DISEASE OF THE NOSE,

PARANASAL SINUSES,
AND FACE PART 1
LEE JAE YONG
07120090099
S TA S E : T H T

MALFORMATIONS OF THE NOSE,

PARANASAL SINUSES AND FACE
Choanal Atresia
Frontobasal Dysraphias
Dorsal nasal fistulas
Dermoids
Cephaloceles

CHOANAL ATRESIA
Epidemiology
1 in 5000 - 10000
Unilateral > bilateral
Symptoms
- Bilateral
Acutely life threatening emergency
Asphyxia when mouth is closed -> hypoxia -> paradoxical cyanosis,
bradycardia, erratic respiratory rate.
- Unilateral
Purulent nasal charge on affected side.
Possibly accompanied by other anomalies. (CHARGE syndrome:
coloboma; heart disease; atresia of the choanae; retarded growth,
development and/or central nervous system anomalies; genital
hypoplasia; ear anomalies or deafness)

 Diagnosis
Rigid or flexible endoscope examination

Treatment
Intubation
Perfortation of atresia plate
Recurrent stenosis -> stent with suture
Definitive surgical repair
- 1week to months for bilateral
- School age for unilateral

FRONTOBASAL DYSRAPHIAS
Epidemiology
1 in 20000-40000

 Manifestations
- Dorsal nasal fistula
- Keratinized squamous epithelium and forms a tiny
opening on the dorsum or tip of the nose.
- Fistulas that terminate blindly manifested clinically at an
older age. Inflammation around the fistulous opening
- Fistula tht communicates with the subarachnoid space
cause severe complication (cerebrospinal fluid leakage,
meningitis, or brain abcess)

 Diagnosis
CT scan
MRI

Treatment
Complete removal of the fistulous tract.

NASAL DERMOID
Keratinized squamous epithelium on dorsal nasal
midline and nasal flank.
May coexist with a dorsal nasal fistula.
Abcess may develop as an inflammatory
complication.
Treatment: complete removal of fistulous tract.

CEPHALOCELE
Herniations of intracranial contents through a
bony defect in the skull.
Etiology: congenital
Classification:
Sincipital: located near the glabella, forehead, orbit
Basal: nasal cavity or nasopharynx

 Presentation
Sincipital cause pulsating mass near the glabella
Basal: intranasal mass -> airway obstruction (similar to
polyp)

Diagnosis
CT scan
MRI

Treatment
Surgery removing the cephalocele and repairing the bural
defect.

NASAL DEFORMITIES
Septal deviation
Deformities of the external nose

SEPTAL DEVIATION
A congenital or traumatically acquired bending or bow
ing of the nasasl septum
Symptoms
Bowing, spurring, or ridging of the cartilaginous or bony nasal
septum.

Diagnosis
External inspection
Anterior Rhinoscopy
Endoscopy

Treatment
Septoplasty: removing the deviated cartilaginous and bony
portions of the septum along with any spurs and ridges and
reimplanting them as needed.

DEFORMITIES OF THE EXTERNAL NOSE

Congenital or traumatically acquired
Diagnosis: inspection and anterior rhinoscopy
Treatment: corrective surgery

EPISTAXIS
Cause

 Diagnosis

SOFT-TISSUE INJURIES AND PLASTIC

SURGERY
Z-plasty (Fig. 3.9 a,b): When a wound margin
runs perpendicular to the RSTLs, it can be
reoriented with a single or multiple Z-plasty and
lengthened in the direction of the scar axis.
W-plasty: The principal effect of this technique is
to lengthen the scar.
Broken-line closure: The effect of this technique is
to optically disperse the scar, making it more
irregular and less noticeable.

SOFT-TISSUE INJURIES AND PLASTIC

SURGERY

LOCAL FLAP TECHNIQUES

 a Small Burow triangles are excised at the ends

of the incisions, allowing the two rectangular flaps
to be advanced for defect closure.
b The bilobed flap is a butterfly-shaped
advancement flap used to close a defect.
c The rhomboid flap can be used on the nasal
flank, as illustrated, or on the cheek.
d The skin between the defect and superficial flap
is undermined, and the island flap is pulled into
the defect on its subcutaneous pedicle.

REPAIR OF TISSUE DEFECTS

Traumatic or post-tumor resection
Smaller tissue defects: local flaps
Extensive defects: reconstructive procedures
using autologous transfer.

FRACTURES OF THE NASAL PYRAMID

AND LATERAL MIDFACE
Diagnostic procedure:
Inspection
Palpation
radiographs

 Complications
Hematoma formation
Septal abcess

 Surgical Treatment
Laterally displaced
fragments are reduced by
external digital pressure.
If the nasal pyramid is
depressed, the fragments
have to be elevated with
an instrument from within
the nasal cavity.

LATERAL MIDFACIAL FRACTURES

Cause: blunt trauma to the side of the face.
Affected structures:
Maxillary sinus
Orbit
Zygoma

Symptoms

Depressed fracture of the zygoma

Limited mouth opening
Fracture of the orbital floor causing diplopia
Sensory disturbances

 Diagnosis
Inspection :
swelling,
asymmetry of the affected facical half,
Enophthalmos (orbital floor)

Palpation
Frontozygomatic suture
Infraorbital margin
Zygomatic arch

 Sensory testing: CN VII

Radiographs: CT scan
Displaced bone fragments
Herniated orbital contents (hanging drop sign)
Blow-out fracture

 Treatment:
Surgical treatment is unnecessasry for:
Undisplaced
Asymptomatic fractures

Surgical treatment indicated for:

Displaced
Symptomatic (sensory deficits)

Treatment of choice:
Reduction and fixation by miniplates and interosseous
wiring.

FRACTURES OF THE CENTRAL MIDFACE

AND ANTERIOR SKULL BASE
Classification:
Central midfacial fractures
Frontobasal fractures

 Symptoms:

Hematoma
Dish face (Le Fort II-III, Escher III)
Cerebrospinal fluid rhinorrhea
Vision loss
Diplopia
Cerebral prolapse
Anosmia

 Diagnosis

Inspection (rhinoscopy, oral cavity, oropharynx, otoscopy)

Hearing and balance testing
Olfactory testing
Palpation

 CT scan

fracture of the
anterior and posterior
walls of the frontal
sinuses (arrows) (a)
a clivus fracture
(arrow) that extends
anteriorly into the
sphenoid sinus (b).
The coronal scans
showair in the cranial
cavity (c)
fracture of the
ethmoid roof (d)

 Treatment: surgery

 Apa Penanganan awal pada choanal atresia?

A. reposisi B. reduksi C. intubasi D. surgical repair
Pembuluh darah apa yang paling sering pecah pada
epistaksis anterior?
A. plexus kiesselbach B. a. sphenopalatine
C. a. Labialis D. a. Nasalis
Kapan kita menggunakan broken line closure technique?
A. untuk memanjangi luka
B. untuk minimalisasi bekas luka C. untuk luka bakar
D. untuk luka tajam
Apa tujuan local flap technique?
A. Untuk luka tumpul B. untuk luka tajam
C. untuk luka yang jaringannya perlu ditutupi
D. untuk fraktur frontalis

 Pemeriksa apa yang menegakkan diagnosis pada

Fractures of the central midface and anterior skull
base?
A. inspeksi B. palpasi C. x-ray D. CT scan