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

www.indiandenta...
History
 CC:

“I can’t breath through the left side of
my nose”

• What else do you want to ask the patient?
• HPI:
•
•
•...
Physical Exam
 Eyes:

EOMI, PERRL, no diplopia, no
proptosis
 Ears: TM’s clear
 Nose: Left nasal mass, edematous,
obstr...
Diagnostic Studies
 CT:

evaluate bony destruction
 MRI: evaluate soft tissue, differentiate
mucous from mass

www.india...
Differential Diagnosis
 V– hemangioma, AVM, juvenile nasoangiofibroma, hamartoma
 I – sinusitis, nasal polyposis, mucoce...
Esthesioneuroblastoma
 Epidemiology:
– Male:female (1:1)
– Bimodal distribution 2nd and 6th decades

 Pathophyisiology:
...
Spectrum of lesions



Broad range of lesions arise
from the olfactory mucosa
Diverse cell poplulation in the
olfactory ...
Histology
 Histologic

grading based on Hyams criteria

Grade I: 14%
Grade II: 48%

Grade III: 21%
Grade IV: 17%

 Progn...
Immunohistochemistry

www.indiandentalacademy.com
Histology

www.indiandentalacademy.com
Grading System


Kadish system
Stage A: limited to nasal cavity
Stage B: Extends into paranasal sinuses
Stage C: Extends ...
Grading Systems
Distribution of Patients:
 Kadish
– Stage A 12%
– Stage B 27%
– Stage C 61%

 Dulguerov
–
–
–
–
–

and C...
Treatment
 Surgery

and Radiation therapy is most commonly
accepted modality of treatment
 Chemotherapy may be indicated...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Nasal obstruction /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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Nasal obstruction /certified fixed orthodontic courses by Indian dental academy

  1. 1. Nasal Obstruction INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. History  CC: “I can’t breath through the left side of my nose” • What else do you want to ask the patient? • HPI: • • • • • 6-8 mo h/o left nasal obstruction. Slowly progressive Occasional epistaxis when bends over Decreased sense of smell left nasal passage No visual changes, no headaches www.indiandentalacademy.com
  3. 3. Physical Exam  Eyes: EOMI, PERRL, no diplopia, no proptosis  Ears: TM’s clear  Nose: Left nasal mass, edematous, obstructing almost entire nasal passage  OC/OP: No masses/lesions  Neck: no LAD  CN: II-XII intact www.indiandentalacademy.com
  4. 4. Diagnostic Studies  CT: evaluate bony destruction  MRI: evaluate soft tissue, differentiate mucous from mass www.indiandentalacademy.com
  5. 5. Differential Diagnosis  V– hemangioma, AVM, juvenile nasoangiofibroma, hamartoma  I – sinusitis, nasal polyposis, mucocele, allergic rhinitis, T – acquired nasal deformity  A – Wegener’s granulomatosis, relapsing polychondritis  M – none  I – Sarcoid, rhinitis medimentosum  N – mucosal melanoma, lymphoma, nasopharyngeal carcinoma, extramedullary plasmacytoma, adenoid cystic carcinoma, adenocarcinoma, squamous cell ca, papillomas, fibrous dysplasia, osteoma, hemangiopericytoma, esthesioneuroblastoma, sarcomas, SNUC  C – teratomas, dermoid,  D – none www.indiandentalacademy.com
  6. 6. Esthesioneuroblastoma  Epidemiology: – Male:female (1:1) – Bimodal distribution 2nd and 6th decades  Pathophyisiology: – Neuroectodermal origin – Arise from olfactory mucosa – Common symptoms:   Unilateral nasal obstruction (70%)* Epistaxis (46%)* * Irish J, Dasgupta R, Freeman J, et al. Outcome and analysis of the surgical management of esthesioneuroblastoma J Otolaryngol 1997; 26:1-7. www.indiandentalacademy.com
  7. 7. Spectrum of lesions   Broad range of lesions arise from the olfactory mucosa Diverse cell poplulation in the olfactory mucosa – Sensory neurons – Sustentacular cells – Basal cells  Within olfactory neuroblastoma a spectrum exists www.indiandentalacademy.com
  8. 8. Histology  Histologic grading based on Hyams criteria Grade I: 14% Grade II: 48% Grade III: 21% Grade IV: 17%  Prognostically grouped as high or low grade  Low grade: 56%, High grade 25% www.indiandentalacademy.com *Pilch B. Head and Neck Surgical Pathology. Lippencott. Philadelphia. 2001
  9. 9. Immunohistochemistry www.indiandentalacademy.com
  10. 10. Histology www.indiandentalacademy.com
  11. 11. Grading System  Kadish system Stage A: limited to nasal cavity Stage B: Extends into paranasal sinuses Stage C: Extends beyond nasal cavity and paranasal sinuses  Dulguerov and Calcaterra* T1: nasal cavity/paranasal sinuses (not sphenoid or superior most ethmoids) T2: includes sphenoid w/ extension to/erosion of cribiform plate T3: extends into orbit or anterior cranial fossa w/o dural invasion T4: tumor involving brain N0: no cervical lymphadenopathy N1: any cervical metastasis M0: no metastases M1: distant metastases * Dulguerov P, Allal A, Calcaterra T. Esthesioneuroblastoma: a meta-analysis and review. Lancet Oncol. www.indiandentalacademy.com 2001; 2:683-690.
  12. 12. Grading Systems Distribution of Patients:  Kadish – Stage A 12% – Stage B 27% – Stage C 61%  Dulguerov – – – – – and Calcaterra T1 25% T2 25% T3 33% T4 17% N1 5% 5 year survival:  Kadish – Stage A 72% – Stage B 59% – Stage C 47%  Dulguerov – – – – – – and Calcaterra T1 81% T2 93% T3 59% T4 48% N0 64% N1 29% *Dulguerov P, Allal A, Calcaterra T. Esthesioneuroblastoma: a meta-analysis and review. www.indiandentalacademy.com Lancet Oncol. 2001; 2:683-690.
  13. 13. Treatment  Surgery and Radiation therapy is most commonly accepted modality of treatment  Chemotherapy may be indicated for advanced lesions but is controversial*  Treatment of the neck is controversial** *Eden BV, Debo RF, Larner JM, et al. Esthesioneruroblastoma: long-term outcome and patters of failure-the University of Virginia experience. Cancer. 1994;73:2556-2562. ** Davis RE, Weissler MC. Esthesioneuroblastom and neck metastasis. Head Neck. 1992;14:477-482. www.indiandentalacademy.com
  14. 14. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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