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Student’s Name
University Affiliation
Date
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Respiratory system
kibaru
Congenital abnormalities of the
nose
Objectives
At the end of thi session the students
should be able to
◦ Outline common congenital and acquired
abnormalities affecting the nose
◦ Outline how to make the diagnosis and treat
this conditions
◦ Discuss the common complications
associated with the acquired conditions
Congenital structural nasal malformations are
uncommon compared with acquired
abnormalities.
Congenital absence of the nose (arhinia),
complete or partial duplication, or a single
centrally placed nostril may occur in
isolation
usually occur as part of malformation
syndromes
supernumerary teeth may be found in the
nose, or teeth may grow into it from the
maxilla.
nasal bones may be are sufficiently
malformed to produce severe narrowing
of the nasal passages.
the alae nasi may be sufficiently thin and
poorly supported to result in inspiratory
obstruction
there may be congenital nasolacrimal
duct obstruction with cystic extension
into the nasopharynx causing respiratory
distress
Nasal congestion
is common during the first year of life and
may affect the quality of breathing during
sleep
it may be associated with a narrow nasal
airway, viral or bacterial infection with
congestion, enlarged adenoids, or maternal
estrogenic stimuli similar to rhinitis of
pregnancy.
Treatment
Supportive care
with a bulb syringe
saline nose drops
topical nasal decongestants
antibiotics, when indicated
prognosis
The internal nasal airway doubles in size
during the first 6 mo of life, leading to
resolution of symptoms in many infants.
Choanal Atresia
This is the most common congenital anomaly of the
nose
has a frequency of approximately 1/7,000 live
births.
It consists of a unilateral or bilateral
bony (90%) or membranous (10%) septum
between the nose and the pharynx
most cases are a combination of bony and
membranous atresia.
Nearly
50% of affected infants have other
congenital anomalies, with the anomalies
occurring more frequently in bilateral cases
Associations
1.
2.
Ear anomalies or deafness, or both-is one of the
more common anomalies associated with choanal
atresia.
The CHARGE syndrome
Coloboma
Heart disease
Atresia choanae
Retarded growth and development
CNS anomalies, or both;
3. Genital anomalies or hypogonadism, or both.
Clinical MANIFESTATIONS
Newborn infants have a variable ability to breathe
through their mouths, so nasal obstruction does not
produce the same symptoms in every infant.
Unilateral obstruction
When unilateral, the infant may be
asymptomatic for a prolonged period
Symptom
occur during respiratory infection
◦ diagnosis may be suggested by nasal
discharge or persistent nasal obstruction.
Bilateral choanal atresia
Neonates have difficulty breathing
with mouth breathing
makes vigorous attempts to inspire
often suck in their lips
develop cyanosis.
Distressed children then cry (which relieves the
cyanosis) and become more calm with normal skin
color, only to repeat the cycle after closing their
mouths.
Those
who are able to breathe through
their mouths at once experience
difficulty when sucking and swallowing,
becoming cyanotic when they attempt to
feed.
DIAGNOSIS
This is established by the inability to pass a firm
catheter through each nostril 3-4 cm into the
nasopharynx.
The atretic plate may be seen directly with
fiberoptic rhinoscopy.
The anatomy is best evaluated by using CT scan.
TREATMENT.
Supportive by maintaining the mouth in an open
position, or intubation.
A standard oral airway may be used (such as that
used in anesthesia), or a feeding nipple may be
fashioned with large holes at the tip to facilitate air
passage
Definitive management is surgical
Congenital defects of the nasal
septum
Perforation
can be developmental (very rare) or acquired
causes
infection
◦ syphilis
◦ tuberculosis
◦ trauma.
iatrogenic perforation
◦ Continuous positive airway pressure cannulas
Trauma from delivery
Treatment
it may be corrected with immediate realignment
using blunt probes, cotton applicators, and topical
anesthesia.
Formal surgical correction, when required, is usually
postponed to avoid disturbance of midface growth.
Congenital midline nasal
masses
include dermoids, gliomas, and encephaloceles (in
descending order of frequency).
They present intranasally or extranasally and may
have intracranial connections.
Nasal dermoids often have a dimple or pit on the
nasal dorsum, sometimes with hair being present
may predispose to intracranial infections if an
intracranial connection is present.
Recurrent infection of the dermoid itself is
common
treatment
Surgical excision of these masses is
generally required
Acquired conditions affecting
the nose
Foreign Body
common things that are introduced to the nose
include
◦ Food, crayons, small toys, erasers, beads, beans, stones, or
pieces of sponge
Clinical features
Initial symptoms are local obstruction, sneezing,
relatively mild discomfort
Irritation results in mucosal swelling
some foreign bodies are hygroscopic and increase in
size as water is absorbed, signs of local obstruction
and discomfort may increase with time.
Infection
usually follows and gives rise to
a purulent, malodorous, or bloody
discharge.
Diagnosis
Unilateral nasal discharge and
obstruction should suggest the presence
of a foreign body.
Purulent secretions must often be
removed so that the foreign object can
actually be seen.
The object is usually situated anteriorly .
When of long standing, a foreign body
may become embedded in granulation
tissue or mucosa and appear as a nasal
mass.
A lateral skull radiograph assists in
diagnosis if the foreign body is metallic or
radiopaque.
Treatment
Removal should be carried out promptly to
minimize the danger of aspiration and prevent local
tissue necrosis.
This can usually be performed with topical
anesthesia, using either forceps or nasal suction.
Infection usually clears promptly after the removal
of the object, and generally no further therapy is
necessary
Complications
Tetanus is a rare complication of longstanding nasal foreign bodies in
nonimmunized children.
Toxic shock sy...