostia
4.Nasolacrimal
orifice
duct
Roof:
1.Cribriform palate
2.Ethmoid fovea
Floor:
Hard palate
1.Maxilla (Ant)
2.Palatine (Pos)
Air-filled
cavities
that
communicate
with
the
nasal
cavities
All but the sphenoid
sinus are present as
outpunching
of
the
mucosa
during
embryonic
life,
but
except for the ethmoid
air cells, they do not
develop
into
bony
cavities until after birth.
Medial:
Lateral nasal
wall
Superior:
Orbital floor
Posterior:
Pterygopalatine
fossa
Inferior:
Alveolar ridge
( root of second
premolar and first
molar)
Medial:
Middle turbinate
Superior:
Fovea
ethmoidalis ( Ant
cranial fossa)
Posterior:
Sphenoid sinus
Lateral:
Lamina
papyruses ( orbit)
Inferior:
Nasopharynx
Superior:
Ant and middle
cranial fossa ,
Sellae tursica
Posterior:
Clivus and
posterior cranial
fossa
Lateral:
Optic nerve
Internal carotid
Cavernous sinus
Inferior:
Orbital roof
Posterior:
Innervation
Muscular attachments
Mucus:
Squamous epithelium
Respiratory Mucosa
Olfactory Mucosa
Respiratory Mucosa:
1.Epithelium
2.Lamina Properia:
Venous erectile tissue
Nasal glands
Immunocompetent cells
Olfactory Mucosa:
primary olfactory center
( olfactory bulb)
secondary olfactory
center (olfactory cortex)
tertiary olfactory
centers (including the
hippocampus,
anterior insular region, and
reticular formation)
Nasal Cycle
Regulate
by
autonomic nervous
system
80% of human each 2
hours
Humidification
Temperature
regulation
Nonspecific
Defense
Mechanisms
1.Mechanical
defenses
(mucociliary apparatus)
2. Nonspecific protective
factors (Interferon,
Proteases, Protease
inhibitors , Lysozyme
Antioxidants)
3.Cellular defenses
(phagocytic cells)
Specific Immune
Responses
1.Humoral
immune
response
2.Cellular immune
response
3.The endothelial cells
4.The epithelial cells
Glottis,
Supraglottic vocal tract,
Central nervous system
must be coordinated in order to produce a normal voice sound
1.
2.
3.
4.
1.
2.
3.
4.
5.
Patients
should be given an
opportunity to describe their
complaints in their own words,
Nasal obstruction
Discharge
Epistaxis
Specific allergy history
Headaches
Olfactory dysfunction
Facial pressure or pain
1.
2.
3.
4.
1.
2.
3.
4.
5.
Transport of odorants
Nasal obstruction Deviated
septum, mucosal
swelling, polyps, tumor
Scar tissue occluding the
olfactory groove
After intranasal surgery
Perception: damage to
the olfactory epithelium
caused by:
Toxic substances SO2, NO,
ozone,
Heavy metals, varnishes
Drugs
Viral infections Influenza
Radiotherapy (rare)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Inspection
1.Mouth breathing
2.Shape of the external
3.Skin changes such as
nose
erythema
Palpation
Useful
To
Nasal
endoscopy is
particularly useful for
evaluating the
ostiomeatal unit
Nasal
Hold
Patency:
Skin
Tests
The
Nasal
provocation test
The
1.
2.
3.
Objective
Conventional Radiographs
Computed Tomography (CT)
Magnetic Resonance Imaging
Ultrasonography
Limited
Water projection
Caldwell
Acute inflammation
To evaluate midfacial
fractures
WATERS
CALDWELL
If
The
Indications
An occasional malformation,
The main indications for CT scanning
The
The
The strength of
MRI lies in its
superior softtissue
discrimination
Patients
Modern
The
The
1.
2.
Inverted
Papilloma
Osteomas
Treatment:
Treatment:
The
Because
Unilateral
1.
2.
3.
4.
5.
Various
manifestations that
include:
1. Dorsal nasal fistulas
2. Dermoids
3. Frontonasal extracerebral
4. Frontonasal extracerebral
cephaloceles
gliomas
Most are
manifested
clinically
during
childhood.
The sincipital
forms appear
as:
a pulsating mass
near the glabella,
often associated
with a broad
nasal dorsum and
hypertelorism