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• Palpation of the nasal bones for tenderness and cripitus in fracture of the nasal bones

• This examination is called ……….

• The srtuctures seen by this examination are the anterior part of:

• 1-• 2-• 3-• 4-

• This examination is called anterior rhinoscopy

• The srtuctures seen by this examination are the anterior part of:

1-Floor of the nose

2-Inferior turbinate & meatus

3-Middle turbinate & meatus

4-Nasal septum

Nasal Air Flow Test

• The metal tongue depressor is held below the nostril during quiet respiration

• The area of fogging gives an idea about the patency of the nasal airway

Rigid endoscope

• An optical telescope• Used for direct visualization of the nose (and

also ear & throat)• What is the Value of this instrument ?

• Endoscopy can be carried out in the out-patient clinic

• Provide good illumination & visualization• Allows examination of difficult-to-examine

areas• Many therapeutic procedures in the nose and

sinuses can be done by this instrument

Flexible fibro-optic naso-pharyngo-laryngoscope

• To examine - Nasal cavity- Pharynx- larynx

• Hump Nose

• Bifid Nose

Nasoalveolar cystThe arrow points to flaring of the ala

• The arrow points to………• It is used for………………..

What is your diagnosis?

Treatment?

Foreign Body (Bead) in Left Nasal Cavity

Rhinolith

Saddle Nose

• 25-year-old man complains of midfacial pain, fever, and general malaise of about 48 hours' duration. He denied having a cough, rhinorrhea, or nasal congestion. The patient reported being hit in the nose about 10 days earlier. The patient's temperature was 38.1° C orally and he had no frontal or maxillary sinus tenderness. Nasal examination (see accompanying figure).

• What is the most likely diagnosis?

• The answer : septal hematoma. The midline swelling of the septum is typical of septal hematoma and is consistent with the patient's history of facial trauma.

• Typically soft and fluctuant when compressed, a septal hematoma is a collection of blood between the nasal mucosa and the cartilaginous septum.

• It may occur unilaterally or, more commonly, bilaterally following nasal trauma with or without associated nasal fracture.

• This urgent condition warrants immediate referral to an otolaryngologist.

• Incision and drainage of septal abscess

Vestibulitis

• This child presented also with foul odor from the right nasal side

• You should suspect……………

FB in the right nasal cavity

• Orbital abscess

• The black arrow points to frontal mucocele • The red arrow points to the orbit which is

displaced downwads and laterally

• Picture 1(left). A male with orbital cellulitis with proptosis, ophthalmoplegia, and edema and erythema of the eyelids. The patient also exhibited pain on eye movement, fever, headache, and malaise

• The same patient (right) exhibited chemosis and resistance to retropulsion of the globe

• The cardinal signs of an orbital cellulitis are decreased eye movements, proptosis, decreased vision. The conjunctiva may be injected in either periorbital or orbital cellulitis

Rhinophyma

Frunculosis

• In this patient1- incision and squeezing the

lesion is a proper treatment2- The causative organism is

strptococcus pnumonia 3- diabetes millitus should be

considered especially if the lesion is bilateral

4- cavernous sinus thrombophlebitis is never a complication of this lesion

• This child presented with fever, , pain in the eye, edema of the right lids, limitations of eye movements and gave a history of recurrent attacks of nasal obstruction and discharge.

• Examination of the nose revealed right yellowish nasal discharge but no masses

• Acute ethmoiditis complicated by orbital infection

1-Orbital cellulitis2-Subperiosteal

abscess3-Orbital abscess

• Patient undergoing Caldwell-Luc surgery, involving removal of the diseased lining of the maxillary antrum

Oral-Maxillary Fistula. 

• This patient presented with left nasal offensive discharge, and left nasal regurgitation of fluids

• ??

• The patient shown on the right has a small hole in the middle of a tooth socket.  A tooth had been pulled and a hole was made into the maxillary sinus.  The hole did not fully heal and a small fistula was left in the middle of the upper alveolar ridge

Oro-maxillaryfistula

Rhinoscleroma• Bilateral reddish non ulcerating firm nodules which

firstly appear at the muco-cutaneous junction• As seen below the nodules spread and coalesce to

fill the nasal cavity and broaden the nose

Atrophic Rhinitis

• A 20 years old female presented with crusty nose and anosmia. Examination revealed roomy nose, greenish crusts and pale atrophic nasal mucosa

• A traditional ribbon gauze pack,

• Prefabricated expandable packs,

• Intranasal balloons

Anterior nasal packing

Epistaxis Ballon for anterior and posterior nasal packing