1、耳鼻咽喉头颈外科学,潘世恺,内容,鼻前庭炎 鼻疖 鼻炎 鼻中隔疾病 鼻异物,鼻前庭炎 Vestibulitis of nose 鼻前庭皮肤的弥漫性炎症。 Etiology（病因）： Irritation of rhinorrhea and dust（分泌物和灰尘）； secondary to skin infection（挖鼻） 患糖尿病者易发。,鼻前庭,Symptoms & Sign（症状和体征）,Red, swelling and ulcerative skin， crusting inside the vestibule, tenderness of the nasal tip or a
2、la.,Acuteantibiotic ointment,thermotherapy or infrared Chronic3%H2O2, antibiotic ointment,Treatment：,鼻前庭炎（急性）,鼻前庭炎（慢性）,鼻疖Furuncle of nose 鼻前庭或鼻尖部的毛囊、皮脂腺或汗腺的局限性急性化脓性炎症。,Etiology,金黄色葡萄球菌。 Secondary to chronic vestibulitis. Diabetics and weaklings will be subject to the disease.,Furuncle of nose,Sympto
3、ms & Sign： Redness, swelling, heat, and pain； matureulcerate. Serious cases: Phlegmon （蜂窝织炎）,Furuncle of nose,Complications （并发症） ：Thrombosis of cavernous sinus and cranial infection（海绵窦栓塞和颅内并发症） 出现眼部症状和剧烈头痛,Not mature：antibiotic，physiotherapy Mature：drainage(排脓)，Do not crash and press Ulcerate：drai
4、nage，antibiotic,Treatment：,Furuncle of nose,Complications：antibiotics，call ophthalmologist（眼） and neurologist for assistance,鼻疖,蜂窝织炎,Acute & chronic inflammations of the nasal cavities Acute rhinitis Common cold (coryza) 病毒感染引起的鼻腔粘膜急性炎症性疾病。,Etiology,Rhinoviruses, influenza & parainfluenza viruses. a
5、denoviruses, coronaviruses,Causes（诱因）:,general factors：受凉 local factors：鼻腔慢性疾病；邻近的感染病灶。,Symptoms & Sign：,Sneezing,nasal obstruction,malaise（不适）, fever. Nasal mucosa congestion, swelling, secretion in meatus.,Complications：,1、Sinusitis 2、Acute otitis media（中耳炎） infection pass through the Eustachian t
6、ube（咽鼓管） to middle ear 3、Acute pharyngolaryngitis, trachitis & bronchitis,Differential Diagnosis（鉴别诊断）,1、Influenza 2、Allergic rhinitis（变应性鼻炎） 3、Vasomotor rhinitis（血管运动性鼻炎） 4、Acute infectious disease,Treatment,General treatment： 发汗，中成药，抗生素，及休息。 Local treatment： 减充血剂,急性病毒性鼻炎初期,急性病毒性鼻炎中期,急性病毒性鼻炎（恢复期）,急
7、性病毒性鼻炎（合并感染）,Chronic rhinitis Etiology：非感染性疾病 Local causes： 1、Acute-chronic， 2、Chronic diseases of nose & sinus， 3、Infective focus around nasal cavity， 4、 Iatrogenic（医源性）: misuse nasal drops,Professional and environmental causes：,Dusts harmful chemical gas physical changes,General factors： 1、chronic
8、 diseases， 2 、 malnutrition， 3、endocrinic dysfunction（内分泌失调）4、cigarette and alcohol,Pathology：,Chronic simple rhinitisno hyperplasia（无增生） Chronic hypertrophic rhinitisnasal mucosa, submucosa, even periosteum & osteum: limited or extensive hypertrophy（肥大）,Symptoms & Sign： Nasal obstruction, rhinorrhe
9、a（流涕）, hypertrophied inferior turbinate （下鼻甲肥大）,Treatment：,1、Pathogenic treatment 2、Local treatment,1) Simple chronic rhinitis：,鼻内用糖皮质激素。 鼻腔冲洗。 用减充血剂（拟交感血管收缩剂）。 acupuncture（针刺）,2) Hypertrophic chronic rhinitis：,Vasoconstrictor sympathomimetics, Partial inferior turbinectomy（下鼻甲部分切除，粘膜下部分切除术，粘骨膜下切除术，
10、）. 下鼻甲骨折外移术（inferior turbinate outfracture）,Hypertrophic chronic rhinitis：,electric coagulation（电凝）,laser, microwave, radiofrequancy.,慢性鼻炎（细菌感染）,慢性鼻炎（细菌感染）,药物性鼻炎,萎缩性鼻炎 Atrophic rhinitis Etiology： Primary（原发性）： Endocrine imbalance, functional disorders of autonomic nerve,Atrophic rhinitis,infection,（
11、coccobacillus foetidus ozena, diphtheroid bacilli）, poor nutrition, hereditary factors, autoimmunophathy？,Atrophic rhinitis,Secondary（继发性）：1)Infection:chronic inflammation;2) Irritant: dust, gas,Secondary（继发性）：,3)Iatrogenic （医源性） : excessive surgical destruction of mucosa (empty nose syndrome); 4)Sp
12、ecial infection: tuberculosis（结核）, syphilis（梅毒）.,Pathology：,Endoarteritis and periarteritis of terminal arterioles, metaplasia of the epithelium, atrophy of the mucosa, glands, periosteum.,Symptoms & Sign：,1)Nose, nasopharynx is dry 2)Nasal obstruction (detached crusts),Symptoms & Sign：,3) Epistaxis
13、 （鼻出血） 4) Anosmia （嗅觉丧失） 5) Foul or fetid odor（恶臭） 6) Headache,Treatment：,1、Local management： nasal irrigation by warm waterliquid paraffin（石腊油） 2、 Surgery 3、General management：vitaminB2、C、E 3、：,萎缩性鼻炎,萎缩性鼻炎,Deviation of nasal septum 鼻中隔偏曲,Etiology：,Unequivalent development between bone and cartilage
14、 2) Injury 3) Tumor,Symptoms & Sign,1、Nasal obstruction； 2、Nosebleed； 3、Headache；,Diagnosis：,History; symptoms+examination (deviation),Treatment：,Septoplasty,rhinoseptoplasty,鼻中隔前位偏曲,Spur(鼻中隔棘突),Deviation of nasal septum，ridge嵴突,鼻中隔偏曲,鼻中隔偏曲下甲代偿肥大,鼻中隔偏曲下甲代偿肥大用药后,鼻中隔棘突,鼻中隔偏曲,鼻中隔偏曲,鼻中隔棘突,鼻中隔棘,鼻中隔血肿和脓肿,
15、指软骨或骨膜下积血或积脓。（hematoma of nasal septum, abscess of nasal septum） trauma(hematoma) infection(abscess),Symptoms & Sign,血肿：鼻塞、头痛和压迫感。鼻中隔两侧对称性半圆形隆起，穿刺有血液。 脓肿：除了上述外，全身症状，如发热。局部症状，如鼻尖红肿热痛。局部触痛明显，穿刺有脓。,Treatment,血肿：穿刺或切排，压迫止血，预防感染。 脓肿：切排，清洗，用抗生素。,鼻中隔血肿,Perforation of nasal septum,鼻中隔贯穿两侧鼻腔的永久性穿孔。 Etiology:
16、 Trauma infection tumor foreign body in the nose or rhinolith,Symptoms & Sign,干燥和脓痂，头痛和鼻出血。 吹哨声。,Treatment,Repair,鼻中隔穿孔,鼻中隔粘连,Foreign body in the nose,Endogenic Dead bone, blood clot, rhinolith Extrogenic Plant seeds, insect, metals, stone, woods Biologic Nonbiologic,Etiology： 1、Children 2-3yrs old
17、2、Insects 3、Injury：wood, rocks, metals 4、Iatrogenic,Diagnosis： Unilateral purulent drainage with foul smell in children Foreign body in the nose? History； nasal examination； plain X-ray; CT scan,Treatment：,Remove foreign body in different ways Prevent foreign body in the nosein bronchi,Metal in nasal cavity,鼻内异物,鼻内异物,鼻石,鼻石,鼻石,
