Pathology of sinus injury

2021-01-31 12:00 AM

Open wounds: must be washed, cut filtered, sewn the correct anatomical layer, put the wick fixed. If present, if any, bone injuries are treated, such as closed trauma, will be treated.

Nose injury

Reason

Accidents: often caused by traffic accidents, work accidents or sports.

Hit: hard objects such as sticks, bricks, punched in the nose.

Due to fire: shrapnel, shrapnel shot on.

Symptom

Function

Nasal bleeding is always severe or mild depending on the nature of the damage (bleeding from the nose first, bleeding from the back to the throat).

Physical examination

Nasal deformation: common in the bridge of the nose or nose root, maybe the nose tower collapsed, is crooked to one side, closed or broken open.

At the time of trauma, due to bruising oedema, sometimes there was no deviation and must be re-examined a few days.

In children, trauma to rupture of the nose, or to be overlooked, will leave negative aesthetic and functional sequelae.

The force of the injury from the side can distort the nose. The anterior-posterior injury force breaks the main bone of the nose and septum, blocking and deviating the nose.

Palpate the traumatic area to find a throbbing, abnormal displacement of the main bone of the nose.

Front nose microscopy observed to find bleeding points or displacement of the septum, damage of the curly bones.

Note: after a few hours of trauma, facial wounds often bruise and oedema, making it difficult to assess the damage.

X-ray

Tilted skull and Blondeau: will see bone damage to the nose itself.

Diagnose

Based on examination and X-rays.

Direction of treatment

Nasal bleeding: stop bleeding by placing the nasal wicks or the posterior wicks. If bleeding persists, constrict the external carotid artery or node.

Main fracture of the nose: correct to the old position and then place the wick fixed (to be straightened early because the nasal bone is easy to calcify).

Open wounds: must be washed, cut filtered, sewn the correct anatomical layer, put the wick fixed. If present, if any, bone injuries are treated, such as closed trauma, will be treated.

Sinus injury

Characteristics

The facial sinuses are much related to the skull and brain, molars, face, eyes, wounds, wide, large blood clots, swollen face difficult to diagnose anatomical lesions.

It is common to experience injury to the maxillary and frontal sinuses because these sinuses are located just in front, under the skin of the face, and have thin bone walls.

Reason

Bullets, hard objects pierce or pierce the sinus wall.

Punches, falls due to traffic accidents, labour accidents, fighting broke sinus walls or broken facial bones.  

Frontal sinus injury (depending on the injury)

The frontal sinus is susceptible to injury, the broken outer plate is usually self-healing, but sometimes due to blood accumulation in the infected sinuses, there are many complications. If the inner version is broken, the meninges are easily torn, so they can bleed, produce air sacs, water from the brain spinal cord to the nose and meningitis ...

Closed frontal sinus injury

Sinus wall is fractured, subsided, the skin of the forehead is not torn, does not reveal sinuses.

The skin of the frontal sinus is swollen, bruised, and possibly hematoma.

Touching may cause air spills under the skin.

Press the upper corner of the eye sockets clearly sore.

Often there are nosebleeds.

An open frontal sinus injury

The sinus wall was broken, the skin of the forehead was torn, punctured to the sinus.

Torn skin, swelling, bruising, hematoma, bleeding.

Often there is an air spillage under the skin.

Through the tear can see a broken sinus wall, a fragment of bone in the sinus or hematoma.

Eyes: upper eyelid oedema, hematoma, synaptic haemorrhage, diplopia.

Can see cerebrospinal fluid mixed with blood.

X-ray: Tilted skull and Blondeau: blurred sinus or bone fragments in the sinus, inner wall often damaged.

To solve

Anti-shock, stop bleeding.

The concussion of the brain, monitoring to see if the meninges are torn? (In the cerebrospinal fluid there is blood or cerebrospinal fluid outward).

Frontal sinus surgery: removing fragments, damaged mucous membranes, nasal drainage.

Injury to the jaw sinus, sinus screening

May rupture in transverse upper jaw injuries (Le Fort models).

This is a very serious facial injury in the context of multiple trauma, sometimes to be resolved in a large centre requiring the coordination of many specialities: trauma surgery, neurosurgery, Eye, Ear Nose Throat, Teeth and Faces ... in which life problems arise first such as shock, suffocation, bleeding ... and then comes the problem of ear, nose and throat.

Open injury

Injury causes perforation of the sinus wall, tearing the skin, exposing the sinus together with airflow under the skin. Painful sinus pressure, the patient may leak blood.

Closed injury

Hard objects hit the sinus wall or fall ... can cause rupture of the jaw sinus wall.

Swollen swelling on the side of the face, skin bruising, pain and pressure.

There is subsidence or bone, subcutaneous air spillage, purple upper lip, eyelids, synaptic haemorrhage

Bleeding in the wound, from the sinuses out through the nose, examination: blood stagnant in the middle nasal passages.

X-ray: Tilted skull and Blondeau: blurred sinus with stretch may be caused by hematoma or foreign body in the sinus requires additional Axial and coronal CT Scan for a more complete assessment.

To solve

If the perforation is small, only fractures: wipe the wound, stop bleeding, clear the nose, keep antibiotic monitoring, the wound can heal.

If the perforation is wide, broken bone needs surgery: remove foreign bodies, broken bones, make holes drain from the nose and sinuses, fix the sinus wall.

Injury coordination

Characteristics

When there is a fracture injury to the facial bone mass, the rupture line is divided into 3 layers:

The upper floors are mainly related to the eyes.

The middle layer is mainly nose and sinuses.

The lower layer is mainly related to the molars.

Symptom

Shock, tongue drop, difficulty breathing, choking ...

Swelling, bruising can tear the skin ...

Deformation of the face.

Eye symptoms: double vision, oedema, bruising in the eyes, synaptic membrane, bleeding in the eye ...

Oral symptoms: inability to move the upper jaw, pain when opening the mouth, often accompanied by traumatic brain injury.

To solve

Shock resistance, fixed tongue, stop bleeding, open trachea when there is a danger of breathing difficulties Treatment of traumatic brain injury, treatment of sinus injuries. 

Emergency nosebleeds

Nasal vascular surgery

Features of the nasal mucosa

The respiratory tract lining warms, moistens and cleans the air thanks to a dense network of capillaries and the capillaries go so shallow that only a slight injury can cause bleeding.

The capillaries go very shallow so it is very vulnerable to nose picking and trauma

Distribution of blood vessels in the nose - sinuses

The external carotid artery includes the palate artery, the female palate artery.

The inner carotid artery includes anterior sieve artery and posterior sieve artery.

These artery branches gather at a point in front and below the septum, about 1.5 cm from the anterior nasal opening, known as the Kissel Bach vascular point.

Reason

Surgical causes: trauma during wartime and peacetime (knife stab wound, labour accident, traffic accident, bullet shot…).

Medical causes: high blood pressure, blood diseases (acute myelogenous leukaemia, myelosuppression, haemophilia), haemorrhagic fever, chronic liver and kidney failure.

Unknown cause: in some cases, young people.

Classify

Kissel Bach vascular point bleeding.

Bleeding due to artery damage.

Bleeding from damage to a vein.

Disseminated bleeding due to capillaries: blood oozing throughout the nasal mucosa, no certain point usually occurs in acute myelogenous leukaemia, haemophilia, typhoid, dengue fever.

Clinical

Mild nose bleed

Causes: minor injury due to nose picking or diseases such as influenza, typhoid, sometimes normal healthy people can suddenly bleed.

Nasoscope: blood is flowing from an artery or point. The bleeding is not much, dripping drip and tends to handle itself. The disease often recurs many times. This type of nosebleed is commonly seen in children and has a mild prognosis.

Moderate nose bleed

Cause: due to trauma to the nose or after sinus surgery.

Nasoscope: blood is flowing from the corner of the nose or rolling the nose. Does not affect the whole body.

Severe nose bleed

Cause: damage to the nasal artery in high blood pressure, atherosclerosis, cirrhosis ... is common in elderly patients with chronic diseases. In trauma often damage the screening artery and cause bleeding difficult to stop.

Rhinoscopy: discharge is difficult to see because the discharge is usually high above and behind. Pale mucous skin, rapid pulse, drop in blood pressure.

Treatment

Before a patient with nosebleeds, the first thing is to stop bleeding immediately, then find the cause.

Mild nose bleed

Bleeding from the vascular point or the female palate artery.

Using two fingers to squeeze the wings of the nose again causes the Kissel Bach point to be pressed.

Use wick to absorb vasoconstrictor drugs such as: Ephedrine 1% or Antipyrine 20% stuffed tightly into the nasal cavity and vestibule.

Incineration with silver nitrate or electrolyte.

Moderate and severe nose bleeds

Must use positive measures.

Method of pre-nasal insertion:

Tools: Clar lamp, nose opener, elbow, tongue pressing, 1.5cm wide mèche, 40cm long, finger glove, currently using Merocel (Xomed - USA).

Drugs: vasoconstrictor, aesthetic Lidocaine 6%, paraffin oil.

How to insert the nasal sesame first: first tell the patient to bleed all the blood and put in the nose a piece of sesame pastes 6% Lidocaine and 10cm long vasoconstrictor works to reduce pain and vasoconstriction during the procedure. After 3 minutes to withdraw the mèche, use the nose to open the nostril wide through the inside of the nasal cavity to see if the patient has septum crest or septum crooked or not in order to not cause more bleeding when performing the procedure. Pump antibiotic grease or paraffin oil into the nasal cavity then insert the condom over the open nose, then put the condom into the nasal cavity. Use a felt elbow to stuff mèche into the nasal cavity through opening the nose 6-8cm deep, continue to put mèche into the nasal cavity, starting from the top and bottom (deep close to the back door) and in front, outback to the door nose. Mèche is arranged in a zigzag pattern in the style of a harp). While stuffing the nose mantle should be tightly stuffed to not let space die. Check the back of the throat to see no blood flowing down the throat.

Withdraw sesame: should not be left for more than 48 hours, often withdraw if there is a fever. While withdrawing mèche to withdraw slowly, lying on its side, the physician pulls the mèche slowly, one by one, each segment does not exceed 5 cm, each pause for 5 minutes, while withdrawing hydrogen peroxide into the nose. Withdraw mèche lasts about 20 to 30 minutes.

Method of inserting the following nose:

If nosebleeds are caused by trauma to the posterior and upper nasal cavities or have already been ineffective, the posterior nasal cavity insertion procedure must be applied.

Tools: in addition to tools such as for pre-nasal insertion, a small rubber Nelaton tube is required, 2 pince Koche (with and without claw), a cylindrical swab 3cm in diameter tied to two threads It is probably 25cm long, and a second swab is also cylindrical but smaller than 1cm in diameter.      

How to insert the posterior nasal cavity: Place the Nelaton tube in the side nostril that is bleeding and push the tube down the throat. Have the client open his mouth, and using Pince not to pull the Nelaton's head pair out of his mouth. Tie the thread of the large swab to the end of the Nelatel tube. Pull the Nelaton tube upside down from the throat to the back door. The gauze was pulled back from the throat by the thread to the nasopharynx and buttoned into the back door. When the gauze is passed through the waist, it is often entangled, the physician should use the index finger of his right hand to push the gauze upward and back to help it get through the tightness. The left-hand holds the Nelaton tube and the thread pulls forward. Then remove the thread from the Nelaton tube and tie it to the second swab, which covers the first nostril.

After inserting posterior nasal congestion, it is possible to place reinforcement of the anterior nasal bridge as described above.

Arterial constriction method:

If the posterior nasal cavity is inserted and the anterior nasal cavity is still bleeding, we have to constrict the inner jaw artery in the jaw pit or the external carotid artery and constrict the anterior and posterior sieve at the inner edge of the eye socket.

Node circuit method:

Currently, by means of vascular intervention, an angiogram detects the bleeding point and source, then proceeds with a temporary or permanent node to help stop bleeding accurately and reduce pain and injury to the patient.

Drug treatment:

Infusion, blood transfusion (pay attention to transfusion of fresh blood when necessary).

Haemostatic drugs: Vitamin C, Vitamin K, Transamin, Hemocaprol, CaCl2 ...

Cardiovascular drugs: Spartein, Uabain ....

Strong broad-spectrum antibiotic: Cephalosporin III generation

Analgesics: Profenid, Alaxan, Efferalgan codein ..

Sedatives: Rotunda, Gardenal, Valium, Stilnox ...