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

2,822 views
2,674 views

Published on

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

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,822
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
264
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

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

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

×