1 dr. Bambang Udji Joko, Sp.THT7. Mechanical Obstruction of The Airway MECHANICAL OBSTRUCTION OF AIRWAY DR.dr. BAMBANG UDJI DJOKO RIANTO, SP.THT,M.KES. Referrences: Simpson J.F, Robin I., Ballantyne J.C., Groves J A synopsis of otolaryngology. Becker W., Naumann H.H., Pfaltz C.R Ear, Nose, and Throat Disease. Block 12, May 28, 2008 Week 2 International Programme

2 CONGENITAL TRAUMA INFLAMMATION/INFECTION NEOPLASM CORPUS ALIENUM

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4 - aetiologi: non canalization & non epithelial plug NOSE ABNORMALITY CONGENITAL MALFORMATIONS ATRESIA & STENOSIS OF ANTERIOR NARES - aetiologi: non canalization & non epithelial plug between the medium & lateral nasal processes - incidence: rare - treatment: the web must be excised

5 dr. Bambang Udji Joko, Sp.THT7. Mechanical Obstruction of The Airway Block 12, May 28, 2008 Week 2 International Programme

6 Aetiology: persistence of the primitive bucco- nasal membrane2. ATRESIA POSTERIOR NARES Aetiology: persistence of the primitive bucco- nasal membrane Degrees: - complete unilateral  most commonly - incomplete unilateral - complete bilateral - incomplete bilateral Type or origin mucous membrane bony  most commonly mixed

7 Choanae Tonsilla palatina Epiglottis Aditus laringeus

8 The partition is attached to: basis sphenoid, above PATHOLOGY The partition is attached to: basis sphenoid, above medial pterygoid plate of sphenoid vomer, on the inner side hard palate, below - The thickened vary from: 1-10 mm

9 females are more commonly than maleINCIDENCE neonatal females are more commonly than male CLINICAL FEATURES Unilateral atresia: - nasal obstruction  may not notice for some years - excessive nasal discharge  at /soon after birth  glue like in consistency

10 Bilateral atresia - soon after birth - urgent  death from asphyxia - nasal discharge - delayed symptom: - mouth breathing - failure to develop taste & smell

11 rubber catheter or probe  can’t be passed DIAGNOSIS rubber catheter or probe  can’t be passed through the nose into nasopharynx (NP) - posterior rhinoscopy  atresia  - radiograph  a radiophag substance instilled into the nose doesn’t reach the NP

12 - transpalatal excision  not for acute emergency case TREATMENT - transpalatal excision  not for acute emergency case  best performed after early childhood - transnasal perforation - simple perforation  gauge/burr - emergency procedure in infant - tracheostomy

13 Blows to the front or side of the nose MAXILLOFACIAL TRAUMA FRACTURED NASAL BONE AETIOLOGY Blows to the front or side of the nose Nasal obstruction caused by dislocation or haematoma of the septum DIAGNOSIS Clinical examination  crepitation sign  rhinoscopy anterior radiographic examination

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15 Reposition of the fracture Incision of haematom Anti inflammationTREATMENT Reposition of the fracture Incision of haematom Anti inflammation

16 INFLAMMATION/INFECTIONNON SPECIFIC CHRONIC INFECTIVE RHINITIS caused by inferior turbinate swells (simple type) - permanent hypertrophic changes  cellular infiltration in mucous stroma, glands, blood vessels, lymphatic tissue  fibrosis  venous & lymphatic obstruction  passive oedema  nasal polyp

17 NASAL ALLERGY RHINITIS - caused by venous stasis of the conchae/mucosa - nasal polyp DIAGNOSIS - symptoms: itching/sneezing, nasal obstruction, rhinorrhea - careful history  family & personal record clinical examination/rhinoscopy conchae hypertrophy nasal discharge

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19 SUPPORTING TEST - eosinophil in nasal discharge - skin test  show single or multiple sensitivity - intranasal test (provocation test) TREATMENT -removal of precipitating factors -nasal allergic treatment - Operative  nasal polyp

20 VASOMOTOR RHINITIS - nasal mucosa is hyperactive to certain stimuli- the absent of any specific allergic cause caused by: - an autonomic imbalance in nasal mucosa - endocrine imbalance - septal deflection - drugs  hypotensive drugs  overuse local application - atmosphere condition - fume, dust, alcohol

21 Nasal obstruction caused by:- hypertrophy of the inferior turbinate - nasal polyp TREATMENT elimination of cause factors nasal medicament  decongestant cauterization submucosal diathermy removal of polyp psychological adjustment

22 FOREIGN BODIES IN THE NOSEmore common in children in adult  psychiatry case - through the anterior nares  most commonly - through the posterior nares  food, enter during an attack of vomiting - through penetrating wound - organic or inorganic

23 unilateral nasal discharge & obstruction nose bleeding  may occur CLINICAL FEATURE unilateral nasal discharge & obstruction nose bleeding  may occur sneezing foreign body

24 - clinical/rhinoscopy examinationDIAGNOSIS - clinical/rhinoscopy examination TREATMENT - removal foreign body

25 - nasal concretions formed round a foreign bodies, blood, or mucousRHINOLITH - nasal concretions formed round a foreign bodies, blood, or mucous AETIOLOGY -foreign bodies  exogenous (commonest cause) -blood-cloth or inspissated pus

26 - Clinical examination/anterior rhinoscopyDIAGNOSIS - Clinical examination/anterior rhinoscopy TREATMENT -removal

27 - mixed infective allergic rhinitisNASAL POLYP SIMPLE NASAL POLYP - allergic rhinitis - vasomotor rhinitis - inflammatory: - acute - chronic non specific - chronic specific - mixed infective allergic rhinitis

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29 - antral more commonly in children & young adult2. NEOPLASTIC Benign Malignant Site of origin: - ethmoidal sinuses  incidence at any age - antral more commonly in children & young adult

30 - primary  nasal cavity NASAL NEOPLASMS - primary  nasal cavity - secondary  from paranasal sinuses, nasopharynx DIAGNOSIS clinical examination/rhinoscopy histopathological examination TREATMENT based on: -the symptoms, signs -histopathological test results

31 MOUTH & PHARYNX CONGENITAL ANOMALIES THYROGLOSSAL CYSTS- between the suprasternal notch and the foramen caecum 2. STENOSIS OF THE PHARYNX - in the nasopharyngeal isthmus 3. WEB OR STRICTURE OF THE PARYNX - rare - in post cricoid region of the laryngopharynx

32 THE PHARYNGEAL LIMPHOID TISSUEINFLAMMATION OF THE PHARYNGEAL LIMPHOID TISSUE nasopharyngeal tonsil hypertrophic physiologic condition at the 3-7 years old DIAGNOSIS -clinical examination  posterior rhinoscopy -X-ray film TREATMENT -surgical

33 Suppuration in the retropharyngeal lymph-gland ACUTE RETROPHARYNGEAL ABSCESS Abscess lies between the buccopharyngeal and pre Vertebral fasciae AETIOLOGI Suppuration in the retropharyngeal lymph-gland Infection spreading from naso & oropharynx TREATMENT -incision of the abscess -systemic disinfection -tracheostomy

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35 - male more common than female - age: -8-50 years old TUMOURS OF THE NASOPHARYNX INCIDENCE - male more common than female - age: years old  commonest TYPE OF TUMOURS - juvenile nasopharyngeal fibroma - juvenile nasopharyngeal angiofibroma

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37 - varying degrees of differentiation SQUAMOUS CELL CARCINOMA - the commonest type - varying degrees of differentiation - fossa Russenmulleri is a common site DIAGNOSIS - symptoms & signs - posterior rhinoscopy - biopsy & histopathological examination

38 TREATMENT - based on the stage & metastatic spreading - tracheostomy - irradiaton - surgery - combination of both

39 - especially inferior group TUMOURS OF THE LARYNGOPHARYNX - especially inferior group - between the upper border of the cricoid cartilage and oesophageal opening - female more common (90%) DIAGNOSIS - radiography & endoscopy - biopsy & histopathological examination

40 - based on the stage & metastatic spreading - tracheostomy TREATMENT - based on the stage & metastatic spreading - tracheostomy - irradiaton - surgery - combination of both

41 - tissue of the larynx are flabby - congenital web of the larynx CONGENITAL ABNORMALITIES LARINGOMALACIA - tissue of the larynx are flabby - congenital web of the larynx - fibrous tissue stroma covered by epithelium - usually in the anterior half of glottis - atresia may be complete DIAGNOSIS - endoscopic examination

42 Choanae Tonsilla palatina Epiglottis Aditus laringeus

43 no treatment  in the milder form (just hoarseness) - tracheostomy  severe stridor & dyspnoea - web  excision

44 - compression (closed) injury - penetrating (open) injuryTRAUMATIC CONDITION - compression (closed) injury - penetrating (open) injury DIAGNOSIS - the history & physical signs - radiography TREATMENT - intubation/tracheostomy - systemic disinfection - repair the effect of trauma

45 BURNS AND SCALDS AETIOLOGY - inhalation of irritant fumes or gases- swallowing of corrosive fluids - inhalation of steam DIAGNOSIS - the history & physical signs TREATMENT - rest - steroid - systemic desinfection - tracheostomy or laryngotomy

46 INHALED FOREIGN BODIES- organic or anorganic foreign bodies DIAGNOSIS - the history & physical signs - radiography - endoscopy TREATMENT - removal by direct laryngoscopy - tracheostomy or laryngotomy - systemic disinfection, anti inflammation drug

47 - most serious than in adult - lymphatic supply is richer INFLAMMATION OF THE LARYNX ACUTE SIMPLE LARYNGITIS IN CHILDREN - most serious than in adult - lymphatic supply is richer - the submucosa more likely to be infected - neuromuscular is more easily spasm - less able to expel the secretions by coughing

48 - systemic disinfection - oxygen - nasotracheal tube - tracheostomy TREATMENT - rest in bed - systemic disinfection - oxygen - nasotracheal tube - tracheostomy - laryngotomy

49 - acute laryngotracheobronchitis - diphtheritic laryngitisOTHER DISEASE - acute epiglottitis - acute laryngotracheobronchitis - diphtheritic laryngitis

50 -single papilloma of the larynx -multiple papillomata NEOPLASM OF THE LARYNX BENIGN NEOPLASM Epithelial tumours: -single papilloma of the larynx -multiple papillomata 2. Connective tissue tumours: -fibroma of the vocal cord -chondroma -angioma

51 a. supraglottic b. glottic c. infraglottic MALIGNANT OF THE LARYNXEPITHELIAL TUMOURS  squamous cell carcinoma a. supraglottic b. glottic c. infraglottic 2. CONNECTIVE TISSUE

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53 - radiography & endoscopy - biopsy & histopathological examinationDIAGNOSIS - symptoms & signs - radiography & endoscopy - biopsy & histopathological examination TREATMENT - based on the stage & metastatic spreading - tracheostomy - irradiaton - surgery - sombination of both

54 Stenosis of tracheal & bronchi Tracheo-oesophageal fistula TRACHEA AND BRONCHI CONGENITAL ABNORMALITIES Stenosis of tracheal & bronchi Tracheo-oesophageal fistula tracheocoele

55 - injuries: cut throat, stab, gun-shot wounds - crush injury TRAUMATIC CONDITIONS - usually associated with laryngeal injuries - injuries: cut throat, stab, gun-shot wounds - crush injury - medical operation  upper end of oesophagus  trachea

56 - clinical symptoms & signsDIAGNOSIS - clinical symptoms & signs TREATMENT - tracheostomy - surgical repair

57 vegetables & non vegetablesFOREIGN BODIES vegetables & non vegetables DIAGNOSIS - right bronchus most commonly than left - history inhale a foreign body - fisical examination  stridor - radiography TREATMENT - removal through a bronchoscope - removal by thoracotomy - tracheostomy

58 - accompanies with laryngitis or bronchitis INFLAMMATION OF THE TRACHEA & TRACHEOBRONCHIAL TREE ACUTE SIMPLE TRACHEITIS - accompanies with laryngitis or bronchitis - cause by medical instrumentation - allergic reaction DIAGNOSIS - symptoms & signs - clinical examination

59 - occurs in infants & young children up to 4 years old ACUTE LARYNGOTRACHEOBRONCHITIS - occurs in infants & young children up to 4 years old - it is serious & sometimes lethal DIAGNOSIS - symptoms & signs - examination - radiography TREATMENT - oxygen - humidification - systemic disinfection - tracheostomy

60 INFLAMMATION OF THE BRONCHI & LUNGS- ACUTE BRONCHITIS PULMONARY COLLAPSE LUNG ABSCESS DIAGNOSIS - symptoms & signs - clinical examination - radiography TREATMENT - systemic disinfection - postural drainage and breathing exercise - bronchoscopic aspiration - external drainage

61 THE TRACHEOBRONCHIAL TREEMALIGNANT TUMOURS OF THE TRACHEOBRONCHIAL TREE CARCINOMA OF THE TRACHEA secondary invasion more commonly than primary DIAGNOSIS - indirect and direct laryngoscopy TREATMENT - tracheostomy - operative - irradiation - combination

62 90% occur between 40-70 years oldCARCINOMA OF THE BRONCHUS 80% are in the male 90% occur between years old DIAGNOSIS - symptoms & signs - radiography: bronchography, bronchuscopy - cytology TREATMENT - surgery - radiotherapy - combination

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