Published on March 15, 2014
Nasal cavity: • Nares (columella and ala) • Choana (vomer and pterygoid) • Roof: cribriform plate • Floor: hard palate (maxilla and palatine bones) • Medial wall: nasal septum • Lateral wall
The nasal septum
The lateral nasal wall
The osteomeatal complex (between lamina papyracea and middle turbinate)
The dangerous triangle • Root of the nose to the corners of the mouth. • Why dangerous? Cavernous sinus thrombosis (transmission of infection through the ophthalmic veins).
The paranasal sinuses • Anterior group: maxillary, frontal and anterior ethmoid. • Posterior group: posterior ethmoid and sphenoid. • Maxillary sinus boundaries: orbit, alveolar process(2nd premolar and 1st molar), pterygopalatine fossa, nasal cavity and cheek.
X-ray paranasal sinuses
CT paranasal sinus
physiology • Nasal functions: respiratory, smell, resonance of voice, drainage of lacrimation, protective (vibrissae, cilia, sneezing, lysozymes), humidification and warming of air. • PNS functions: lighten skull, humidification and resonance). • Mucociliary clearance: gel superficial thick layer and sol deep thin layer with biphasic cilia movement (inhibited by smoking, infection and excessive heat or cold).
Nasal trauma and fracture Deformity, crepitus, x-ray, reduction.
Le Fort facial fracture lines
I: palatal dislocation II: palatal and upper midface dislocation III: complete craniofacial dislocation
Oroantral fistula • Fistula between oral cavity and maxillary antrum. • Causes: inflammatory, neoplastic or traumatic (accidental and surgical “ dental extraction, excision of dental or dentigerous cyst, radical antrum operation”). • Symptoms: unilateral nasal regurgitation, unilateral offensive nasal discharge and discharge through the fistula to the mouth.
• Signs: either seen or probing (not preferred) • Investigations: x-ray (PNS or panorama), CT scan PNS.
• Treatment: 1. recent :small---heals spontaneously, large----surgical closure (buccal or palatal flap). 2. old : surgical closure + radical antrum. 3. Failed: dental obturator.
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