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Epistaxis (nosebleed)Etiology：1、Local causes：1）Trauma：mucosa laceration blood vessel injury2）Inflammation of nose and sinus3）Diseases of septum4）Tumor：nasal cavity tumor sinus tumor angiofibroma of nasopharynx2、General factorsSystematic diseaseAscension of arterial pressure and venous pressure，Dysfunction of coagulation,Change of blood vessel tension.1）Acute epidemical diseases2）Cardiovascular diseases3）Hemological diseases4）Nutrition defect：VitC、K、P or calcium5）Liver,kidney diseases and rheumatic fever6）Poison：phosphorus,mercury,arsenic,benzene7）Oslers disease hemorrhagic familial telangiectasia8）Endocrinic imbalanceTreatment：1、Fundamental treatment Emergency:sedation estimate the bleeding amount keep proper posture No blood ingest2、Hemostatic methods1）Identify the bleeding site pinch the nostrils 2）Cautery techniques chemical electrical laser radiofrequency microwave3）Nasal packing resorbable material,gel foam.anterior postorior water or air balloon3、Artery ligationanterior ethmoid arteryposterior ethmoid arteryinternal maxillary artery external carotid artery 4、Angiography and embolization submucous resection endoscopic cautery and ligation 5、Systematic management.1）sedative2）hemostatic agent3）Vitamine C,K.4）sclerosant5）anti-shock management6）Traditional Chinese MedicineForeign body in the noseEndogenicDead bone,blood clot,rhinolithExtrogenicPlant seeds,insect,metals,stone,woodsBiologicNonbiologicEtiology：1、Children 2-3yrs old2、Insects3、Injury：wood,rocks,metals4、IatrogenicMetal in nasal cavityRhinolith in nasal cavityDiagnosis：Unilateral purulent drainage with foul smell in children Foreign body in the nose?History；nasal examination；plain X-ray;CT scan Treatment：Remove foreign body in different waysPrevent foreign body in the nosein bronchiMucocele and CystCyst of nasal vestibuleVestibule,maxillary dental alveoli,unilateral round/oval cystDiagnosis:palpation,punction X-rayTreatment:resection of cystMucoceleBenign neoplasms:Obstruction of sinus ostia and accumulation of fluidEtiology:chronic inflammation,allergic sinonasal disease,trauma,and previous surgeryPathology：retention of intrasinus secretion,progressive augmentation of internal pression,bony remodeling and erosion.Morbidity:China:ethmoid frontal sphenoid maxillaryAbroad:frontal ethmoid sphenoid maxillarySymptoms&Sign：Orbital apex syndromeFacial protrude Rhinorrhea,nasal obstruction,hyposmia Diagnosis:History,symptoms and signPunction,X-ray/CT scanTreatment:Operation:“open surgery”,marsupializationDiagnosis：X-ray and CT scanner.Treatment：surgical treatment:drainage,creation of vast communication with nasal cavityTumor of nose and skull baseBenign tumor in the nose 40 kinds of benign tumor nasal organ is small,difficult to identify the origin.recurrence and malignant transformationHemangiomaCapillary hemangiomanasal septum&anterior inferior turbinateCavernous hemangiomamaxillary&nasal bonePapilloma in the nosePathogenesis unclear humon papilloma virus(HPV)Pathology:1)Keratotic papilloma simple cutaneous wart,exophytic with broad base,in the nasal vestibule or nasal septum.2)Inverted papillomaAge40ys，high morbidity:5060ys;M:F=3:1Features：Hyperplastic epithelia with inverting pattern of growth.Epithelial inversion into underlying stroma.Basal membrane is intact.Malignant transformation:5-15%.squamous cell carcinoma,adenocarcinoma.Symptoms&Signs：Nasal obstruction,rhinorrhea with blood staining,sometimes with headache and abnormalities of smell.Firm red or grey masses,unilateral,arising from lateral wall of the nose,extension into the ethmoid and maxillary sinuses.TreatmentComplete excisionSome times it is difficult.Recurrence:28-74%Lateral rhinotomy.Endoscopic excision,with reasonable recurrence rates.Malignant transformation-radiotherapyMalignant tumor of nasal cavity and paranasal sinusesMorbidity in China:2.05-3.66%of malignant tumors in all21.74%-49.22%of malignant tumors in ORLCarcinoma:cancer=8.5:1M:F=1.5-3.0:1Cancer:-40-60ys，Sarcoma-younger 24%of whole body carcinorna.more frequently in sinus than nasal cavity maxillary 6080%ethmioid 3.8%frontal 2.5%for advanced case difficult to identify the original site.Squamous:7080%more in maxillary sinusAdenocarcinoma:48%more in ethmoid sinusAdenoid cystic carcinoma 4%more in ethmoid sinusSarcoma:10-20%malignant tumors in ORLMore in nasal cavity and maxillary sinus.Malignant lymphoma60%；Malignant epithelia tumor.Carcinoma of nasal vestibule and Septum Carcinoma of the paranasal Sinus Melanoma Esthesioneuroblastoma Malignant nonepithelial tumor.Rhabdomyosarcoma.Hemangiopericytoma lymphoma Extramedullary plasmacytoma.Symptoms&Signs：Nasal Cavity:nasal obstruction.epistaxis.pain.numbness of cheek.Paranasal sinus:purulent drainage with blood nasal obstruction(unilateral,progressive)extrusion of cheek extrusion of hard palate Ophthalmologic symptoms:proptosis,epiphora,visual acuity decrease,orbital apex syndrome cranial involvement Diagnosis:Caution!40yrs,unilateral,progressive symptoms increase doctors index of suspicion nasal examination nasal endoscopic examination biopsy CT、MRI PET(positron emission tomograph)Treatment:1.Radiotherapy:5000-6000rad within 4-8w，6w after radiotherapy-surgery2.Surgery-cornerstone -lateral rhinotomy.-midfacial degloving -Maxillectomy -Maxillectomy+orbital contents exenteration -Craniofacial resection.3.Chemotherapy-unwilling or unsuitablefor surgery Prognosis:Survival advantage radiation and surgery.The value of the chemotherapy undetermined.5yr survival rate:30-40%for maxillary sinus MT复习与思考：复习与思考：1、鼻出血的病因有哪些？如何处理鼻出血？2、鼻腔鼻窦恶性肿瘤的临床表现有哪些？3、鼻腔鼻窦恶性肿瘤的处理原则是什么？
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