Nose Surgeries

ABSCESS OF DANGEROUS AREA OF FACEA

 

The dangerous triangle of the face consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla.Due to the special nature of the blood supply to the human nose and surrounding area, it is possible (although very rare) for retrograde infections from the nasal area to spread to the brain. This picture depicts a pustule at the nostril. Diabetics are more prone to get this infection. Self inflicted trauma of nose such as nose picking cause infection of hair follicle with severe pain. It is advisable to admit this patient to ward for intra venous antibiotics. Incision and drainage is rarely required. Until infection settles blood sugar level should be controlled with insulin.

SEPTAL ABSCESS

 

This picture depicts a nose with a swelling of the middle partition or septum due to an abscess. Nasal obstruction is the most common presenting symptom seen with septal abscess. Others include nose pain, general malaise, fever, headache, and tenderness over the nose. The presenting symptoms depend on the cause. A history of trauma can usually be elicited. Staphylococcus aureus is the most common organism. Streptococcus pneumoniae, Streptococcus milleri, Streptococcus viridans, Staphylococcus epidermis, Haemophilus influenzae are found occationally. There are several proposed mechanisms for the development of a septal abscess. (1) direct extension along the tissue planes as seen with sinusitis; (2) infection of a septal hematoma; (3) infections of dental etiology; and (4) venous spread from the orbits or cavernous sinus. Nasal septal abscess usually occurs secondary to a nasal hematoma. There is usually an inciting traumatic event, ranging from major trauma, including child abuse and nasal septoplasty, to less traumatic and forgotten events such as falling off a bicycle or bumping heads during play. The rupture of the small vessels that supply the nasal septum form a hematoma that separates the mucoperichondrium from the septal cartilage. Cartilage destruction follows as a result of ischemic and pressure necrosis. Blood forms a medium for bacterial growth and subsequent abscess formation.The initial treatment usually consists of fine needle aspiration of the hematoma or abscess under topical anesthesia. The aspirate is sent for gram stain, culture and sensitivity. Intra venous antibiotic should be started.The most common pathogen involved is S aureus, thus a semisynthetic penicillin is a reasonable choice. In patients who are allergic to penicillin, vancomycin can be used. After antibiotics have been started, the next step in management is incision and drainage. The hematoma or abscess should be evacuated to relieve the pressure and restore blood flow. Intravenous antibiotics should be continued for 3 to 5 days and if the patient exhibits a favorable response then it is reasonableto switch to oral antibiotics. Oral antibiotics should be continued for 7 to 10 days. The complications of a septal abscess include meningitis, saddle nose deformities, sepsis, bacteremia, and in younger patients maxillary hypoplasia. Meningitis, sepsis, and bacteria can result from vascular, lymphatic, or direct spread through tissue planes.

ANATOMY OF NOSE / SEPTUM

 

This picture shows mid-line septum of the nose when the nasal lining is removed. There is both bone and cartilage in it. Blue colour represents cartilage.

Nasal septum is not always in the center. When it is grossly deviated to one side, there is nasal  block and snoring. This deviation is usually due to fracture of bone or cartilage following trauma.

ANATOMY OF NOSE / LATERAL WALL

 

This pictures shows  the interior of the side wall of the  nose. There are three bony projections called turbinates,at three levels. The uppermost one is the smallest.   They are full of blood vessels which are sensitive to weather changes and hormone changes.

The turbinates help  to warm inspired air and add water vapour before it reaches  the lungs.  

 

When we look in to our nose through a mirror, we can see them as pinkish swellings attached to the side the side walls of the nose. Many people get scared suspecting them as nasal polyps. Size of the turbinates can vary depending on the temperature and presence of allergens. When turbinates are very large, nose is blocked. There is snoring in the night.

These turbinates can be reduced in size by passing a low electric current in to the turbinates. They can be completely removed by surgery. But this operation is not done frequently as there can be dryness of nose .

CORONAL CT SCAN_EYES_CONCHAE

 

This picture depicts a CT scan image of paranasal sinuses with collection of pus in the sinuses on the left side. Sinusitis The sinuses are air filled cavities located in the bones of the face. The sinuses are divided into groups based on their location and are named maxillary, ethmoid, frontal and sphenoid sinuses. Sinusitis is inflammation or infection of one or more of the sinuses. Depending on the age of the child, infection may occur in the pair of sinuses located between the eyes (ethmoid) and/or the pair behind the cheekbones (maxillary), as both of these sinuses are present at birth.

 

As children get older, they develop a pair of frontal sinuses (in the forehead) and a pair of sphenoid sinuses (behind the nose), which can also become affected. Sinusitis has symptoms of runny nose, stuffy nose, fever, headache, cough (especially at nighttime), post nasal drip (causes frequent throat clearing), bad breath, facial swelling and bleeding. Many times it is difficult to tell the difference between a cold and a sinus infection. A cold has many of the same symptoms but will usually get worse around the 3rd or 4th day and be improving by a week to ten days. A sinus infection is usually worsening instead of improving at a week to ten days. Sinusitis is caused by an infection within the sinus cavities. Anything which causes blockage of the natural drainage openings of the sinuses can lead to infection. This means colds, flu, allergy or bacterial infection may be responsible. Blockage may also occur from POLYPS, which may be caused by allergies or chronic infection. Once blockage of the natural drainage passageways has occurred,mucoid secretions are collected. This may lead to inflammation and, eventually, infection of trapped mucus, otherwise known as acute sinusitis. Diagnosis of sinusitis based mostly on the history. Sinusitis is also diagnosed by how long the symptoms last. If the child has a simple cold or flu, symptoms will usually last from 7 to 10 days. If the symptoms described previously persist beyond ten days, sinusitis is likely to have occurred and your child should be evaluated by a physician.

 

The next step is an examination of the patient's ear, nose and throat. Occasionally special nasal endoscopes will be used to see farther into the nose. In addition, your doctor might order x-rays to completely evaluate the sinuses. These x-rays may include plain x-rays of the sinuses or a computed tomography (CAT) scan, which will give your doctor the most accurate information. As the first line of treatment, antibiotics are given for several weeks to clear the sinus infection. Nasal decongestants or nasal sprays may also be prescribed. If the diagnosis is acute sinusitis, symptoms should improve within the first few days.Three week course of antibiotics has to be given to prevent recurrence of infection. . chronic sinusitis which does not seem to go away completely with antibiotics, need surgical treatment of the sinuses using FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS). Other procedures such as SINUS CULTURE or ADENOIDECTOMY may also be recommended. Serious complications of sinusitis include orbital cellulitis (an infection in the tissues around the eye), osteomyelitis (an infection in the bones), meningitis (infection in the fluid surrounding the brain and spinal cord),or brain abscess. These complications are rare.

CORRECTION OF NASAL DEFORMITIES

Rhinoplasty is correction of deformities of nose. It is frequently done in Sri Lanka. Plastic Surgeons and ENT Surgeons do this operation. No external scar involved. All the cuts are done inside. Sometimes cartilage from patients ribs are used to improve the shape. There will be dressings inside and outside the nose which are removed after one week.

© 2019 Dr. Chandra Jayasuriya
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