- Anatomy of the External nose.

- The external nose extends the nasal cavities onto the front of the face and positions the nares so that they point downwards.

- The anterior parts of the nasal cavities are held open by a  skeletal framework (i.e external nose ).

- The external nose is pyramidal in shape , has anterior border called "dorsum" and two lateral sides.
- It´s root lies at the naso-facial suture.
- It´s apex called the tip of the nose.
- The septum below the tip of the nose called "columella".
- The opening of the nose to air is called "nostrils" or "anterior nares" which are openings through which air enters nasal cavities...

- The external nose is composed of two parts:

1- Upper bony part:-
which is composed of :

• Nsal bones which is articulate together in the middle line .
• Nasal process of frontal bone.
• Nasal process of maxillry bone.

2- lower cartilagenous part:-
which is composed of :

• upper lateral cartilage.
• Major alar cartilage(lower lateral cartilage).
• Minor alar cartilage at ala nasi.

N.B: Major alar cartilage is composed of two crura lateral and medial.
The two medial crura form "columella".

*References:-
-Netter anatomy atlas.
-Richard l.darke,wayne vogl& Adam mitchell:Gray´s anatomy for students.
-Mohammed Fareed:Illustrated Otolaryngology.
-Hassan Allam:Manual of Otorhinolaryngology.
-Mansoura E.N.T department:Essentials of Otorhinolaryngology.

-Ten ways to reduce risk of cancer.

1- Balanced diet ( which supply the body with sufficient food stuffs,satisfy body requirement,free of toxins or infection,selected in proper portion 50-60% cHO,15-20% proteins,20-30% fat).

2-choose diet rich in fibers.

3-Increase vegetables and fruits for more than 2 servings /day.

4-Control weight,avoid obesity.

5-Excercise regularly.

6-limit highly salted food.

7-limit smoky and  pickled food.

8-Decrease fat intake.

9-Stop alcohol.

10-Stop smoking with its different forms (cigarettes,Bidi,Cigar,Goza ,Hook-ah,Hubble-bubble,Tobacco chewing,Snuff,pipe).

Dr Ibrahim samaha

-Three in human ear.

There are...

- 3 parts of the human ear:-

1. External ear.
2. Middle ear.
3. Inner ear.

- 3 parts of the External ear:-

1. auricle (pinna).
2. external auditory meatus.
3. Tympanic membrane.

- 3 layers in tympanic membrane:-

1. Outter skin layer.
2. middle fibrous layer.
3. inner mucosal layer.

- 3 cranial nerves innervate the tympanic membrane:-

1. C.N. V (trigeminal).
2. C.N. IX(glossopharyngeal).
3. C.N. X (Vagus).

 -3 Parts of middle ear:-

1. Tympanic cavity.
2. Eustachian tube.
3. Mastoid air cells.

- 3 parts of the tympanic cavity:-

1. epi-tympanum.
2. meso-tympanum.
3. hypo-tympanum.

- 3 middle ear bones (auditory ossicles):-

1. malleus.
2. incus.
3. stapes.

- 3 parts of the malleus:-

1. Head.
2. lateral process.
3. handle.

- 3 parts of labyrinth:-

1. Bony cochlea.
2. 3 semicircular canals.
3. Vestibule.

- 3 semicircular canals :

1. Posterior.
2. lateral.
3. superior.

- 3 compartments of cavity of bony cochlea :-

1. scala vestibuli: Upper compartment.
2. scala media (cochlear duct):middle compartment.
3. scala tympani: lower compartment.

- 3 membranes in cochlear duct:-

1. vestibular.
2. Tectorial.
3. Basilar .

- 3 labyrnthine sensory end organs:-

1. Of cochlea..called organ of corti.
2. of s c c....called crista.
3. of utricle and saccule..called macula.

Enjoy it,,,,,
Dr Ibrahim...

-Dangerous area of the face.

Dangerous area of the face

- It is the area () the root of  the nose and 2 angles of the mouth.
- The veins in this region are connected to cavernous sinus so any infection in this area may lead to cavernous sinus thrombosis.

- Venous draingae of Dangerous area:-

• Antearior and  post etmoidal veins drain to opthalmic vein.
• sphenopalatine & greater palatine veins drain to pterygoid veins.
• Angular vein,lateral nasal and superior labial veins drain to facial vein...

- All of the above veins drain finally to cavernous sinus.

So, Donnot put your finger in your nose..:)

See you,
Dr Ibrahim...

- Stapedectomy.

**Stapedectomy**

-Def :-

is a surgical procedure of the middle ear

performed to improve hearing.

-Indications:-

• Conductive deafness due to fixation of stapes (Otosclerosis)
  
• Air bone gap of at least 40 dB.
  

-Contraindications:-

• Poor general condition of the patient.
• Only hearing ear.
• Poor cochlear reserve as shown by poor speech discrimination scores.
• Patient with tinnitus and vertigo.
• Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
• Conductive deafness due to Ehlers-Danlos Syndrome (EDS).
  

- Complications of stapedectomy:-

• Facial palsy.
• Vertigo.
• Vomiting.
• Floating foot plate.
• Tympanic membrane tear
• Dead labyrinth
• Labyrinthitis.
  

-surgery:-

*Preoperative:-

The patient will have a hearing test just prior

to or during admission to the hospital.

*The day of surgery:(technique):

Surgery can be done under local ansesthesia or

general anesthesia.

We prefer to use general anesthesia, i.e. the patient

is asleep during the operative procedure.

During the operative procedure the eardrum is gently lifted,

the diseased and fixed stapes is removed.

Next, a prosthesis is put in place.

The eardrum is gently put back into place and held

there by absorbable packing ointment.

*Postoperative:-

After awakening from anesthesia, the patient is

returned to his room and is usually discharged

the next morning. During this immediate post-operative

period, it is important NOT to blow the nose and

not to get the ear wet until the ear has completely healed.

This video is an Stapedectomy by Dr. Bliouras Konstantinos.

enjoy, see you...