鼻腔灌洗法 - 洗鼻的原因,洗鼻過程

 

需要洗鼻的原因：

• 一些嚴重鼻敏感的病人有大量積液引致鼻塞。
•  病人於鼻腔及鼻竇手術後，鼻液和血塊，積聚於鼻腔內，引致阻塞。
•  病人在接受頭頸區放射治療時，鼻黏膜容易受感染而導致鼻液積聚，因此需定時清洗鼻腔減少黏膜發炎機會。
  

所需用品：

• 用1公升沸水加入兩茶匙餐桌鹽待水温和暖後方可使用。
• 20亳升(無針咀) 針筒。
•   器皿一個(如小血) ，用於洗鼻後盛載從鼻腔流出的水。
  

洗鼻過程：

1.          病人可坐下或站立，用針筒注洗器將温暖的鹽水從不同角度，慢慢注入鼻內，使鼻腔內不同位置都可被沖洗。

2.          當水流進喉部時，將水吐出。注意吐出的水是否混濁或有沉殿物質。如有混濁，應重複灌洗直至到流出的水清澈。

3.          建議每天洗鼻至少2次，通常早及晚。若分泌物多時，建議早、午及晚清洗。

4.          噴鼻藥應在洗鼻後使用(如有需要)。

注意事項：

• 用和暖的鹽水(使用前請先試水温) 。
• 洗鼻時請停止說話及呼吸。
• 咳嗽和打噴嚏時，請停止洗鼻。
• 患有中耳炎或急性上呼吸道感染時不宜洗鼻。
•  已開盬水可存放48小時。

參考資料: www.entific.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

 

Caudal Septal Deflections

Caudal septal deflections (as seen with the patient in Figure 13) can be specific challenges to septal surgery because they can often cause persistent nasal obstruction and may require complex septal reconstructions. 50,51 Simply resecting the caudal septal cartilage would clearly violate the inverted L-strut that is providing tip and colu- mellar support. 47 The simplest technique (and often the first attempt to correct this problem) involves vertically scoring or incising the caudal septal cartilage on the con- cave side in an attempt to remove the "spring" memory from that portion of the septum. 1,50

Another method to correct a deviated caudal septum is the "swinging door" technique, originally described by Metzenbaum. 52 In this technique, the septum is treated as in a standard septoplasty and then raised out of its maxil- lary crest groove with an elevator, like a Cottle. The wedge of cartilage along the maxillary crest is then excised. At this point, the caudal edge of the cartilage is freed from the anterior nasal spine and caudal attachments and is now only attached superiorly. This single attachment then allows the cartilage to swing into a more midline or straight position, where it can be secured with a suture to the nasal spine. 47,52 Pastorek and Becker 50 later modified this method and termed it the "doorstop technique."

In this modification, the cartilage that is dissected out of the maxillary crest is not resected but is instead flipped to the side of the nasal spine, opposite the obstruction, and secured with a suture. In this method, the nasal spine acts as a "doorstop" to prevent the caudal septum from return- ing to the other side.

An additional way to straighten the caudal septum is through the placement of an ethmoid bone splinting graft. As described by Metzinger et al, 51 a straight piece of the perpendicular plate may be harvested and small holes are then drilled in the bone with a hand drill.

A Keith needle then secures the bony splint to the caudal septal cartilage, which may be straightened first by scoring. It should be noted, however, that the ethmoid bone, when secured in place at this location, can cause the caudal septum to thicken. The surgeon should be sure that the additional piece of bone does not itself cause nasal obstruction when it is secured. 1

At times, excision and replacement of the caudal sep- tum may be necessary. An external rhinoplasty approach facilitates this technique.



Figure 13. (A, C) This 45-year-old man presented with a caudal septal deflection, which can be a specific challenge in septal surgery. (B, C) One year after rhinoplasty with the doorstop technique described by Pastorek and Becker. 50

 

 

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

認識睡眠窒息症 - 睡眠窒息症病徵

 

何謂睡眠窒息症

睡眠窒息症病是指患者在睡眠中停止呼吸，每次持續十秒至數分鐘不等，導致身體缺氧，但窒息後不久，病人會扎醒，並回復正常呼吸，整夜週而復始地病發十數次至數百次不等。

睡眠窒息症的病徵包括

• 睡醒後仍覺疲倦
• 早晨感到頭痛
• 日間常打瞌睡
• 不能集中精神，反應緩慢
• 記憶力衰退
• 性情改變，脾氣暴躁
• 性慾減退
• 嚴重的鼻鼾聲

睡眠窒息症分為三類

甲、阻礙性睡眠窒息症

這是最常見的一類，患者多為過重的中年男仕，由於上呼吸道過窄，或喉部組織鬆弛下垂，造成阻塞，於是空氣不能順利通過，造成窒息。

乙、中樞性睡眠窒息症

由於腦部受創或其他問題，不能有效地發出呼吸指令，令患者睡眠時呼吸間歇停止，造成窒息。

丙、混合性睡眠窒息症

是上述兩種睡眠窒息症的混合體，患者同時有阻礙性及中樞性的病徵。

 

參考資料: www.entific.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

Injection rhinoplasty

Rhinoplasties with injectable fillers are very popular in Asia and are used extensively. The advantages of injection rhinoplasty include:

Short learning curve for clinicians
Minimal tooling necessary
Inexpensive injectables
Local anesthetic procedure
Quick operative time
Immediate result
Per-operative client defined endpoint
Minimal postoperative downtime for patient

The idea of a simple local procedure with immediate results is very attractive to the Asian clients. Furthermore the down time is minimal; this minimizes the social exposure and questioning that some Asian clients may not welcome as plastic surgery on the nose remains a taboo in some Asian communities. The traditional injectables e.g. silicone gel and Teflon paste are generally falling out of favor due to their associated and recognized complications. The newer synthetic NASHA and PAAG injectables are increasingly being used. The skill-training time required for a clinician is very short and hence, many general practice clinicians have embraced this practice. Coupled with the marketing forces, this area of rhinoplasty has increased significantly.

The injection rhinoplasty technique depends primarily on:

• the desired aesthetic result and
• the injectable filler used.

It can be employed either as:

• a primary injection rhinoplasty procedure to augment the nose or
• as a secondary procedure to enhance a surgical rhinoplasty result (See Figures 3a-c)

Reference: www.rhinoplastyarchive.com/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.