Anatomy, Physiology & Diseases of nose. Paranasal sinuses

1. CLINICAL ANATOMY AND
PHYSIOLOGY OF THE NOSE
AND PARANASAL SINUSES.
ACUTE AND CHRONIC
SINUSITIS.

3. NOSE AND
PARANASAL SINUSES
Anatomy:
• External
• Nasal cavity
• Paranasal sinuses

4. EXTERNAL NOSE
NASAL SKELETON

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. EXTERNAL NOSE
FUNCTION: 1.COSMETIC.
2.PROTECTIVE.

7. NASAL CAVITY
WALLS:
1.EXTERNAL.
2.INTERNAL.
3.SUPERIOR.
4.INFERIOR.

8. EXTERNAL WALL
ANATOMY:
-NASAL BONE;
-LACRIMAL BONE;
-ETHMOIDAL BONE;
-MAXILLA;
-PALATINAL BONE;
-SPHENOIDAL BONE;
-INFERIOR CONCHA

9. EXTERNAL WALL
CONCHAS:
1.INFERIOR.
2.MIDDLE.
3.SUPERIOR.

10. EXTERNAL WALL
PASAGES:
1.INFERIOR
(nasolacrimal canal).
2.MIDDLE
(maxillary, frontal,
front and middle cells
ethmoidal bone).
3.SUPERIOR
(sphenoidal, back cells
ethmoidal bone) .

11. OSTIOMEATAL COMPLEX
• MIDDLE TURBINATE
• UNCINATE PROCESS
• BULLA ETHMOIDALIS

12. INTERNAL WALL
PARTS:
• CARTILAGINOUS
(QUADRANGULAR CARTILAGE)
• OSSEOUS
(PERPENDICULAR PLATE OF
THE ETHMOID BONE, VOMER )

13. NASAL CAVITY
(PHYSILOGY)
BREATHING

14. NASAL CAVITY
(PHYSILOGY)
OLFACTION

15. NASAL CAVITY
AREAS:
1.AIRWAY.
2.OLFACTORY.

16. NASAL CAVITY
OLFACTORY AREA

17. NASAL CAVITY
(PHYSILOGY)
PROTECTION

18. NASAL CAVITY
(PHYSILOGY)

19. NASAL CAVITY
(PHYSILOGY)
RESONATION

20. PARANASAL SINUSES
FRONTAL, ETHMOIDAL, MAXYLLARY, SPHENOIDAL

21. DEVELOPMENT OF
PARANASAL SINUSES

22. EXTERNAL WALL
(ANATOMY AND PHYSILOGY )
Frontal sinusAL
Opening of the
frontal sinus
Opening of
the maxillary
sinus
Ethmoidal sinus
Opening of the
sphenoidal sinus
Sphenoidal sinus

23. NASAL CAVITY
(PHYSILOGY)

24. PARANASAL SINUSITIS

25. PATHOGENESIS
Violation of the ventilation
and drainage
Change of the microbiocenosis
and growing of the saprophyte
microorganisms
Inflammation
of the lamina proprea
Change the secrets
composition and
acidity
Injuring
of the epithelium
Violation of the mucous
membranes breathing
Edema
of the mucous
membranes
Blockade
of the openings
Engorgement of
the secret

26. WAYS OF THE
INFLAMMATORY PROGRESS
RHINOGENOUS 90%
ODONTOGENOUS 5%
HEMATOGENOUS
LYMPHOGENOUS
TRAUMATOGENOUS
NOSOCOMIAL

27. LOCALISATION
ETMOIDITIS 50-85%
MAXILLARY SINUSITIS 45-50%
SPHENOIDITIS 2-25%
FRONTITIS 4-15%

28. COURSE
to 4 weeks
more 12 weeks
4 or more times along one year, every
time continues more then 7-10 days,
but symptoms of the chronic sinusitis are
absent
ACUTE
CHRONIC
RECCURENT

29. PATHOLOGICAL MANIFESTATION
EXUDATIVE FORM:
1. CATARRHAL

30. PATHOLOGICAL MANIFESTATION
EXUDATIVE FORM:
1. CATARRHAL
2. SEROSIS

31. PATHOLOGICAL MANIFESTATION
EXUDATIVE FORM:
1. CATARRHAL
2. SEROSIS
3. HEMORRHAGICAL

32. PATHOLOGICAL MANIFESTATION
EXUDATIVE FORM:
1. CATARRHAL
2. SEROSIS
3. HEMORRHAGIC
4. SUPPURATIVE

33. PATHOLOGICAL MANIFESTATION
•EXUDATIVE FORM: CATARRHAL, SEROSIS,HEMORRHAGIC, SUPPURATIVE
•PRODUCTIVE FORM: HYPERTROPHICAL, POLYPOSIS, CYSTOSIS

34. PATHOLOGICAL MANIFESTATION
•EXUDATIVE FORM: CATARRHAL, SEROSIS,HEMORRAGIC, SUPPURATIVE
•PRODUCTIVE FORM: HYPERTROPHICAL, POLYPOSIS, CYSTOSIS
•ALTERATIVE FORM: ATROPHIC, CHOLESTEATOMIC, NECROTIC

35. PATHOLOGICAL MANIFESTATION
•EXUDATIVE FORM: CATARRHAL, SEROSIS,HEMORRAGIC, SUPPURATIVE
•PRODUCTIVE FORM: HYPERTROPHICAL, POLYPOSIS, CYSTOSIS
•ALTERATIVE FORM: ATROPHIC, CHOLESTEATOMIC, NECROTIC
•VASOMOTOR AND ALLERGIC FORMS

36. PATHOLOGICAL MANIFESTATION
•EXUDATIVE FORM: CATARRHAL, SEROSIS,HEMORRAGIC, SUPPURATIVE
•PRODUCTIVE FORM: HYPERTROPHICAL, POLYPOSIS, CYSTOSIS
•ALTERATIVE FORM: ATROPHIC, CHOLESTEATOMIC, NECROTIC
•VASOMOTOR AND ALLERGIC FORMS
•MIXED FORMS

37. SYMPTOMS
1. General.
2. Local:
• Pain in the affected sinus.
• Discharge from nose.
• Hyposmia.
• Nasal breathing violation.

38. INVESTIGATION
1. RHINOSCOPY:
•Hyperemia and edema mucous membrane.
•Pus or polyps in the meatus.
2. X-RAY METHODS.
3. PUNCTION OF THE SINUS

39. TREATMENT
Restore the function:
medicamentouses,
surgical
Opening of
the sinus
Antibiotic
Drainage of the
sinus
AIR
Pathogenic
microorgani
sms
(facultative
and
obligate
anaerobs) Mucociliary transport
Temperature
Dumpnes
рН
Aeration of
the sinus

40. MEDICAL ALGORITHM OF THE SINUSITISES
TREATMENT
CHRONIC
Еxudative
ACUTE
Productive
Endoscopic
operation on the
ethmoidal sinus
with removement of
the polyps and
pathologycal tissues
Decongestans
Antihistamine
Endoscopic
operation on
the ethmoidal
sinus with
restoration of
the opening
Corticosteroid
(local and general)
Infection Allergy
Antibiotics
Decongestans
Sondage
Punction
Remove the
antigen
Antihistamine
Corticosteroid
Immunotherapy
Surgical treatment of the violation nasal
breathing
SINUSITIS

41. TREATMENT

42. ACUTE PURULENT MAXILLARY SINUSITIS
CT
Endoscopic microantrostomy
1 day after operation 30 days after operation
Endorynoscopy

43. CHRONIC POLYPOSIS MAXILLARY SINUSITIS
CT
Endoscopic polypoethmoidoantrostomy
Endorynoscopy
1 day after operation 30 days after operation

44. COMPLICATION
1. REACTIV EDEMA OF THE CONNECTIVE TISSUE OF THE ORBIT
AND EYELIDS
2. PERIOSTITIS OF THE ORBIT (purulent and nonpurulent)
3. EYELID ABSCESS
4. RETROBULBAR ABSCESS
5. ORBITE PHLEGMON

45. INTRACRANIAL COMPLICATIONS
1.EXTRADURAL ABSCES.
2.SUBDURAL ABSCES.
3.BRAIN ABSCES.
4.MENINGITIS.
5.THROMBOSIS OF THE CAVERNOUS
AND SUPERIOR SAGITAL SINUSES.
6.RHINOGENOUS SEPSIS.

46. Common walls
between sinuses and orbitCAUSES

47. Common veins of sinuses and orbitCAUSES

48. I WISH
YOU TO
BE
HEALTHY!
!!