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nasal bone fracture reduction under local anesthesia скачать в хорошем качестве

nasal bone fracture reduction under local anesthesia 5 лет назад

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nasal bone fracture reduction under local anesthesia
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nasal bone fracture reduction under local anesthesia

The nasal framework is very delicate tripod of two nasal bones and one nasal septum. The fracture of nasal bone dislocates this tripod balance specially in displaced fracture. The X ray of nasal bone is very important before undertaking this procedure as it has medicolegal importance as after the reduction of nasal bone fracture, the evidence of fracture disappears. The nose is packed with 4% xylocaine atleast 30 minutes before the surgery. The fallowing nerves are blocked by infiltrating 2%xylocaine (1)The infraorbital nerve can be blocked by two ways- either passing the needle through the intercartilagenous area, needle passing under the skin reaching up to the exit of infraorbital nerve. The left hand finger guides the positioning of needle. This nerve can also be blocked by direct puncture of skin reaching upto the infraorbital nerve.(2) the nasal branches of greater palatine nerve is blocked near to anterior nasal spine. (3) Infratrochlear nerve (4) External nasal nerve , both the nerves are blocked by the same single puncture at intercartilagenous area, the needle is advanced up to the infratrochlear nerve area and after infiltration , the needle is withdrawn slowly while continue to infiltrate the area thus blocking the external nasal nerve. Thus both these nerves are blocked by the single puncture.Surgeon has to wait for some time for the 2%xylocaine to get the desired effect of blocking the nerves. The Walsham forceps is introduced at the nasal cavity, The rubber side of the Walsham forceps is kept outside to prevent skin damage. The nasal bone is firmly fixed between two blades of Walsham forceps, The fracture site is disimpacted first and then impacted back to the normal position. The similar step is repeated on the other side. The basic principle is first to increase the deformity and then reduce it. The Asch forceps is introduced the bony nasal setptum is firmly fixed between two blades of Asch forceps and the nasal septum is lifted up. This brings nasal septum in alignment with tripod concept of nasal bone and septum. This step of Asch forceps is slightly painful to the patient. Some gentle digital manipulation is required for finesse and to bring everything into the perfect order and position to provide the shape of nose as it was before the fracture. the light anterior nasal packing is done which is removed next day.The micropore tape is applied on the dorsam ,1/3 overlapping previous one to prevent the displacement of reduced nasal bone.The plaster of Paris cast is applied which is secured with dynaplast and it is removed after three weeks. The patient is instructed to avoid sleeping face down on bed during this period. Thankyou very much Dr. Vikas Sinha Professor ENT

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