INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com


Four sessions:

1.

Anatomy, Physiology, and Immunology of the Nose, Paranasal Sinuses, and
Face

2.

History and Clini...
 Including:
1. Initial assessment: 10 min
2. Lesson delivery: 60 min
3. Discussion: 15 min
4. Question and problems of pr...
Anatomy, Physiology, and Immunology of the Nose, Paranasal
Sinuses, and Face

www.indiandentalacademy.com


Basic Anatomy of the Nose, Paranasal Sinuses, and Face



Morphology of the Nasal Mucosa



Basic Physiology and Immu...
•The relaxed skin tension lines

(RSTLs):
Scars can be made less
conspicuous by taking these
tension lines into account
•T...
Knowing the various
components of the bony facial
skeleton and their
relationship to one another
is important in trauma
ma...
www.indiandentalacademy.com
Nasal Vestibule
Nasal Septum
Nasal Valve
Lateral nasal Wall
Choana

www.indiandentalacademy.com
Bony Structure:
1.Maxilla

2.Ethmoid
3.Palatine

4.Inferior Turbinate
5.Sphenoid

Functional apparatus:
1.Turbinate
2.Meat...
Roof:
1.Cribriform palate
2.Ethmoid fovea

Floor:
Hard palate
1.Maxilla (Ant)
2.Palatine (Pos)

www.indiandentalacademy.co...
Air-filled cavities that
communicate with the
nasal cavities
All but the sphenoid sinus are
present as outpunching of the
...


Medial:
Lateral nasal wall



Superior:
Orbital floor



Posterior:
Pterygopalatine fossa



Inferior:
Alveolar ridg...


Medial:
Middle turbinate



Superior:
Fovea ethmoidalis ( Ant
cranial fossa)



Posterior:
Sphenoid sinus



Lateral...


Inferior:
Nasopharynx



Superior:
Ant and middle cranial
fossa , Sellae tursica



Posterior:
Clivus and posterior
c...
Inferior:

Orbital roof
Posterior:

Anterior cranial fossa

www.indiandentalacademy.com
www.indiandentalacademy.com
Innervation

www.indiandentalacademy.com
Muscular attachments

www.indiandentalacademy.com
www.indiandentalacademy.com
Mucus:

Squamous epithelium
Respiratory Mucosa
Olfactory Mucosa

Respiratory Mucosa:
1.Epithelium

2.Lamina Properia:
...
Nose is of major importance in conditioning
the air before it reaches the lower airways

www.indiandentalacademy.com
Nasal Air Flow

Laminar vs Turbulent

Nasal Cycle

Regulate by autonomic

nervous system
80% of human each 2 hours

www....
Humidification
Temperature regulation

www.indiandentalacademy.com
Nonspecific Defense
Mechanisms
1.Mechanical defenses

(mucociliary apparatus)
2. Nonspecific protective
factors (Interfero...
Various organ systems are involved in the production of voice and speech:
Glottis,
 Supraglottic vocal tract,
 Central n...


The human olfactory system consists of

1.
2.

Intranasal olfactory mucosa
Primary olfactory center
Secondary olfactory...
1.
2.
3.
4.
5.

Name the main the nasal septum
structure.
Name the functions of the nose?
The major artery of the nose is ...
History and Clinical Examination of the Nose; Tumors of the External
Nose and Face

www.indiandentalacademy.com
 Patients

should be given an opportunity to
describe their complaints “in their own
words,”

www.indiandentalacademy.com
 Nasal

obstruction
 Discharge
 Epistaxis
 Specific allergy history
 Headaches
 Olfactory dysfunction
 Facial press...

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Acute and chronic rhinitis (e.g., allergic, atrophic)
• Sinusitis
• Deviated septum (con...

1.
2.
3.
4.

1.
2.
3.
4.
5.

Transport of odorants
Nasal obstruction Deviated septum,
mucosal
swelling, polyps, tumor
S...
 Inspection
1. Mouth

breathing
2. Shape of the external nose
3. Skin changes such as erythema

www.indiandentalacademy.c...
 Palpation
 Useful

for detecting bony discontinuities
 In patients with suspected neuralgias

www.indiandentalacademy....
 To evaluate the nasal vestibule

and the anterior portions of the
nasal cavity

www.indiandentalacademy.com


Posterior rhinoscopy was formerly done to evaluate
the nasopharynx and posterior nasal cavity
(choanae, posterior ends ...


Nasal endoscopy has become the
most important and rewarding
clinical examination method in
rhinologic diagnosis

www.in...


First the examiner advances the
endoscope into the nasopharynx
and inspects:

Eustachian tube orifice
 Torus tubarius
...
 Nasal endoscopy is particularly

useful for evaluating the
ostiomeatal unit

www.indiandentalacademy.com
www.indiandentalacademy.com
 Nasal Patency:
 Hold a reflective metal plate under the nose
 Holding a wisp of cotton in front of each

nostril
 Act...
 Skin Tests
 The total immunoglobulin E (IgE) assay
 Nasal provocation test

www.indiandentalacademy.com
 The total immunoglobulin E (IgE) assay

www.indiandentalacademy.com


Several types of test substance are used:

1.

Pure odorants that stimulate only the olfactory nerve (coffee, cocoa,
va...
 Objective olfactory testing is far more costly

and is generally performed only at large
centers

www.indiandentalacadem...
 Conventional Radiographs
 Computed Tomography (CT)
 Magnetic Resonance Imaging
 Ultrasonography

www.indiandentalacad...
 Limited indication these days

www.indiandentalacademy.com
 Water projection
 Caldwell

 Acute inflammation
 To evaluate midfacial fractures

www.indiandentalacademy.com
CALDWELL

WATERS

www.indiandentalacademy.com
 If there is a high index of suspicion for

sphenoid sinus involvement, a lateral sinus
projection should be added to the...
 Indications
 An occasional malformation,
 The main indications for CT scanning of the

nose and paranasal sinuses are
...
www.indiandentalacademy.com
www.indiandentalacademy.com
 The normal mucosal lining of the sinuses is

not visualized.
 The bony sinus walls appear hyperdense

(white)

www.indi...
www.indiandentalacademy.com
The strength of MRI
lies in its superior
soft-tissue
discrimination

www.indiandentalacademy.com


Disorders that involve the paranasal sinuses in
addition to the cranial cavity or orbit (e.g., tumors
and congenital ma...
 Patients with electrically controlled devices

such as a cardiac pacemaker, insulin pump,
cytostatic pump, or cochlear i...
 The paranasal sinuses can also be visualized

with ultrasound.
 The sphenoid sinus is inaccessible to

ultrasound imagi...
www.indiandentalacademy.com
1.
2.

Inverted
Papilloma
Osteomas

www.indiandentalacademy.com


It is a locally aggressive tumor, and transformation
to squamous cell carcinoma is periodically described



Symptoms ...


Benign bone tumors that may occur as isolated
masses, especially in the ethmoid cells and frontal
sinus



Symptoms an...


Malignant tumors of the nasal cavity and paranasal sinuses are far
more common than benign masses.



Histologically, ...
 The main sites of predilection are the nasal

cavity and maxillary sinus, followed by the
ethmoid cells, frontal sinus, ...
 Because many tumors originate in the

paranasal sinuses themselves, they often do
not produce clinical manifestations un...












Obstructed nasal breathing
Bloody rhinorrhea
Fetid nasal odor
Swelling of the buccal soft tissues
S...
 Unilateral sinusitis that is refractory to

treatment

www.indiandentalacademy.com


The clinical examination includes



Endoscopic inspection of the nasal cavity



Search for regional lymph-node meta...


Since sinus tumors are apt to invade the nasal cavity
secondarily, endoscopy alone may provide little
information on th...
www.indiandentalacademy.com
www.indiandentalacademy.com


is individualized according to the histology and extent of
the malignant tumor, and the treatment plan should be
coordi...


Since only about 20% of sinonasal malignancies
metastasize to regional lymph nodes, a neck dissection is
necessary only...


Is a rare neurogenic malignancy that arises from the
sensory cells of the olfactory region and generally occurs
in adul...
is based on endoscopy and
especially computed tomography or
magnetic resonance imaging; only
these modalities can accurate...


Based on a combination of tumor resection and
postoperative radiotherapy

www.indiandentalacademy.com
1.
2.
3.
4.
5.

Name five more common sinonasal
symptoms.
How you check the nasal patency?
What imaging modality is the be...
Malformations of the Nose, Paranasal Sinuses,
and Face

www.indiandentalacademy.com


Malformations involving the nose may be
caused by developmental abnormalities of
the nasal floor, palate, nasal roof, a...
Incidence of one in 5000 to one in 10,000 births.
More often unilateral than bilateral.
The atresia is bony in 90% of case...


Bilateral choanal atresia is an acutely life
threatening emergency because the neonate,
except when crying, is an oblig...


Unilateral choanal atresia may be manifested by a
purulent nasal discharge on the affected side.

www.indiandentalacade...


Choanal atresia may be associated with various
other anomalies:



CHARGE syndrome (coloboma; heart disease; atresia
o...


The clinical suspicion of choanal
atresia can be confirmed by
examination with a rigid or flexible
endoscope

www.india...


The acute care of choanal atresia in asphyxia consists of
intubation followed by perforation of the atresia plate



T...


Incidence of dysraphias involving the anterior

skull base is approximately one in 20,000 to one in
40,000 births

www....
 Various manifestations that include:

Dorsal nasal fistulas
2. Dermoids
3. Frontonasal extracerebral gliomas
4. Frontona...
 A dorsal nasal fistula consists of a fistulous tract

that is lined by keratinized squamous epithelium
and forms a tiny ...


Fistulas that terminate blindly are usually
manifested clinically at an older age due to
inflammation around the fistul...


The diagnosis is established by computed
tomography or magnetic resonance imaging.



Diagnostic catheterization or co...


Treatment consists of complete removal
of the fistulous tract

www.indiandentalacademy.com


Cephaloceles are herniations of intracranial
contents through a bony defect in the skull

www.indiandentalacademy.com


Most cephaloceles are congenital, but rare cases
are post-traumatic

www.indiandentalacademy.com
 Sincipital cephaloceles are located near the

glabella, forehead or orbit.
 Basal cephaloceles are found mainly in the ...
Most are manifested
clinically during
childhood.
The sincipital forms
appear as:
a pulsating mass near
the glabella, often...
 Basal forms present as :

an intranasal mass, typically with associated
nasal airway obstruction.
They closely resemble ...


Computed tomography (CT) and magnetic
resonance imaging (MRI)

www.indiandentalacademy.com


Always surgical and consists of removing the
cephalocele and repairing the dural defect

www.indiandentalacademy.com
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Nose and paranasal sinuses according to new reference 1 /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Nose and paranasal sinuses according to new reference 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2.  Four sessions: 1. Anatomy, Physiology, and Immunology of the Nose, Paranasal Sinuses, and Face 2. History and Clinical Examination of the Nose; Tumors of the External Nose and Face 3. Malformations and common disorders of the Nose, Paranasal Sinuses, and Face 4. Inflammations of the External Nose, Nasal Cavity, and Facial Soft Tissues Estimated time for each session is 100 min www.indiandentalacademy.com
  3. 3.  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 www.indiandentalacademy.com
  4. 4. Anatomy, Physiology, and Immunology of the Nose, Paranasal Sinuses, and Face www.indiandentalacademy.com
  5. 5.  Basic Anatomy of the Nose, Paranasal Sinuses, and Face  Morphology of the Nasal Mucosa  Basic Physiology and Immunology of the Nose www.indiandentalacademy.com
  6. 6. •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 soft-tissue defects www.indiandentalacademy.com
  7. 7. Knowing the various components of the bony facial skeleton and their relationship to one another is important in trauma management and also in the diagnosis and treatment o inflammatory diseases of the facial skeleton and their complications. www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9. Nasal Vestibule Nasal Septum Nasal Valve Lateral nasal Wall Choana www.indiandentalacademy.com
  10. 10. Bony Structure: 1.Maxilla 2.Ethmoid 3.Palatine 4.Inferior Turbinate 5.Sphenoid Functional apparatus: 1.Turbinate 2.Meatus 3.Sinus ostia 4.Nasolacrimal duct orifice www.indiandentalacademy.com
  11. 11. Roof: 1.Cribriform palate 2.Ethmoid fovea Floor: Hard palate 1.Maxilla (Ant) 2.Palatine (Pos) www.indiandentalacademy.com
  12. 12. 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. www.indiandentalacademy.com
  13. 13.  Medial: Lateral nasal wall  Superior: Orbital floor  Posterior: Pterygopalatine fossa  Inferior: Alveolar ridge ( root of second premolar and first molar) www.indiandentalacademy.com
  14. 14.  Medial: Middle turbinate  Superior: Fovea ethmoidalis ( Ant cranial fossa)  Posterior: Sphenoid sinus  Lateral: Lamina papyruses ( orbit) www.indiandentalacademy.com
  15. 15.  Inferior: Nasopharynx  Superior: Ant and middle cranial fossa , Sellae tursica  Posterior: Clivus and posterior cranial fossa  Lateral: Optic nerve Internal carotid Cavernous sinus www.indiandentalacademy.com
  16. 16. Inferior: Orbital roof Posterior: Anterior cranial fossa www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. Innervation www.indiandentalacademy.com
  19. 19. Muscular attachments www.indiandentalacademy.com
  20. 20. www.indiandentalacademy.com
  21. 21. 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) www.indiandentalacademy.com
  22. 22. Nose is of major importance in conditioning the air before it reaches the lower airways www.indiandentalacademy.com
  23. 23. Nasal Air Flow Laminar vs Turbulent Nasal Cycle Regulate by autonomic nervous system 80% of human each 2 hours www.indiandentalacademy.com
  24. 24. Humidification Temperature regulation www.indiandentalacademy.com
  25. 25. 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 www.indiandentalacademy.com
  26. 26. Various organ systems are involved in the production of voice and speech: Glottis,  Supraglottic vocal tract,  Central nervous system  must be coordinated in order to produce a normal voice sound  Hyponasal speech (rhinophonia clausa) : occurs when these segments contribute less to sound production as a result of partial or complete nasal obstruction or mass lesions in the nasopharynx  Hypernasal speech (rhinophonia aperta): develops when the nasopharynx and nasal cavities over contribute to sound production. cleft palate, velar palsy due to various causes www.indiandentalacademy.com
  27. 27.  The human olfactory system consists of 1. 2. Intranasal olfactory mucosa Primary olfactory center Secondary olfactory center Tertiary olfactory center 3. 4.  The precise sequence of events that are involved in olfaction is still uncertain. www.indiandentalacademy.com
  28. 28. 1. 2. 3. 4. 5. Name the main the nasal septum structure. Name the functions of the nose? The major artery of the nose is …. Sphenoid sinus is drained to …. Orbital cellulitis is seen often due to … sinus involvement. www.indiandentalacademy.com
  29. 29. History and Clinical Examination of the Nose; Tumors of the External Nose and Face www.indiandentalacademy.com
  30. 30.  Patients should be given an opportunity to describe their complaints “in their own words,” www.indiandentalacademy.com
  31. 31.  Nasal obstruction  Discharge  Epistaxis  Specific allergy history  Headaches  Olfactory dysfunction  Facial pressure or pain www.indiandentalacademy.com
  32. 32.  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Acute and chronic rhinitis (e.g., allergic, atrophic) • Sinusitis • Deviated septum (congenital, acquired) • Nasal pyramid fracture • Septal perforation • Nasal polyps • Cephalocele • Adenoids • Tumors of the nose, paranasal sinuses, and nasopharynx • Foreign bodies (especially in small children) • Drugs  Adverse effects: oral contraceptives, antihypertensive agents (e.g., reserpine, propranolol, hydralazine), antidepressants (e.g., amitriptyline)  Drug abuse: e.g., oxymetazoline , phenylephrine www.indiandentalacademy.com
  33. 33.  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) www.indiandentalacademy.com  1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Stimulus conduction and processing Avulsion of fila olfactoria Skull base fracture Aplasia of the olfactory bulb (rare) Kallmann syndrome Injury to olfactory centers Contusion or hemorrhage due to head injury Neurodegenerative diseases Alzheimer disease, Parkinson disease, Diabetes mellitus Olfactory hallucinations after epileptic seizures, in schizophrenia
  34. 34.  Inspection 1. Mouth breathing 2. Shape of the external nose 3. Skin changes such as erythema www.indiandentalacademy.com
  35. 35.  Palpation  Useful for detecting bony discontinuities  In patients with suspected neuralgias www.indiandentalacademy.com
  36. 36.  To evaluate the nasal vestibule and the anterior portions of the nasal cavity www.indiandentalacademy.com
  37. 37.  Posterior rhinoscopy was formerly done to evaluate the nasopharynx and posterior nasal cavity (choanae, posterior ends of the turbinates, posterior margin of the vomer)  Endoscopy is commonly used to examine this region www.indiandentalacademy.com
  38. 38.  Nasal endoscopy has become the most important and rewarding clinical examination method in rhinologic diagnosis www.indiandentalacademy.com
  39. 39.  First the examiner advances the endoscope into the nasopharynx and inspects: Eustachian tube orifice  Torus tubarius  Posterior pharyngeal wall  Roof of the nasopharynx  www.indiandentalacademy.com
  40. 40.  Nasal endoscopy is particularly useful for evaluating the ostiomeatal unit www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42.  Nasal Patency:  Hold a reflective metal plate under the nose  Holding a wisp of cotton in front of each nostril  Active anterior rhinomanometry  Acoustic rhinometry www.indiandentalacademy.com
  43. 43.  Skin Tests  The total immunoglobulin E (IgE) assay  Nasal provocation test www.indiandentalacademy.com
  44. 44.  The total immunoglobulin E (IgE) assay www.indiandentalacademy.com
  45. 45.  Several types of test substance are used: 1. Pure odorants that stimulate only the olfactory nerve (coffee, cocoa, vanilla, cinnamon, lavender) Odorants with a trigeminal component (menthol, acetic acid, formalin) Substances that also have a taste component (chloroform, pyridine). 2. 3.  Patients with a complete loss of smell (anosmia) cannot perceive pure odorants but can at least sense or taste the other substances. www.indiandentalacademy.com
  46. 46.  Objective olfactory testing is far more costly and is generally performed only at large centers www.indiandentalacademy.com
  47. 47.  Conventional Radiographs  Computed Tomography (CT)  Magnetic Resonance Imaging  Ultrasonography www.indiandentalacademy.com
  48. 48.  Limited indication these days www.indiandentalacademy.com
  49. 49.  Water projection  Caldwell  Acute inflammation  To evaluate midfacial fractures www.indiandentalacademy.com
  50. 50. CALDWELL WATERS www.indiandentalacademy.com
  51. 51.  If there is a high index of suspicion for sphenoid sinus involvement, a lateral sinus projection should be added to the study  The craniocaudal extent of the frontal and maxillary sinuses can also be evaluated with this technique www.indiandentalacademy.com
  52. 52.  Indications  An occasional malformation,  The main indications for CT scanning of the nose and paranasal sinuses are 1. Chronic sinusitis 2. Trauma (especially frontobasal fractures) 3. Tumors www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55.  The normal mucosal lining of the sinuses is not visualized.  The bony sinus walls appear hyperdense (white) www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. The strength of MRI lies in its superior soft-tissue discrimination www.indiandentalacademy.com
  58. 58.  Disorders that involve the paranasal sinuses in addition to the cranial cavity or orbit (e.g., tumors and congenital malformations such as encephaloceles)  It can also supply information that is useful in differentiating soft-tissue lesions within the paranasal sinuses (mucocele, cyst, polyp)  It can distinguish between solid tumor tissue and inflammatory perifocal reaction www.indiandentalacademy.com
  59. 59.  Patients with electrically controlled devices such as a cardiac pacemaker, insulin pump, cytostatic pump, or cochlear implant.  Modern internal fixation materials such as titanium are usually nonmagnetic and therefore MRI-compatible www.indiandentalacademy.com
  60. 60.  The paranasal sinuses can also be visualized with ultrasound.  The sphenoid sinus is inaccessible to ultrasound imaging because of its location. www.indiandentalacademy.com
  61. 61. www.indiandentalacademy.com
  62. 62. 1. 2. Inverted Papilloma Osteomas www.indiandentalacademy.com
  63. 63.  It is a locally aggressive tumor, and transformation to squamous cell carcinoma is periodically described  Symptoms and diagnosis:  Nasal airway obstruction, headache, and occasional epistaxis. The lesion often has a polyp-like appearance when inspected by nasal endoscopy    Treatment: The treatment of choice is surgical removal www.indiandentalacademy.com
  64. 64.  Benign bone tumors that may occur as isolated masses, especially in the ethmoid cells and frontal sinus  Symptoms and diagnosis:  Often they do not become symptomatic until they obstruct drainage tracts to or from the paranasal sinuses, leading secondarily to headaches and recurrent bouts of sinusitis  Treatment:  As soon as an osteoma becomes symptomatic, it should be surgically removed www.indiandentalacademy.com
  65. 65.  Malignant tumors of the nasal cavity and paranasal sinuses are far more common than benign masses.  Histologically, the great majority (> 80%) are tumors of the epithelial series (e.g., squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma).  Neoplasms of mesenchymal origin, such as osteosarcomas and chondrosarcomas, as well as malignant lymphomas are much less common.  Metastases from other malignancies are occasionally found, with the primary tumor residing in the kidney, lung, breast, testis, or thyroid gland. www.indiandentalacademy.com
  66. 66.  The main sites of predilection are the nasal cavity and maxillary sinus, followed by the ethmoid cells, frontal sinus, and sphenoid sinus. www.indiandentalacademy.com
  67. 67.  Because many tumors originate in the paranasal sinuses themselves, they often do not produce clinical manifestations until they have reached an advanced stage www.indiandentalacademy.com
  68. 68.            Obstructed nasal breathing Bloody rhinorrhea Fetid nasal odor Swelling of the buccal soft tissues Swelling at the medial canthus Headache, facial pain, and Hypoesthesia or numbness of the cheek Orbital infiltration can lead to displacement of the orbital contents, diplopia, or proptosis Trismous Epiphorea Dental loosening www.indiandentalacademy.com
  69. 69.  Unilateral sinusitis that is refractory to treatment www.indiandentalacademy.com
  70. 70.  The clinical examination includes  Endoscopic inspection of the nasal cavity  Search for regional lymph-node metastases by bimanual palpation of the cervical soft tissues. www.indiandentalacademy.com
  71. 71.  Since sinus tumors are apt to invade the nasal cavity secondarily, endoscopy alone may provide little information on the extent of the mass. For this reason, computed tomography and/or magnetic resonance imaging should always be performed www.indiandentalacademy.com
  72. 72. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74.  is individualized according to the histology and extent of the malignant tumor, and the treatment plan should be coordinated with the radiotherapist and medical oncologist.  Since the great majority of lesions are squamous cell carcinomas, however, the treatment of choice will usually consist of surgery and postoperative radiation www.indiandentalacademy.com
  75. 75.  Since only about 20% of sinonasal malignancies metastasize to regional lymph nodes, a neck dissection is necessary only in patients who have clinically positive cervical nodes  Many of these cases will require postoperative radiotherapy www.indiandentalacademy.com
  76. 76.  Is a rare neurogenic malignancy that arises from the sensory cells of the olfactory region and generally occurs in adults  Advanced, the tumor causes obstructed nasal breathing, recurrent epistaxis, and particularly hyposmia or anosmia.  Some of these tumors become symptomatic only after invading the cranial cavity or orbit, causing headache or visual deterioration www.indiandentalacademy.com
  77. 77. is based on endoscopy and especially computed tomography or magnetic resonance imaging; only these modalities can accurately define the tumor extent www.indiandentalacademy.com
  78. 78.  Based on a combination of tumor resection and postoperative radiotherapy www.indiandentalacademy.com
  79. 79. 1. 2. 3. 4. 5. Name five more common sinonasal symptoms. How you check the nasal patency? What imaging modality is the best for sinonasal evaluation? Name the common symptoms and signs of sinonasal tumor. Which tumor is specific for the nasal cavity? www.indiandentalacademy.com
  80. 80. Malformations of the Nose, Paranasal Sinuses, and Face www.indiandentalacademy.com
  81. 81.  Malformations involving the nose may be caused by developmental abnormalities of the nasal floor, palate, nasal roof, and intranasal region www.indiandentalacademy.com
  82. 82. Incidence of one in 5000 to one in 10,000 births. More often unilateral than bilateral. The atresia is bony in 90% of cases and membranous in only 10%. www.indiandentalacademy.com
  83. 83.  Bilateral choanal atresia is an acutely life threatening emergency because the neonate, except when crying, is an obligate nasal breather until about the sixth week of life.  Cyanosis that is present at rest and improves with exertion is called paradoxical cyanosis because of its opposite pattern relative to cyanosis with a cardiac cause www.indiandentalacademy.com
  84. 84.  Unilateral choanal atresia may be manifested by a purulent nasal discharge on the affected side. www.indiandentalacademy.com
  85. 85.  Choanal atresia may be associated with various other anomalies:  CHARGE syndrome (coloboma; heart disease; atresia of the choanae; retarded growth, development and/or central nervous system anomalies; genital hyperplasia; ear anomalies or deafness). www.indiandentalacademy.com
  86. 86.  The clinical suspicion of choanal atresia can be confirmed by examination with a rigid or flexible endoscope www.indiandentalacademy.com
  87. 87.  The acute care of choanal atresia in asphyxia consists of intubation followed by perforation of the atresia plate  The definitive surgical repair of bilateral choanal atresia is performed during the first weeks or months of life.  Surgery for unilateral atresia can be postponed until school age, when the anatomy of the region is more similar to that encountered in adults www.indiandentalacademy.com
  88. 88.  Incidence of dysraphias involving the anterior skull base is approximately one in 20,000 to one in 40,000 births www.indiandentalacademy.com
  89. 89.  Various manifestations that include: Dorsal nasal fistulas 2. Dermoids 3. Frontonasal extracerebral gliomas 4. Frontonasal extracerebral cephaloceles 1. www.indiandentalacademy.com
  90. 90.  A dorsal nasal fistula consists of a fistulous tract that is lined by keratinized squamous epithelium and forms a tiny opening on the dorsum or tip of the nose www.indiandentalacademy.com
  91. 91.  Fistulas that terminate blindly are usually manifested clinically at an older age due to inflammation around the fistulous opening.  If the fistula communicates with the subarachnoid space, it can lead to severe complications such as cerebrospinal fluid leakage, meningitis, or brain abscess www.indiandentalacademy.com
  92. 92.  The diagnosis is established by computed tomography or magnetic resonance imaging.  Diagnostic catheterization or contrast injection is contraindicated due to the risk of intracranial complications. www.indiandentalacademy.com
  93. 93.  Treatment consists of complete removal of the fistulous tract www.indiandentalacademy.com
  94. 94.  Cephaloceles are herniations of intracranial contents through a bony defect in the skull www.indiandentalacademy.com
  95. 95.  Most cephaloceles are congenital, but rare cases are post-traumatic www.indiandentalacademy.com
  96. 96.  Sincipital cephaloceles are located near the glabella, forehead or orbit.  Basal cephaloceles are found mainly in the nasal cavity or nasopharynx. www.indiandentalacademy.com
  97. 97. 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 www.indiandentalacademy.com
  98. 98.  Basal forms present as : an intranasal mass, typically with associated nasal airway obstruction. They closely resemble intranasal polyps and should be considered in the differential diagnosis of children with suspected nasal polyps, which are rare in this age group www.indiandentalacademy.com
  99. 99.  Computed tomography (CT) and magnetic resonance imaging (MRI) www.indiandentalacademy.com
  100. 100.  Always surgical and consists of removing the cephalocele and repairing the dural defect www.indiandentalacademy.com
  101. 101. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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