INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
A congenital or traumatically acqu...
Mild forms do not cause
symptoms and have no
pathologic significance

www.indiandentalacademy.com
More pronounced degrees of septal
curvature can obstruct nasal breathing
and may also cause olfactory
impairment due to in...


Septal subluxation is a special form in which the anterior
septal margin is displaced from the median plane. This
condi...


The treatment of choice is surgical straightening
of the deviated septum (septoplasty)

www.indiandentalacademy.com
Deformities may be congenital or traumatically
acquired
The most common deformities are a crooked nose,
humped nose, saddl...
www.indiandentalacademy.com


Inspection



Anterior rhinoscopy




Endoscopy

www.indiandentalacademy.com
 The treatment of choice is “functional

septorhinoplasty,” with correction of the
nasal septum and external nose

www.in...
 Nosebleed is a relatively common, usually

harmless symptom that may reflect a
number of diseases of variable severity

...
1.
2.
3.
4.
5.
6.
7.
8.

Perforation
traumatic
iatrogenic
Inflammatory
spurs or ridges
Foreign bodies
rhinoliths
trauma (i...
1.
2.
3.
4.
5.

6.
7.

Atherosclerosis
Infection
Pregnancy
Diabetes mellitus
Congenital: e.g.,
hemophilia A and B,
Willebr...
 Nosebleed requires a simultaneous,

coordinated protocol of diagnostic and
therapeutic actions

www.indiandentalacademy....


The diagnostic work-up begins with blood
pressure measurement.



Except in very minor cases, the Hb should also be
de...


The nasal cavity is inspected by
anterior rhinoscopy or endoscopy
following decongestion and local
anesthesia of the mu...
 General measures:

The nostrils are compressed against the nasal
septum
2. the patient is told not to swallow blood runn...


Mild epistaxis from Kiesselbach’s area can often
be controlled by selective local cauterization

www.indiandentalacadem...
 For severe epistaxis, the anterior nasal

cavity can be packed with ointmentimpregnated gauze strips

www.indiandentalac...


The most common source of bleeding from the
posterolateral part of the nasal cavity is the
sphenopalatine artery (branc...


The main indications for surgery are changes in the
nasal septum such as septal spurs, ridges, and
perforations.



Tr...
www.indiandentalacademy.com
 The nasal pyramid is predisposed to

fractures because of its exposed location.

www.indiandentalacademy.com
Inspection

www.indiandentalacademy.com
 Crepitus noted on palpation confirms the

suspicion of a fracture

www.indiandentalacademy.com
 Further diagnostic measures

include radiographs of the
nose in the lateral projection
 Standard sinus projections to

...
1.

Subperichondria
l hemorrhage
with hematoma

2.

Septal Abcess

www.indiandentalacademy.com


Lateral midfacial fractures are usually caused by
blunt trauma to the side of the face.



Affected structures of the ...
 An isolated fracture of the orbital floor with

a partial herniation of the orbital contents
into the maxillary sinus is...
 Facial asymmetry
 Limited mouth opening
 Diplopia
 Sensory disturbances

www.indiandentalacademy.com
 Inspection

Swelling
2. subcutaneous hemorrhage
3. Asymmetry of the affected facial
4. Enophthalmos
1.

www.indiandental...
 Palpation:


Concomitant soft-tissue swelling can make it
difficult or impossible to palpate sites of bony
discontinuit...
 Sensory testing


Wisps of cotton can be used to test sensory
function on the healthy and affected sides

www.indianden...
 Radiographs


Whenever a lateral midfacial fracture is
suspected, standard sinus radiographs should be
obtained (occipi...


The zygomatic arches may be poorly visualized in
standard projections, and so a “bucket handle”
view should be added wh...
 CT Scans


be helpful to obtain a more discriminating view of
the fracture and also to exclude an involvement of
the an...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com


Surgical treatment



is unnecessary for undisplaced, asymptomatic fractures
is indicated for displaced fractures or f...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Central midfacial fractures (Le Fort I-III)
 Frontobasal fractures (Escher classification)

www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com


Frontobasal fractures occupy a special place
among skull fractures because they are usually an
“indirectly open” injury...
 Unilateral or bilateral periorbital

hematoma
 Dish face: the midface has been separated
from the skull base and displa...
www.indiandentalacademy.com
www.indiandentalacademy.com
Glucose test
β2-transferrin

www.indiandentalacademy.com
 Computed tomography
 Axial scans are for evaluating the anterior and

posterior walls of the frontal sinuses and spheno...
 Testing of hearing and balance
 Olfactory testing

www.indiandentalacademy.com


Every confirmed fracture of the anterior
skull base should be treated surgically in
operable patients, regardless of wh...
www.indiandentalacademy.com
 Life-threatening rise of intracranial

pressure due to intracranial hemorrhage

 Bleeding from the nose or sinuses that...
Open brain injury
 Dural tear from an indirectly open head injury
 Penetrating foreign bodies and impalement
injuries
 ...
Displaced bone fragments
 Fractures involving the drainage tracts of the
paranasal sinuses (“ostiomeatal unit”)
 Acute o...
1.
2.
3.
4.
5.

Define the paradoxical cyanosis.
Name four common nasal deformity.
Where is the common site of epistaxis i...
Inflammations of the External Nose, Nasal Cavity,
and Facial Soft Tissues

www.indiandentalacademy.com
 Folliculitis: the disease is confined to the

hair follicles.



Furuncle: the infection spreads to deeper
tissues and ...


Nasal furuncles present as painful,
tender, erythematous swellings
about the nasal tip and nares

www.indiandentalacade...


Antibiotic that is active against staphylococci:

Dicloxacillin sodium , Cephalexin and so on
2. Combined with the loca...


Inadequate treatment or manipulations of the
nasal furuncle itself can result in:
Hematogenous spread to intracranial s...
 Causative organisms are beta-hemolytic

group A streptococci

 Less common pathogens are streptococci

of other groups,...
 High fever
 Feeling of tension in the soft tissues
 Rapidly by broad areas of erythema and

swelling, which are sharpl...
 The treatment of choice is the parenteral

administration of penicillin

www.indiandentalacademy.com
www.indiandentalacademy.com
 Acute rhinitis (common cold) is the most

prevalent infectious disease

 Rhinoviruses and coronaviruses comprise

almos...
 Dry stage
 Malaise (lethargy, headache, fever) and local

discomfort in the nose and nasopharynx (burning,
soreness).
...


Viral damage to the epithelium promotes bacterial
colonization, which alters the consistency of the clear
nasal dischar...


Treatment consists of supportive measures to
relieve nasal obstruction and prevent sinusitis and
other sequelae by the ...


Nonspecific chronic rhinitis can develop due to
anatomic changes (e.g., marked septal deviation,
septal spur) or other ...
 Patients present clinically with:

Obstructed nasal breathing
2. Mucous nasal discharge
3. Frequent throat clearing and ...
 The most important step is to eliminate the

cause by removing chronic irritants from
the environment or by surgically c...
Tuberculosis
 Sarcoidosis
 Rhinoscleroma
 Actinomycosis
 Syphilis
 Wegner
Granulomatosis


www.indiandentalacademy.c...


Triggered by an immediate, IgE-mediated
reaction of the immune system to any of a
number of foreign substances, particu...
 Mainly by pollens
 Disappear at the end of the pollen season

www.indiandentalacademy.com


Is caused by year-round allergen exposure



The predominant causative allergens are house
dust, pet dander, and molds...
 The clinical manifestations:

Obstructed nasal breathing
2. Sneezing attacks
3. Watery nasal discharge
4. Itching of the...


Detailed allergy history (do the symptoms present yearround or only during contact with certain animals or
plants).


...
www.indiandentalacademy.com


The best treatment strategy is to avoid contact
with the allergen or eliminate allergenic irritants



Pharmacologic t...
 Resembles allergic rhinitis in its clinical

features, but there is no evidence that the
patient has been previously sen...
 Obstructed nasal breathing
 Watery nasal discharge
 Sneezing


The history shows that the symptoms are related
to a t...
 Medical therapy includes

Antihistamines
 corticosteroid-containing nasal sprays




In the Kneipp system of therapy,...
 For intractable vasomotor rhinitis is

surgical reduction of the turbinates a
septoplasty should be performed.

www.indi...
 Characterized by pronounced dryness of

the nasal mucosa.
 Severe cases, especially with secondary

bacterial colonizat...
 Primary atrophic rhinitis is unknown
 Secondary forms

Extensive prior tumor resection
2. Excessive use of nose drops d...
 Conservative:
 Symptomatic measures (saline “nasal douche,”

soothing mucosal ointments).
 Surgery :


reduce the nas...
 Occurs mainly during pregnancy and is

believed to be caused by estrogen-induced
swelling of the mucosa with nasal airwa...
 This disease occurs mainly as a side effect

from the long-term use of decongestant
nose drops

www.indiandentalacademy....


Antihypertensive drugs




Beta-blockers,
Angiotensin-converting enzyme (ACE) inhibitors



Oral contraceptive



C...
 Intranasal anatomic changes such as:



Septal deviation
Septal spurs

 Chronic inflammation
 Allergy

 Trauma

 N...
 Chronic sinusitis frequently affects the

maxillary sinus and ethmoid cells

www.indiandentalacademy.com
 Pain (from feeling of pressure to persistent

or recurrent headaches)

 Nasopharyngeal drainage (postnasal drip)
 Obst...
 Rhinoscopy
 Endoscopy
 Imaging studies

www.indiandentalacademy.com
www.indiandentalacademy.com
 Conservative treatment options
 Appropriate antiallergic therapy
 Sinus surgery

www.indiandentalacademy.com
 The modern surgical treatment of chronic

sinusitis is performed intranasally under
endoscopic or microscopic control.

...
 Genetic causes
 Chronic irritation of the mucosa, like that

occurring in chronic rhinitis or sinusitis
 In response t...
www.indiandentalacademy.com
 Nasal polyps are rarely observed in

children.
 Most occur in a setting of cystic fibrosis.

www.indiandentalacademy.co...
 Obstructed nasal breathing
 Hyposmia or anosmia

Headache
 Snoring
 Rhinophonia clausa
 Frequent throat clearing


...
 Rhinoscopic or endoscopic evaluation
 Computed tomography
 Allergy tests
 Olfactory testing

www.indiandentalacademy....
 Conservative measures



Use of corticoid containing nasal sprays
Systemic antihistamines
Systemic steroids



Surgica...
 The prognosis is guarded even with modern

surgical techniques most meticulous
ablative sinus surgery cannot prevent a
r...
 Adhesions due to

Postinflammatory
 Post-traumatic
 Postoperative


 The most common site of occurrence is the

fron...
 Presents as an isolated, tense

swelling over the anterior wall
of the frontal sinus


It may also cause inferolateral
...
 Swelling in the cheek area

with upward displacement of
the orbital contents

www.indiandentalacademy.com
 Proptosis, limited ocular

movements, and diplopia may
also occur, depending on the
location of the mass.

www.indianden...
 Computed tomography
 MRI

www.indiandentalacademy.com
 The treatment of choice is surgical removal

of the mucocele

www.indiandentalacademy.com
www.indiandentalacademy.com


They occur with highest frequency in children
under 6 years of age

Orbital edema
2. Periosteitis
3. Subperiosteal absc...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Osteomyelitis occurs mainly as a

complication of frontal sinusitis

www.indiandentalacademy.com


The patient presents clinically with
a tender, doughy, erythematous
swelling over the forehead

www.indiandentalacademy...
 Cranial CT scans

www.indiandentalacademy.com
 The treatment of choice is surgical

eradication of the affected bone under
antibiotic coverage

www.indiandentalacademy...
 Epidural, subdural and

intracerebral abscesses
 Meningitis
 Sinus Thrombosis and
Thrombophlebitis

www.indiandentalac...
1.
2.
3.
4.
5.

What is so serious regarding nasal
foliculitis?
Name the common symptoms of sinusitis.
When orbit shift to...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Septal deviation /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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Septal deviation /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com A congenital or traumatically acquired bending or bowing of the nasal septum www.indiandentalacademy.com
  2. 2. Mild forms do not cause symptoms and have no pathologic significance www.indiandentalacademy.com
  3. 3. More pronounced degrees of septal curvature can obstruct nasal breathing and may also cause olfactory impairment due to inadequate ventilation of the olfactory groove. Deficient nasal airflow can also lead to paranasal sinus sequelae such as headaches and recurrent sinusitis. A large septal spur that comes into contact with the nasal turbinates can cause epistaxis www.indiandentalacademy.com
  4. 4.  Septal subluxation is a special form in which the anterior septal margin is displaced from the median plane. This condition is readily identified by external inspection of the nasal base.  Further clinical examination consists of anterior rhinoscopy or endoscopy.  The degree of nasal obstruction can be objectively evaluated by rhinomanometry.  For medicolegal reasons, olfactory testing should always be done prior to surgical treatment www.indiandentalacademy.com
  5. 5.  The treatment of choice is surgical straightening of the deviated septum (septoplasty) www.indiandentalacademy.com
  6. 6. Deformities may be congenital or traumatically acquired The most common deformities are a crooked nose, humped nose, saddle nose, and broad nose, which may occur separately or in combinations www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
  8. 8.  Inspection  Anterior rhinoscopy   Endoscopy www.indiandentalacademy.com
  9. 9.  The treatment of choice is “functional septorhinoplasty,” with correction of the nasal septum and external nose www.indiandentalacademy.com
  10. 10.  Nosebleed is a relatively common, usually harmless symptom that may reflect a number of diseases of variable severity www.indiandentalacademy.com
  11. 11. 1. 2. 3. 4. 5. 6. 7. 8. Perforation traumatic iatrogenic Inflammatory spurs or ridges Foreign bodies rhinoliths trauma (including nose picking) www.indiandentalacademy.com 1. 2. 3. 4. 5. allergy acute rhinitis Traumatic aneurysm of the internal carotid Benign neoplasms malignant neoplasms
  12. 12. 1. 2. 3. 4. 5. 6. 7. Atherosclerosis Infection Pregnancy Diabetes mellitus Congenital: e.g., hemophilia A and B, Willebrand disease Acquired: e.g., anticoagulant therapy, Hepatocellular insufficiency www.indiandentalacademy.com 1.   1. Platelet disorders Congenital Acquired: uremia, dysproteinemia, adverse effects of dextrann and acetylsalicylic acid (ASA) therapy Schönlein– Henoch purpura Osler disease
  13. 13.  Nosebleed requires a simultaneous, coordinated protocol of diagnostic and therapeutic actions www.indiandentalacademy.com
  14. 14.  The diagnostic work-up begins with blood pressure measurement.  Except in very minor cases, the Hb should also be determined, and a coagulation disorder should be excluded by determining the platelet count, bleeding time, thromboplastin time, partial thromboplastin time (PTT), and thrombin time www.indiandentalacademy.com
  15. 15.  The nasal cavity is inspected by anterior rhinoscopy or endoscopy following decongestion and local anesthesia of the mucosa.  In most cases the bleeding site is in Kiesselbach’s area www.indiandentalacademy.com
  16. 16.  General measures: The nostrils are compressed against the nasal septum 2. the patient is told not to swallow blood running down the pharynx. 3. The patient is kept in an upright posture 4. An ice bag can be placed on the back of the neck to induce reflex vasoconstriction 5. An intravenous line should be placed if bleeding is severe 1. www.indiandentalacademy.com
  17. 17.  Mild epistaxis from Kiesselbach’s area can often be controlled by selective local cauterization www.indiandentalacademy.com
  18. 18.  For severe epistaxis, the anterior nasal cavity can be packed with ointmentimpregnated gauze strips www.indiandentalacademy.com
  19. 19.  The most common source of bleeding from the posterolateral part of the nasal cavity is the sphenopalatine artery (branch of the maxillary artery), which can be coagulated or clipped under endoscopic control www.indiandentalacademy.com
  20. 20.  The main indications for surgery are changes in the nasal septum such as septal spurs, ridges, and perforations.  Treatment consists of straightening the nasal septum (septoplasty or closing the septal perforation (e.g., by implanting an auricular cartilage graft and using local mucosal flap advancement www.indiandentalacademy.com
  21. 21. www.indiandentalacademy.com
  22. 22.  The nasal pyramid is predisposed to fractures because of its exposed location. www.indiandentalacademy.com
  23. 23. Inspection www.indiandentalacademy.com
  24. 24.  Crepitus noted on palpation confirms the suspicion of a fracture www.indiandentalacademy.com
  25. 25.  Further diagnostic measures include radiographs of the nose in the lateral projection  Standard sinus projections to exclude bony involvement of the lateral midface www.indiandentalacademy.com
  26. 26. 1. Subperichondria l hemorrhage with hematoma 2. Septal Abcess www.indiandentalacademy.com
  27. 27.  Lateral midfacial fractures are usually caused by blunt trauma to the side of the face.  Affected structures of the bony facial skeleton are the maxillary sinus, orbit, and the zygoma or zygomatic arch www.indiandentalacademy.com
  28. 28.  An isolated fracture of the orbital floor with a partial herniation of the orbital contents into the maxillary sinus is a special type of lateral midfacial fracture called a blow-out fracture www.indiandentalacademy.com
  29. 29.  Facial asymmetry  Limited mouth opening  Diplopia  Sensory disturbances www.indiandentalacademy.com
  30. 30.  Inspection Swelling 2. subcutaneous hemorrhage 3. Asymmetry of the affected facial 4. Enophthalmos 1. www.indiandentalacademy.com
  31. 31.  Palpation:  Concomitant soft-tissue swelling can make it difficult or impossible to palpate sites of bony discontinuity or displacement www.indiandentalacademy.com
  32. 32.  Sensory testing  Wisps of cotton can be used to test sensory function on the healthy and affected sides www.indiandentalacademy.com
  33. 33.  Radiographs  Whenever a lateral midfacial fracture is suspected, standard sinus radiographs should be obtained (occipitomental and occipitofrontal projections to define the extent of the bony discontinuity or displacement www.indiandentalacademy.com
  34. 34.  The zygomatic arches may be poorly visualized in standard projections, and so a “bucket handle” view should be added when a concomitant zygomatic arch fracture is suspected www.indiandentalacademy.com
  35. 35.  CT Scans  be helpful to obtain a more discriminating view of the fracture and also to exclude an involvement of the anterior skull base www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39.  Surgical treatment  is unnecessary for undisplaced, asymptomatic fractures is indicated for displaced fractures or fractures that are causing symptoms such as sensory deficits in the distribution of the infraorbital nerve, diplopia on upward gaze, enophthalmos, restricted jaw opening, or facial asymmetry.   Treatment consists of reduction and fixation of the bone fragments using miniplates, interosseous wiring, or both www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42.  Central midfacial fractures (Le Fort I-III)  Frontobasal fractures (Escher classification) www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com
  45. 45.  Frontobasal fractures occupy a special place among skull fractures because they are usually an “indirectly open” injury that creates a communication between the cranial cavity and the environment lead to life-threatening intracranial complications (e.g., meningitis, brain abscess) www.indiandentalacademy.com
  46. 46.  Unilateral or bilateral periorbital hematoma  Dish face: the midface has been separated from the skull base and displaced inward  Cerebrospinal fluid (CSF) rhinorrhea  Vision loss  Diplopia  Cerebral prolapse  Anosmia www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. Glucose test β2-transferrin www.indiandentalacademy.com
  50. 50.  Computed tomography  Axial scans are for evaluating the anterior and posterior walls of the frontal sinuses and sphenoid sinus  Coronal scans more clearly define the ethmoid roof and cribriform plate www.indiandentalacademy.com
  51. 51.  Testing of hearing and balance  Olfactory testing www.indiandentalacademy.com
  52. 52.  Every confirmed fracture of the anterior skull base should be treated surgically in operable patients, regardless of whether or not a CSF leak has been detected www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54.  Life-threatening rise of intracranial pressure due to intracranial hemorrhage  Bleeding from the nose or sinuses that is refractory to conservative treatment  Bleeding from an open skull injury that is refractory to conservative treatment www.indiandentalacademy.com
  55. 55. Open brain injury  Dural tear from an indirectly open head injury  Penetrating foreign bodies and impalement injuries  Early complications (e.g., meningitis, encephalitis, brain abscess)  Late complications (e.g., meningitis, brain abscess, osteomyelitis)  Orbital complications  www.indiandentalacademy.com
  56. 56. Displaced bone fragments  Fractures involving the drainage tracts of the paranasal sinuses (“ostiomeatal unit”)  Acute or chronic sinusitis at the time of the injury  Post-traumatic sinus inflammation, mucopyocele formation  Supraorbital nerve injury due to an adjacent fracture  www.indiandentalacademy.com
  57. 57. 1. 2. 3. 4. 5. Define the paradoxical cyanosis. Name four common nasal deformity. Where is the common site of epistaxis in old age? What is the most definitive sign for nasal fracture? Name six common symptoms for frontobasal fracture. www.indiandentalacademy.com
  58. 58. Inflammations of the External Nose, Nasal Cavity, and Facial Soft Tissues www.indiandentalacademy.com
  59. 59.  Folliculitis: the disease is confined to the hair follicles.  Furuncle: the infection spreads to deeper tissues and forms a central core of purulent liquefaction. www.indiandentalacademy.com
  60. 60.  Nasal furuncles present as painful, tender, erythematous swellings about the nasal tip and nares www.indiandentalacademy.com
  61. 61.  Antibiotic that is active against staphylococci: Dicloxacillin sodium , Cephalexin and so on 2. Combined with the local application of an antibiotic-containing ointment 1. www.indiandentalacademy.com
  62. 62.  Inadequate treatment or manipulations of the nasal furuncle itself can result in: Hematogenous spread to intracranial structures www.indiandentalacademy.com
  63. 63.  Causative organisms are beta-hemolytic group A streptococci  Less common pathogens are streptococci of other groups, Staphylococcus aureus, and gram-negative rods (e.g., Klebsiella pneumoniae) www.indiandentalacademy.com
  64. 64.  High fever  Feeling of tension in the soft tissues  Rapidly by broad areas of erythema and swelling, which are sharply demarcated from unaffected skin  The tissue is warm to the touch, and small blisters occasionally form www.indiandentalacademy.com
  65. 65.  The treatment of choice is the parenteral administration of penicillin www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67.  Acute rhinitis (common cold) is the most prevalent infectious disease  Rhinoviruses and coronaviruses comprise almost half of the causative organisms of acute viral rhinitis www.indiandentalacademy.com
  68. 68.  Dry stage  Malaise (lethargy, headache, fever) and local discomfort in the nose and nasopharynx (burning, soreness).  Catarrhal stage  Watery, initially serous nasal discharge and nasal obstruction due to mucosal swelling, which mainly involves the turbinates. www.indiandentalacademy.com
  69. 69.  Viral damage to the epithelium promotes bacterial colonization, which alters the consistency of the clear nasal discharge, causing it to become mucopurulent. www.indiandentalacademy.com
  70. 70.  Treatment consists of supportive measures to relieve nasal obstruction and prevent sinusitis and other sequelae by the use of decongestant nose drops  Antibiotics may also be prescribed in patients with bacterial superinfection or paranasal sinus involvement www.indiandentalacademy.com
  71. 71.  Nonspecific chronic rhinitis can develop due to anatomic changes (e.g., marked septal deviation, septal spur) or other lesions of the nasal cavity (polyps, tumors) and nasopharynx (adenoids)  Environmental factors such as sustained extreme temperatures or air pollutants can also bring on this condition www.indiandentalacademy.com
  72. 72.  Patients present clinically with: Obstructed nasal breathing 2. Mucous nasal discharge 3. Frequent throat clearing and occasional hoarseness 1. www.indiandentalacademy.com
  73. 73.  The most important step is to eliminate the cause by removing chronic irritants from the environment or by surgically correcting any intranasal pathology (e.g., septoplasty) www.indiandentalacademy.com
  74. 74. Tuberculosis  Sarcoidosis  Rhinoscleroma  Actinomycosis  Syphilis  Wegner Granulomatosis  www.indiandentalacademy.com Fungal infections 1. Aspergillosis 2. Mucormycosis 3. Rhinosporidiosis 
  75. 75.  Triggered by an immediate, IgE-mediated reaction of the immune system to any of a number of foreign substances, particularly pollens and animal allergens. www.indiandentalacademy.com
  76. 76.  Mainly by pollens  Disappear at the end of the pollen season www.indiandentalacademy.com
  77. 77.  Is caused by year-round allergen exposure  The predominant causative allergens are house dust, pet dander, and molds  The disease may also be caused by certain foods (e.g., strawberries, nuts, eggs, fish) as well as occupational exposure to allergens (e.g., bakers and hairdressers) www.indiandentalacademy.com
  78. 78.  The clinical manifestations: Obstructed nasal breathing 2. Sneezing attacks 3. Watery nasal discharge 4. Itching of the nose and eyes (conjunctivitis) 1. www.indiandentalacademy.com
  79. 79.  Detailed allergy history (do the symptoms present yearround or only during contact with certain animals or plants).  Seasonal allergic rhinitis, a bluish-purple discoloration of the mucosa.  Perennial rhinitis, the mucosa is bright red and shows inflammatory changes.  Careful allergy testing is necessary to identify the antigens involved. www.indiandentalacademy.com
  80. 80. www.indiandentalacademy.com
  81. 81.  The best treatment strategy is to avoid contact with the allergen or eliminate allergenic irritants  Pharmacologic treatment 1. 3. Mast-cell stabilizers Local and systemic H1 antihistamines Local steroids  Immunotherapy or hyposensitization therapy  Surgical options 2. www.indiandentalacademy.com
  82. 82.  Resembles allergic rhinitis in its clinical features, but there is no evidence that the patient has been previously sensitized.  Neurovascular autonomic disturbances in regulating the tonus of the nasal mucosal vessels www.indiandentalacademy.com
  83. 83.  Obstructed nasal breathing  Watery nasal discharge  Sneezing  The history shows that the symptoms are related to a temperature change, the consumption of hot liquid or alcohol, or less specifically to “emotional stress.” www.indiandentalacademy.com
  84. 84.  Medical therapy includes Antihistamines  corticosteroid-containing nasal sprays   In the Kneipp system of therapy, ice-cold water is sniffed up the nose as a way of “training” the neuroautonomic regulation of the blood supply to the nasal mucosa www.indiandentalacademy.com
  85. 85.  For intractable vasomotor rhinitis is surgical reduction of the turbinates a septoplasty should be performed. www.indiandentalacademy.com
  86. 86.  Characterized by pronounced dryness of the nasal mucosa.  Severe cases, especially with secondary bacterial colonization, are marked by a fetid nasal odor that is not perceived by the patient due to degeneration of the olfactory epithelium. www.indiandentalacademy.com
  87. 87.  Primary atrophic rhinitis is unknown  Secondary forms Extensive prior tumor resection 2. Excessive use of nose drops drug abuse (cocaine) 3. Previous radiotherapy for nasal and sinus tumors 1. www.indiandentalacademy.com
  88. 88.  Conservative:  Symptomatic measures (saline “nasal douche,” soothing mucosal ointments).  Surgery :  reduce the nasal cavity by the submucous implantation of cartilage grafts. www.indiandentalacademy.com
  89. 89.  Occurs mainly during pregnancy and is believed to be caused by estrogen-induced swelling of the mucosa with nasal airway obstruction. www.indiandentalacademy.com
  90. 90.  This disease occurs mainly as a side effect from the long-term use of decongestant nose drops www.indiandentalacademy.com
  91. 91.  Antihypertensive drugs   Beta-blockers, Angiotensin-converting enzyme (ACE) inhibitors  Oral contraceptive  Clinical symptoms consist of obstructed nasal breathing, dry mucosa, and occasional olfactory disturbances. www.indiandentalacademy.com
  92. 92.  Intranasal anatomic changes such as:   Septal deviation Septal spurs  Chronic inflammation  Allergy  Trauma  Neoplasms  The common pathogenic mechanism is impaired ventilation of the ostiomeatal unit www.indiandentalacademy.com
  93. 93.  Chronic sinusitis frequently affects the maxillary sinus and ethmoid cells www.indiandentalacademy.com
  94. 94.  Pain (from feeling of pressure to persistent or recurrent headaches)  Nasopharyngeal drainage (postnasal drip)  Obstructed nasal breathing www.indiandentalacademy.com
  95. 95.  Rhinoscopy  Endoscopy  Imaging studies www.indiandentalacademy.com
  96. 96. www.indiandentalacademy.com
  97. 97.  Conservative treatment options  Appropriate antiallergic therapy  Sinus surgery www.indiandentalacademy.com
  98. 98.  The modern surgical treatment of chronic sinusitis is performed intranasally under endoscopic or microscopic control. www.indiandentalacademy.com
  99. 99.  Genetic causes  Chronic irritation of the mucosa, like that occurring in chronic rhinitis or sinusitis  In response to allergic rhinitis and acetylsalicylic acid (ASA) intolerance www.indiandentalacademy.com
  100. 100. www.indiandentalacademy.com
  101. 101.  Nasal polyps are rarely observed in children.  Most occur in a setting of cystic fibrosis. www.indiandentalacademy.com
  102. 102.  Obstructed nasal breathing  Hyposmia or anosmia Headache  Snoring  Rhinophonia clausa  Frequent throat clearing   Spread to the lower airways can lead to laryngitis with hoarseness and bronchitic symptoms. www.indiandentalacademy.com
  103. 103.  Rhinoscopic or endoscopic evaluation  Computed tomography  Allergy tests  Olfactory testing www.indiandentalacademy.com
  104. 104.  Conservative measures  Use of corticoid containing nasal sprays Systemic antihistamines Systemic steroids  Surgical treatment   www.indiandentalacademy.com
  105. 105.  The prognosis is guarded even with modern surgical techniques most meticulous ablative sinus surgery cannot prevent a recurrence www.indiandentalacademy.com
  106. 106.  Adhesions due to Postinflammatory  Post-traumatic  Postoperative   The most common site of occurrence is the frontal sinus, followed by the ethmoid cells, maxillary sinus, and sphenoid sinus. www.indiandentalacademy.com
  107. 107.  Presents as an isolated, tense swelling over the anterior wall of the frontal sinus  It may also cause inferolateral displacement of the orbital contents www.indiandentalacademy.com
  108. 108.  Swelling in the cheek area with upward displacement of the orbital contents www.indiandentalacademy.com
  109. 109.  Proptosis, limited ocular movements, and diplopia may also occur, depending on the location of the mass. www.indiandentalacademy.com
  110. 110.  Computed tomography  MRI www.indiandentalacademy.com
  111. 111.  The treatment of choice is surgical removal of the mucocele www.indiandentalacademy.com
  112. 112. www.indiandentalacademy.com
  113. 113.  They occur with highest frequency in children under 6 years of age Orbital edema 2. Periosteitis 3. Subperiosteal abscess 4. Orbital cellulitis 5. Orbital apex syndrome 6. Cavernous sinus thrombosis 1. www.indiandentalacademy.com
  114. 114. www.indiandentalacademy.com
  115. 115. www.indiandentalacademy.com
  116. 116.  Osteomyelitis occurs mainly as a complication of frontal sinusitis www.indiandentalacademy.com
  117. 117.  The patient presents clinically with a tender, doughy, erythematous swelling over the forehead www.indiandentalacademy.com
  118. 118.  Cranial CT scans www.indiandentalacademy.com
  119. 119.  The treatment of choice is surgical eradication of the affected bone under antibiotic coverage www.indiandentalacademy.com
  120. 120.  Epidural, subdural and intracerebral abscesses  Meningitis  Sinus Thrombosis and Thrombophlebitis www.indiandentalacademy.com
  121. 121. 1. 2. 3. 4. 5. What is so serious regarding nasal foliculitis? Name the common symptoms of sinusitis. When orbit shift to the inferolateral the mucocel perhaps is located in …. sinus. Name the causes of sinonasal polyposis. Subdural abscess is more common when the ….. Sinus is involved. www.indiandentalacademy.com
  122. 122. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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