- What is the abnormal development of the nose
- What triggers / Causes of congenital malformations of nose
- The symptoms of congenital malformations of nose
- Diagnosis of congenital malformations of nose
- Treatment of congenital malformations of nose
- Which doctors should be consulted if You have Abnormalities of the nose
What is the abnormal development of the nose -
According to the classification of B. V. Sirigina (1984) congenital defects and abnormalities of the external nose and its cavity is divided into 3 groups.
- Hypogeusia: external nose (total partial - one half of the nose, nasal openings, krylnyh cartilage - the weakness of the wings of the nose)- intranasal structures (turbinates, natural openings of the sinuses)-
- Hyperkinesia: external nose (total, partial nose, long nose, high nose)- intranasal structures (turbinates, big bubble lattice - bulla ethmoidalis, clasping Cavenago bone, nasal septum)-
- Dysgenesis: the external nose (hooked nose, Kosonsoy, lateral trunk of the nose: one - and two-sided).
- External nose: median cleft nose (full, partial), lateral cleft nose (full, partial), splitting at the tip of the nose, dermoid cyst, nose fistula.
- Intranasal structures: split turbinates, double turbinate, congenital atresia of the Hoan.
Bullous middle turbinate.
The appendage of the nasal septum.
Atypical location of exit orifice of the nasolacrimal duct.
What triggers / Causes of congenital malformations of the nose:
As a result of adverse effects of various endo - and exogenous factors on fetal development disrupted the process of formation of the nose. Facial bones incompletely fused or not fused.
When the embryonic cleft of slits are formed congenital fistulas and cysts of the back of the nose. When nonunion of the two plates of the anterior part of the nasal septum at the apex of the nose is formed a recess, completely severing half of the nose.
Congenital atresia of the Hoan is a consequence of conservation of nasopalatine membranes and occurs between the 6th and 12th weeks of gestation, due to convergence and consistent seam between the rear edge of the opener with the rear ends of the turbinates. There are 3 theories of the origin of atresia:
- intrauterine partial hyperplasia shell-
- excessive growth of the vertical plate of the Palatine bone
- hypoplasia of the entire area of Hoan and throat.
Fusion of Joan may be single and double - partial or full - membranous, cartilaginous, bony or mixed.
The symptoms of congenital malformations of the nose:
Deformation of the external nose (one or two inlet openings in the nose in the absence of the nose and intranasal structures, or excessive development of the nose and its separate structures), difficulty (violation) of sucking and swallowing due to violation of the integrity of the sucking muscles.
The allocation of food through the nose when feeding (occurs when the slit-like defects in the bottom of the nose, by splitting the hard and soft palate in children with "wolfsbane" due to violation of the integrity of the oral cavity, the impossibility of separation of the nasopharynx and oropharynx during swallowing) is a serious obstacle to the proper development of newborns.
Outer estuary congenital fistula of the back of the nose, usually located in the midline at the boundary of the bone and cartilage departments, fistula is directed upwards and ends with a cystic formation in the glabellar.
Fistulas and cysts are prone to inflammation and suppuration, especially in connection with injuries of the nose may develop meningitis when message fistula from the anterior cranial fossa.
Nasal breathing is disrupted due to:
- the weakness and pliability of the nose wings with their prolapse into the side of the nasal cavity (if hypogenesis the wings of the nose)-
- hyperkinesia turbinate and uncinate process with impaired patency of the excretory openings of the paranasal sinuses-
- the development of neonatal asphyxia if not recognized in time full heals wounds both old. May be fatal if an experienced midwife is not time to open the baby's mouth - after the first breath he's mouth breathing is getting better.
The development of purulent process in the paranasal sinuses on the side of unilateral or bilateral incomplete undiagnosed atresia Hoan leads eventually to the violation of the form of the face. It is noted:
- complete absence or nasal obstruction on the affected side-
- improper growth of the incisors-
- high sky and its asymmetry in unilateral atresia-
- the accumulation of thick, viscous mucus at the bottom of the nasal cavity-
- the development of dermatitis in the area of the vestibule of the nose and nasolabial region from constant irritation and discharge from the nasal cavity-
- when rhinoscopy mucosa of the nasal cavity pale, wet sink underdeveloped, shortened and atrophic - nasal septum deviated to the side of atresia-
- when pharyngoscope atrophy and dryness of the mucous membrane of the nasopharynx.
Atresia Joan is more common in girls, with bilateral process is mainly bone, in some cases associated with other congenital malformations and is accompanied by a change in the paranasal sinus and other ENT-organs (curvature of the nasal septum toward Sardinia, atrophy of the posterior end of the inferior turbinate, the change in the magnitude of the orbit, cleft palate).
Diagnosis of Anomalies of the nose:
The diagnosis is made based on the appearance of a child, data survey, and the results of several studies.
X-rays (if necessary with the contrast agent). A reliable sign of atresia Hoan is the delay of contrast medium at the level of the choanae by lateral radiography of the nasal cavity.
Probing of the nasal cavity rubber catheters or metal probes smallest diameter after anesthesia of the mucous membrane of the nasal cavity to detect atresia Hoan.
Burying his nose in a 1 methylene blue solution or aqueous solution of brilliant green, followed by a thorough inspection of the posterior wall of the pharynx, along which the dye should flow in the free lumen of the choanae.
Computed tomography allows to obtain detailed anatomical characterization of atresia of the choanae and identify associated changes of the nasal cavity: the curvature posterior nasal septum, thickening of the lateral bony walls, the extension opener that allows you to successfully carry out choanosomal taking into account all the anatomical features.
Fibroadenoma provides an opportunity to identify abnormally intranasal modified microstructure, not previously available to the inspection.
Agenesia of the nose - two inlet openings in the nose with complete or partial absence of the nose and intranasal structures. If hypogeusia there is insufficient development of the external nose, oral and intranasal structures. Total hypogeusia appears uniform hypoplasia of the external nose and separate intranasal structures - nasal shell of small size or in the initial stages of development - possible lag in the development and deformation of one half of the nose. Hypogeusia of the Alar cartilage is manifested in weakness, compliance and prolapse of the wings to the side of the nasal cavity during forced breathing. Among hypogeusia intranasal structures isolated hypoplasia of nasal turbinate with their close contact to the lateral wall of the nose, usually accompanied by symptoms of atrophic rhinitis.
Hyperkinesia is characterized by excessive development of the nose or its individual structures. When the total hyperkinesia along with the intense growth of the external nose may doubled. In functional terms the most significant hyperkinesia turbinates, especially the bubble lattice and hooklike process, in violation of smell and patency of the excretory openings of the paranasal sinuses.
Dysgenesis of the external nose is a sign of his deformity (hunchback nose, Kosonsoy, lateral trunk) and deformity of the nasal turbinate (different shape curvature and fixing on the side wall of the nose).
Dystopia - the development of separate entities of the nose in an unusual place for them. Relatively frequent dystopia of the nasal cavity is bullous middle turbinate - globose swelling its front end with a violation of patency of the olfactory slit, and partial or complete loss of smell.
Often marked dystopia exit orifice of the nasolacrimal duct, the plots of deviation in the region of the vomer and perpendicular plate of the ethmoid bone.
Persistence implies the preservation of those elements, which by the time of birth should not be. Among the malformations of the nose of this type has the following value.
Median cleft nose split from tip of nose to complete his cleft, when the two halves of the nose are at a distance from each other. Forked or double turbinate with a pronounced violation of patency of the nasal passages.
Treatment of Anomalies of the nose:
In congenital malformations of the nose is only surgical treatment. Partial hyperkinesia the tip of the nose is addressed by cosmetic correction.
In the case of the slits of the bottom of the nasal cavity by splitting the hard and soft palate in children with "wolfsbane" shown plastic heaven to restore power and prevent further deepening of the cleft of the hard palate. In case of untimely operation of deformation of the palate and nose are progressing, dramatically impaired speech and development of the alveolar process of the maxilla. The time of surgery in each case is determined individually.
Fistulas and cysts are surgical treatment as they are identified, regardless of the age of the child. Surgeonalgebraic excision fistulas and cysts should be preceded by fistulography. When the frontobasal localization of congenital fistula of the back of the nose, communicating with the anterior cranial fossa, the operation is performed with the participation of a neurosurgeon.
In the treatment of these malformations of the external nose along with cosmetic operations is widely used functional microsurgery of intranasal structures - sparing surgery type with preservation of olfaction and other functions of the nose. This submucosal total and sectoral turbinotomy, removal of spherical entities and hypertrophied hamulus, Redressal and laterobasal the lower and middle turbinates.
Treatment with atresia Hoan exclusively surgical. In congenital bilateral atresia Hoan shown urgent surgery to restore patency of Joan and the act of sucking.
There are 3 main access at haemotoma.
Transnasal approach (elimination of choanal atresia directly through the nasal cavity) is mainly used in newborns and infants, called intranasal removal method atresia - in hospitals with the aim of using a trocar. In older children, surgery is that with a scalpel make an oval incision of the mucosa from the nasal septum on the bottom of the nasal cavity with further delamination blunt to the site of the proposed atresia, which reveal haemotoma or fluted chisel, bone edge formed choanae smooth acute bone spoon, the generated holes are injected with a special thermoplastic drainage pipe.
Transaxillary access is used when simultaneously it is necessary to open the maxillary sinus in empyema.
Transaxillary access is not shown to infants and young children, as it damaged the beginnings of teeth.
Transalating access is via the hard palate, provides a good visual inspection of the operated area. During the operation, through the hard palate after separating cellular Muco-nachrangige flap (at a distance of 0.5 cm from the edge of the gums) produce trepanation of the posterior edge of the hard palate. After opening of the nasal cavity under visual control eliminate atresia. At older ages, currently the most trusted transalating access with the use of microsurgical techniques. Thanks to the optimal overview of the surgical field and reconstructive plastic surgery techniques transplatinum access is the safest and provides a good long-term results.
In the postoperative period requires careful maintenance, regular lubrication of the nasal passages with a solution of adrenaline and toilet, change of drainage tubes every 10-14 days. The formation of the lumen of Joan after the surgery takes 1 to 2 months.