E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
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E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)

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The lecture has been given on Dec. 13th & 20th, 2010 by Dr. Yousif Chalabi.

The lecture has been given on Dec. 13th & 20th, 2010 by Dr. Yousif Chalabi.

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E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi) Presentation Transcript

  • 1. Masses of nose and paranasal sinuses
  • 2.
    • Nasal polyps
    • .its apedunculated portion of oedematous mucosa of nose and paranasal sinuses.
    • Aetiolgy
    • There are five theories of causes:
    • Bernouli phenomena.
    • Polysaccharide changes.
    • Vasomotor imbalance.
    • Infection.
    • Allergy.
  • 3.
    • 1.Conditions associated with nasal polyps:
    • a.asthma.
    • b.Aspirin hyperactivity.
    • c.Cystic fibrosis.
    • d.Kartageners syndrome.
    • e.Youngs syndrome.
  • 4.
    • Types of nasal polyps:
    • Simple polyp .
    • .it arise from a mucosal lining of ethmoid sinus through medial meatus
    • .pale insensitive to touch by probing.
    • .its multiple and bilateral.
    • .Redness is due to repeated trauma and infection which cause squamous metaplasia of the epitheliem.
  • 5.  
  • 6.
    • .its a disease of adulthood .
    • .mostly in males.
    • .there is genetic preisposition.
    • .the epithelial lining is ciliated columnar .
    • .fluid analysis shows IGE,IGA and eosinophilia in 90%.
    • .culture may shows sreptococcus and G_ve bacteria.
    • . Below 10 years of age is associated with cystic fibrosis.
  • 7.
    • C/F
    • 1. Nasal obstruction.
    • 2. Nasal congestion (watery running and sneezing.
    • 3.Partial or perminant loss of smell and taste.
    • 4.Pain due to sinusitis.
    • 5. Postnasal drip.
    • 6. Epistaxis is infrequent.
    • 0
  • 8.  
  • 9.
    • Treatment
    • Preoperative therapy :
    • .Intranasal corticosteroid , for 1 month since half of patient respond .betamethasone nasal drop 2 drop /twice/daily.
    • or beclomethasone,budesonide,fluticasone spray 2 puffs/twice/daily.
  • 10.
    • 2. Postoperative therapy :
    • .Intranasal corticosteroid, in patient with recurence or symptoms.
    • .Oral prednislone is indicated if there is no response ,5 — 30 mg/daily for 10 days with topical steroid.
  • 11.
    • Surgery
    • Simple intranasal polypectomy.
    • Intranasal ethmoidectomy.
    • External ethmoidectomy.
    • Postoperative antihistamine have no role for recurence.
  • 12.
    • 2 . Antrocoanal polyp :
    • .Arise from floor and lateral wall of maxillary antrum.
    • .Common in male.
    • .It has three parts ,antral,nasal and choanal.
    • .Its single and unilateral.
    • .It cause unilateral nasal obstruction, if large may cause bilateral obstruction mostly on expiration.
    • .It may be seen by posterior rhinoscopy.
    • .There is mucoid nasal discharge.
  • 13.  
  • 14.
    • Radiological examination :
    • Occipitomental view will show complete opacity of maxillary antrum.
    • Lateral X — Ray of postnasal view will shows shadow in nasal cavity and postnasal space .
  • 15.
    • TREATMENT:
    • .NO role of medical treatment , almost always
    • Its surgery.
    • .Simple intranasal polypectomy can be done with risk of recurence.
    • .Caldwell – Luc operation is treatment of choice with no recurrence.
  • 16.  
  • 17. Tumors . Benign tumors Epithelial tissue Connective tissue Neural tissue
  • 18.
    • Epithelial tissue tumors :
    • 1- Papiloma
      • In the nasal vestibule it may arise as a small sessile or pedunculated wart ,single or multiple.
      • Treated by excision with cautary to the base to prevent recurrence.
      • Histopathological examination is essential to exclude carcinoma.
  • 19.
      • In the nasal fossa and paranasal sinuses ,transitional or inverted papiloma, appear as gross thickening of the epithelial surface leads to infolding but the basement membrane remains intact
      • Malignant change occur in about 3% of cases
      • Rare tumors occur in men over 50 years old
      • The commonest site is on the lateral wall of the nasal cavity and or in the antrum and ethmoids ,it may be multicentric
  • 20.
      • Nasal obstruction is the presenting symptom
      • It should be removed surgically
      • Recurrence indicate malignancy
  • 21.
    • 2- Adenoma
      • Rare ,it remains encapsulated and is frequently symptomless but it may cause nasal obstruction , it may become malignant
      • Rx surgical excision
  • 22.
    • Connective tissue tumors
      • 1 – fibroma
      • Its rare tumor, the septum and turbinate are the commonest sites
      • Usually remain small and cause no symptom other than slight nasal obstruction and occasionally epistaxis
      • 2- osteoma
      • There are two main type
      • * localized compact osteoma
      • - mostly occur in the frontal sinus
      • - it may be sessile or pedunculated
      • - it has ivory – hard consistancy
  • 23.
      • Symptom usually evident in young adult
      • It may remain small and symptomless and discovered on radiographic examination
      • Displacement of the eye is sometime caused by expansion of the affected sinus .
      • Empyema or mucocele of the sinus results from obstruction of frontonasal duct
      • Pressure atrophy of the wall of the anterior cranial fossa may cause CSF rhinorrhea and intracranial infections
      • A dense bony mass with well defined edge is seen on x ray,a large one may completely fill the sinus
      • Rx:surgery if symptom develop.
  • 24.
    • 3- Angioma
      • capillary haemangioma :
        • it ’ s the commonest type ,mostly affect the nasal septum so its also known as a bleeding polypus
        • Epistaxis is the usual symptom
        • Rx by excision ,cautery of the site of origin
      • Cavernous
        • May involve the whole tip of the nose
  • 25. Capillary haemangioma
  • 26.
      • 4- Rhinophyma
      • Its not strictly a neoplasm its caused by fibrosis and hyperplasia of the sebaceous tissue of the skin of the nose
      • Swelling of the nasal tip and nostril results
      • Rx by shaving of the excessive tissue,a covering skin graft rarely necessary .
  • 27. Rhinophyma
  • 28.
    • Malignant tumors
          • Epithelial Tumors .
    • 1. Squamous cell carcinoma .
    • . It ’ s the commonest malignant tumour of nose and paranasal sinuses.
  • 29.  
  • 30.
    • .lymph node metastasis is to upper cervical and retropharyngeal groups but its uncommon.
    • .distant metastasis is also uncommon.
    • .Its seen in nickel industry.
    • 2.adenocarcinoma.
    • .it arise from glands of URT mucous membrane,especially in maxillary antrum.
  • 31.
    • .its a slow growing tumour.
    • .exposure to wood dust for along time may be the cause.
    • 3.Adenoid cystic ca ..
    • .they appear as a firm,round,localized,encapsulated tumour,especialy in the alveolus,hard palate,and antral floor.
  • 32.
    • .they tend to recur locally and spread intracranially along the cranial nerves.
    • .they are regarded as malignant.
    • .L.N metastasis is rare.
    • .its radioresistant.
    • 4.Olfactory neuroblastoma.
    • .Rare tumour ,may present as intranasal,ethmoidal,or intracranial tumour.
    • Treatment is by craniofascial resection and radiotherapy.
  • 33.
    • B.Connective tissue tumors
    • 1.Sarcoma .
    • .very rare ,it may be osteosarcoma,fibrosarcoma and lymphosarcoma.
    • .treated by radiotherapy or chemotherapy.
    • 2.Nasal lymphoma .
    • .suggested to be a T cell lymphoma.
    • .it is a slow progressive destructive tumor of the midline.
    • .treated by radiotherapy.
  • 34.
    • c.Secondary metastasis .
    • .from breast ,prostate and thyroid may affect the sinuses even many years after cure of primary one.
  • 35.
    • Sites of malignant tumors .
    • .80% of malignant tumors of the nose and paranasal sinuses are S.C.C.
    • .60% arise in the antrum .
    • .30% in the nasal cavity.
    • .10% in the ethmoidal sinuses.
    • .frontal and sphenoid sinuses are rarely affected.
  • 36.
    • C/F
    • 1. Unilateral nasal obstruction.
    • 2. Bleeding and discharge from the nose .
    • 3. Swelling of the cheek,alveolar margin,nasal bridge and palate.
    • 4. Loosening of teeth.
    • 5. Unilateral proptosis.
    • 6. Involvement of facial skin is later.
  • 37.
    • 7. Ulceration of the palate .
    • 8. Pain is relatively late facial,ear or dental.
    • 9. Epiphoria.
    • 10. Others like diplopia,trismus,limitation of jaw movement ,anosmia,optic atrophy,maxilary and frontal sinusitis.
    • 11. L.N metastasis ,deep upper cervical and retropharyngeal nodes are involved in 10 — 15% of cases.
  • 38.
            • Diagnosis.
    • 1.Radiography.
    • .cyst and benign tumors appear as awell defined shadow.
    • .Malignant tumors appear as a dense,ill defined shadow,with or without bony erosion.
    • .CT and MRI.
    • 2.Biopsy.
  • 39.
            • Treatment.
    • .Surgical excision ,radiotherapy and chemotherapy.
    • .prognosis ,5 year survival with treatment is 25---35%.
  • 40.
            • Cysts.
    • 1. Cyst associated with fusion of embryological elements forming the maxilla.
    • A. Medial groups.
    • B. Lateral groups
  • 41.
    • 2. Cyst of dental origin.
    • a.Primordial cysts.
    • b.Cyst of eruption.
    • c.Dentigerus cyst.
    • d.Dental cyst.
    • 3. Dermoid cyst, in the midline of the face may extend into the septum.
  • 42.  
  • 43.
    • 4. Mucoceles of the paranasal sinuses.
    • May be due to:
    • .blockage of mucous gland duct.
    • .cystic formation of the mucosa underlying polyposis.
    • Mucoceles mostly occur in frontal sinuses.
  • 44.
    • 1.Specific like T.B ,syphilis,leprosy,yaws,Aids
    • ,scleroma,actinomycosis, mucormycosis,leishmaniasis,rhinosporidosis,and Aspergillosis.
    Nasal granuloma
  • 45.
    • 2. Non specific like sarcoidosis,sinonasal lymphoma,and
    • wegeners granuloma: characterized by focal necrosis, vasculitis, and granuloma in upper and lower air passage and kidneys presented as epistaxis, hemoptysis, hematuria, Dx by high ESR, presence of anti-neutrophilic cytoplasmic antibody, Rx by radiotherapy or Chemotherapy.
  • 46.
            • Thank You
    • I hope I did the best and wish you the best