Atrophic rhinitis.pptx

Atrophic rhinitis

1. ATROPHIC RHINITIS (OZAENA)

2. DEFINITION: It is a chronic inflammation of the nasal mucosa resulting in atrophy , squamous metaplasia and crust formation due to periarterial fibrosis and end arteritis. Key-points: Atrophy of the nasal mucosa and turbinate. Scanty viscid secretion Loss of ciliated columnar epithelium Crust formation

3. TYPE: Primary Secondary: infection or surgery Long-standing purulent sinusitis. Iatrogenic: Radical turbinectomy, maxillectomy, post-radiotherapy. Tuberculosis, Syphilis , Leprosy, Rhinoscleroma . Deviated nasal septum (atrophy in wider nasal cavity). FORM: Rhinitis sicca : mild form Severe form : ozaena Turbinante atrophy Squamous metaplasia Degeneration of goblet cells Secondary growth of saprophytes

4. PATHOPHYSIOLOGY:

5. ETIOLOGY PRIMARY : Not known

6. ETIOLOGY PRIMARY : Not known Developmental: Congenitally spacious nasal cavity Poor pneumatization of maxillary antrum Heredity: 30% cases autosomal inheritance; 67% = Dominant, 33% = Recessive. Endocrinal: estrogen progesterone imbalance, common in female after puberty; Symptoms aggravated due to estrogen deficiency. Race: white & yellow races >>> negroes Malnutrition: chronic iron deficiency anemia , vitamin A & D deficiency Chronic inflammation Nasal and sinus suppuration: Klebsiella ozaenae ( Perez & Abel bacillus ), Coccobacillus foetides ozaena, Bacillus mucosus , Diphtheroids , Haemophilus influenzae, Proteus vulgaris, E. coli, Staphylocococci & Streptococci. More common: Blood group O and B Immunological factor: Altered cellular immunity and loss of tolerance of nasal tissue may trigger destructive autoimmune process on nasal mucosa . Reflex sympathetic dystrophy syndrome (RSDS) causes vasodilatation & hyperaemic decalcification of turbinates followed by vasoconstriction. Surfactant deficiency in nasal secretion: ciliary dysfunction + stasis of nasal secretions.

7. CLINICAL FEATURES Age : Onset after puberty, 14-16 years Sex: more in females Race: Rare in negroes

8. SYMPTOMS Nasal obstruction Crusting Anosmia Headache Epistaxis Foetor SIGNS Crust Greenish discolouration Roomy nose Atrophied turbinates Choana / nasopharynx visible Pus in the middle meatus Posterior rhinoscopy MERCIFUL ANOSMIA

9. INVESTIGATIONS Radiology: X ray PNS, CT scan of the PNS Hematology : ESR, Sugar, Estrogen , Progesterone, Serology; Serum iron, vitamin-A/ D & protein levels- malnutrition Pathology: Nasal swab- smear or HPE of nasal mucosa. Saccharine test:  ed nasal muco-ciliary clearance time. Culture & sensitivity of nasal discharge.

10. HISTOPATHOLOGY

11. D/D Syphilis Lupus Leprosy Tuberculosis Rhinoscleroma Sinusitis D/D for ozaena D/D for dry nose Atrophic rhinitis Atrophic rhinitis Purulent sinusitis Rhinitis sicca Nasal foreign body Radiotherapy Rhinitis caseosa Sjogren’s syndrome Malignancy

12. SPECIFIC INVESTIGATIONS TO RULE OUT OTHER D/Ds: Chest X-ray: T.B., bronchiectasis, lung abscess Serology for syphilis: V.D.R.L., T.P.H.A., T.P.I. Sputum for AFB, Mantoux test: T.B. Nasal smear study: Leprosy Complement fixation test & biopsy: Rhinoscleroma

13. COMPLICATION Nasal myiasis Sinusitis

14. TREATMENT

15. ACTION OF PLACENTAL EXTRACT

16. SURGICAL TREATMENT Aim: Decrease size of nasal cavity Decrease air entry Increase lubrication Narrowing of nasal cavity: At lateral wall: Dermofat graft Bone cartilage graft Synthetic teflon paste or acrylic mould At floor: placental graft submucosally Young’s and modified young’s operation Transplantation of parotid duct

17. TYPES OF SURGERY

18. AIM OF SURGERY

19. ADVANTAGES OF MODIFIED YOUNG’S SURGERY