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MediaCenter.thieme.com

plus e-content online

Videos demonstrating step-by-step

endoscopic repair of septal perforation are

online at MediaCenter.Thieme.com!

Simply visit MediaCenter.thieme.com and, when prompted during the

registration process, enter the code below to get started today.

8FXV-733V-ND3G-75Y4

Nasoseptal Perforations: Endoscopic

https://t.me/med1917

Repair Techniques

Isam Alobid, MD, PhD

Professor Rhinology and Skull Base Unit Department of Otolaryngology Hospital Clinic, University of Barcelona Barcelona, Spain

Paolo Castelnuovo, MD, FRCSEd, FACS

Full Professor and Chairman Division of Otorhinolaryngology Department of Biotechnology and Life Sciences Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC) University of Insubria ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi Varese, Italy

218 illustrations

Thieme Stuttgart • New York • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is

https://t.me/med1917

available from the publisher

Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, customerservice@thieme.de

Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, customerservice@thieme.com

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at

the time of production of the book.

Nevertheless, this does not involve,imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaﬂets accompanying each drug and to check, if necessary in consultation with a physicianor specialist,whether the dosageschedulesmentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used orhavebeen newly releasedonthe market. Every dosage schedule or every form of application used is entirelyat the user’s own risk and responsibility. The authors and publishersrequest every user to report tothe publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though speciﬁc reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, customerservice@thieme.in

Thieme Publishers Rio, Thieme Publicações Ltda. Edifício Rodolpho de Paoli, 25ºandar Av. Nilo Peçanha, 50 – Sala 2508 Rio de Janeiro 20020-906, Brasil +55 21 3172 2297 / +55 21 3172 1896

Cover design: Thieme Publishing Group Typesetting by Thomson Digital, India

Printed in India by Replika Press Pvt. Ltd. 5 4 3 2 1

ISBN 978-3-13-205391-5

Also available as an e-book: eISBN 978-3-13-205401-1

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographingor duplication of any kind,translating, preparation of microﬁlms, and electronic data processing and storage.

First and foremost, I want to thank my wife, Adriana, and the rest of my family, who supported

https://t.me/med1917

and encouraged me inspite of all the time it took me away from them. I also want to thank

all of the contributors. They made this book worth doing.

Isam Alobid

To my wife Lorella and my sons Matteo, Chiara, Andrea, for making everything possible,

for their continued support and love throughout my life.

Paolo Castelnuovo

https://t.me/med1917

Contents

https://t.me/med1917

Videos .................................................................................. xiii

Foreword

Preface

Acknowledgments

Contributors

1. Nasal Anatomy

............................................................................... xv

................................................................................. xvii

.................................................................... xix

........................................................................... xxi

......................................................................... 3

Alfonso García-Piñero, Eugenio Cárdenas, Ariel Kaen, Juan Antonio Simal-Julian

1.1 Front Door to Nasal Cavity

1.1.1 Piriform Aperture ..................... 3

1.1.2 Nasal Pyramid ........................ 3

........... 3

1.2 Medial Wall of Nasal Cavity: Nasal Septum

1.2.1 Septal Cartilage ....................... 4

1.2.2 Perpendicular Plate of Ethmoid ......... 4

1.2.3 Vomer ............................... 4

1.2.4 Septal Crests of Palatine and Maxillary

Bones ............................... 5

............................. 4

1.3 Lateral Nasal Wall ................... 5

1.3.1 Lateral Wall of Nasal Cavity ............. 5

1.3.2 Maxillary Sinus ....................... 7

1.4 Ceiling of Nasal Cavity: Nasal Vault, Ethmoid Cells, and Frontal Sinus

1.4.1 Ethmoid Cells ........................ 8

1.4.2 Frontal Sinus ......................... 8

...... 7

1.5 Nasal Floor .......................... 8

1.5.1 Palatine Process of Maxilla ............. 8

1.5.2 Horizontal Process of Palatine Bone ...... 9

1.6 Back Door of Nasal Cavity ............ 9

1.6.1 Choana .............................. 9

1.6.2 Sphenoid Sinus ....................... 9

2. Nasal Physiology ....................................................................... 13

Jonathan Frankel, Emily Hrisomalos, Steven M. Houser

2.1 Normal Nasal Physiology

2.1.1 Mucous Blanket and Mucociliary

Clearance ............................ 13

2.1.2 Innate Mucosal Immunity .............. 14

2.1.3 Nasal Sensation/Innervation ............ 14

2.1.4 Nasal Airflow ......................... 14

2.2 Abnormal Nasal Physiology .......... 14

2.2.1 Disorders of Mucociliary Transport ...... 14

2.2.2 Infection and Inflammation ............ 14

............. 13

2.2.3 Exposure to Ciliotoxic Agents ........... 15

2.3 Tests of Nasal Physiology ............. 15

2.3.1 Rhinomanometry ..................... 15

2.3.2 Acoustic Rhinometry .................. 15

2.3.3 Mucociliary Transport ................. 15

2.3.4 Ciliary Activity ....................... 15

2.4 Conclusion .......................... 16

vii

Contents

https://t.me/med1917

3. Nasal Septum and Nasal Wall Vascularization ...................................... 19

Juan R. Gras-Cabrerizo, Juan Ramón Gras Albert, Elena Garcia-Garrigós, Humbert Massegur-Solench

3.1 Introduction

3.2 Branches of Maxillary Artery (Arteria Maxillaris)

3.2.1 Sphenopalatine Artery (Arteria

Sphenopalatina) ...................... 19

3.2.2 Posterior Superior Alveolar Artery (Arteria

Alveolaris Superior Posterior) ........... 20

3.2.3 Infraorbital Artery (Arteria Infraorbitalis). 21

3.2.4 Descending Palatine Artery and the Greater Palatine Artery (Arteria Palatine Descendens and Arteria Palatine Major).. 21

3.2.5 Artery of Foramen Rotundum ........... 22

........................ 19

........................... 19

3.2.6 Artery of Pterygoid Canal or Vidian Artery

(Arteria Canalis Pterygoidei) ............ 22

3.2.7 Pharyngeal Branch or Pterygovaginal

Artery (Ramus Pharyngeus)............. 22

3.3 Branches of Facial Artery (Arteria Facialis)

3.3.1 Superior Labial Aartery (Arteria Labialis

Superior)............................. 23

3.3.2 Lateral Nasal Artery (Arteria Lateralis Nasi)23

............................. 23

3.4 Branches of Ophthalmic Artery (Arteria Ophthalmica)

........................ 23

4. Nasal Perforation Etiology ............................................................ 29

Mauricio López-Chacón, Arturo Cordero Castillo, Cristobal Langdon, Francesca Jaume, Isam Alobid

4.1 Introduction

4.2 Pathogenesis ........................ 29

4.3 Etiology ............................. 30

4.3.1 Traumatic Causes ..................... 30

........................ 29

4.3.2 Intranasal Drug Abuse ................. 30

4.3.3 Occupational Exposure ................ 31

4.3.4 Neoplasm ............................ 32

4.3.5 Systemic Diseases ..................... 32

4.4 Conclusion .......................... 32

5. Systemic Diseases Associated with Septal Per foration ............................ 35

Mauricio López-Chacón, Arturo Cordero Castillo, Cristobal Langdon, Alfonso Santamaría, Isam Alobid

5.1 Infectious Diseases

5.1.1 Tuberculosis .......................... 35

5.1.2 Leprosy .............................. 35

5.1.3 Syphilis .............................. 36

5.1.4 Human Immunodeficiency Virus ........ 37

5.1.5 Fungal Infections ...................... 37

.................. 35

5.2.1 Granulomatosis with Polyangiitis ....... 37

5.2.2 Eosinophilic Granulomatosis with

Polyangiitis .......................... 38

5.2.3 Sarcoidosis ........................... 38

5.2.4 Systemic Lupus Erythematosus ......... 38

5.3 Conclusion .......................... 38

5.2 Multisystemic Disorders (Vasculitis and Autoimmune Diseases)

.......... 37

6. Preoperative Clinical Evaluation of Patient .......................................... 43

Fabio Ferreli, Paolo Castelnuovo

7. Conservative Treatment .............................................................. 49

Arturo Cordero Castillo, Mauricio López-Chacón, Cristobal Langdon, Isam Alobid

7.1 Introduction

7.2 Pathogenesis ........................ 49

7.3 Symptoms .......................... 49

........................ 49

7.4 Conservative Treatment .............. 50

7.4.1 Saline Irrigation ...................... 50

7.4.2 Ointments ........................... 50

7.4.3 Nasal Packs .......................... 51

7.4.4 Hemostatic and/or Reabsorbable Agents . 51

viii

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