2. uran 29:45 (O Prophet) convey to people all that is revealed to you of the
Book, and establish system of Salat (establish the Divine System). For, verily,
establishment of Salat (the Divine System) will shut off lewdness, stinginess and
behavior contrary to the Divine Values. This is so, because Allah’s Law is the Greatest
Law that can give you eminence. And (O People) Allah knows whatever you contrive on
your own.
3. Vasomotor And Atrophic rhinitis
By
Lt Col Saeed Ullah, MBBS, MCPS,
FCPS Classified ENT, Head and
Neck surgeon CMH Quetta
11. Autonomic nerve supply
• Sympatheitic stimulation
▫ Vasoconstriction
▫ Smooth muscle around sinusoids constrict
▫ Decongestion and opening of nose
• Parasympathetic stimulation
▫ Engorgement of nasal mucosa
▫ Increase glandular activity
▫ Nasal congestion and blockage
12. Definition of rhinitis
• Inflammation of nasal lining, characterized by
one or more of the following symptoms
▫ Nasal congestion
▫ Rhinorrhoea
▫ Sneezing
▫ Itching
16. Pathogenesis
• Rich blood supply of nasal mucosa
• The turbinate’s erectile tissues
• Sinusoids surrounded by smooth muscle fibers
• Under control of autonomic nerves
• Autonomic nerves under control of
hypothalamus
• Sympathetic stimulation leads to
vasoconstriction
• Parasympathetic stimulation causes
vasodilatation
17. Pathogenesis
• Unstable autonomic nervous system
▫ Parasympathetic dominance
• Nasal mucosa is hyper reactive
▫ Change in temp
▫ Humidity
▫ Blasts of air
▫ Dust and smoke
23. Atrophic rhinitis
Chronic inflammatory condition in which nasal
mucosa, glands & bones are atrophied There is
widening of nasal cavities with greenish crusts
in nasal cavities
24. Types of Atrophic rhinitis
1. Primary:
exact cause is not known
2. Secondary:
to some underlying factors
25. Primary atrophic rhinitis
• Infection
Klebsiella Ozaenae
Diphthroid Bacillus
Coccobacillus foetidus ozaenae
• Hormonal imbalance
At puberty
More common in females
• Nutritional
Poor socioeconomic status
Vit D and iron deficiency
• Heredity
• Autoimmune
27. Secondary Atrophic Rhinitis
1. Chronic purulent sinusitis
2. Enthusiastic surgery on nose
3. Syphilis
4. Tuberculosis
5. Marked DNS with wide nasal cavity on one
side
28. Pathology
• Epithelium
Patches of metaplasia
Transition from ciliated columner into stratified
squamous
• Lamina propria
Chronic cellular infilterats
Granulation tissues, fibrosis
• Mucous glands
Decrease in size and number
• Vascular
Decreased vascularity
29. Symptoms
Nasal obstruction due to:
Crusts
Loss of sense of air passage
Recurrent Epistaxis
Offensive smell (stench)
Anosmia due to Atrophy of Olfactory nerve
Headache
Choking
30. Signs
• External nasal deformity
• Very wide nasal cavities
• Inf. Turbinates shrunken / rudimentary
• Greenish / dirty crusts
• Stench (dead body like smell)
• Maggots
35. Treatment
Conservative:
Alkaline nasal douches with ¼ lit. of warm
lotion of
Sod. Chloride 2 parts
Sod. Bicarbonate 1 part
Sod. Diborate 1 part
Removal of crusts
25% Glucose in glycerin nasal drops
Oestradiol in Arachis oil
36. Treatment
Surgical Treatment:
Narrowing nasal cavities:
Injecting Paraffin or Teflon submucosally
Insertion of cartilage graft
Stellate ganglion block
Parotid duct transposition
Closure of one / both nostrils leaving 3mm
hole
Young’s operation
Sympatheitic nerve fibers
Carotid plexus
Deep petrosal nerve
Do not form synopsis in pterygopalatine ganglion
Secretomotor and vasomotor
Parasympathetic nerve fibers
Superior salivatory nucleus
Greater petrosal nerve
Vidian nerve
This slide shows the greenis nasal discharge which forms as a result of the changes occurred in the glands