Full nasal breathing is the key to optimal functioning of the systems of the whole organism. If it is disturbed, the brain ceases to receive a sufficient amount of the necessary oxygen. The air in the nose is also warmed, moisturized and purified.

With diseases of the respiratory system, a person's well-being worsens. When the nose is stuffed up, the patient breathes through the mouth. Working capacity decreases, memory weakens, irritability, headache, dizziness appear. Night sleep is disturbed.

Etiology

Turbine hypertrophy is the most common nasal pathology. The provoking factor is chronic hypertrophic rhinitis.

The epithelium of the nose is permeated with many blood vessels. They form the cavernous (cavernous) plexus. The capillaries have a thin wall with muscle fibers that promote vasodilation and contraction. When their vasomotor (narrowing-expansion) activity is disturbed, swelling of the mucous membrane occurs. There is an overgrowth of the nasal mucosa. The nasal passages narrow, the air flow decreases, and shortness of breath develops.

Hypertrophy is often combined with deformation of the nasal septum. This leads to a violation of full breathing. Sometimes the pathology manifests itself in adolescence with changes in the hormonal background in the body.

There are two forms of the disease: diffuse (diffuse) and limited. The tissue of the lower part of the shells is usually affected. Less commonly, there are changes in the cavernous tissue (the middle part of the nasal cavity).

Symptoms

The thickening of the mucosa is accompanied by:

The accumulated mucus causes a sensation of a lump or foreign body in the throat. Removal of secretions by blowing the nose is difficult. Sometimes the acuity of smell and taste decreases.

Secondary symptoms (consequences) of hypertrophy of the nasal mucosa:

• nasalness (talking "in the nose");
• hearing impairment (tubo-otitis) - develops as a result of impaired ventilation of the auditory tube;
• conjunctivitis, dacryocystitis (inflammation of the lacrimal sac) - is noted with changes in the anterior lower part of the shell, when the opening of the nasolacrimal canal is squeezed.

In some cases, the formation of polyps is observed with the growth of the corpora cavernosa. It is often necessary to treat such a pathology promptly.

Diagnostics

The main and most effective research method is endoscopy. It allows you to accurately determine the degree and location of the pathology.

With rhinodiagnostics, hyperplasia (thickening) of the nasal membrane of the lower section, less often of the middle, is noted. The surface of the altered areas ranges from smooth to bumpy. The mucous membrane is reddened and somewhat cyanotic. No enlargement of the turbinates occurs with thickening of the bone base.

Another method of examination is rhinopneumometry. With its help, the volume of air that passes through the nasal cavity for a specific time is determined. With hypertrophy, the volume of air entering the body is significantly reduced.

Therapy

Medication is often ineffective. The therapeutic effect of drugs is short-lived and poorly expressed. Prolonged use of vasoconstrictor drugs (adrenomimetics) leads to overdrying of the mucous membrane. Discomfort appears - dryness, burning in the nose. Addiction to drugs develops, the patient needs to increase the dosage and frequency of drug use. As a result, the therapeutic effect is reduced. Obstruction (blockage) of the nasal passages is difficult to eliminate.

The main types of surgical treatment:

• moxibustion (chemocaustics);
• conchotomy;
• lateroposition;
• UZDG.

The indication for one method or another is the degree of hypertrophic damage and respiratory disturbances. The manipulations take place under local or general anesthesia.

Cauterization is carried out using chemical compounds - 30-50% lapis (silver nitrous acid), chromic acid. Recently, it has been rarely used and only in the initial stages of hypertrophic degeneration.

The development of medicine has provided the emergence of new powerful optical systems. With the help of endoscopes, it is possible to accurately carry out surgical correction of hypertrophied nostrils, especially the poorly visible posterior parts of the nasal cavity. Thanks to a gentle surgical intervention, minimal tissue trauma can be achieved.

Regeneration of the mucous membrane occurs in the shortest possible time. Clinical studies indicate a rapid recovery of the ciliated epithelium while maintaining its functions. Accurate surgical correction avoids post-traumatic complications - tissue atrophy.

Osteoconchotomy is a careful removal of a part of the submucosal bone base of the inferior turbinate. Sometimes the above surgical interventions are combined with a lateroposition - the displacement of the shells to the lateral wall of the nasal cavity.

Some experts recommend septoplasty (alignment of the nasal septum) when clearly needed. Important! In septoplasty, the surgeon must model a curved septum from the same cartilaginous tissue.

During the operations, analgesics, antiallergic drugs and anticholinergics ("Promedol", "Atropine sulfate", "Diphenhydramine") are used. A 1% solution of novocaine, 1-2% lidocaine, 0.5% ultracaine or trimecaine is used as a local anesthetic. Surgical treatment takes place in a hospital setting.

On an outpatient basis, ultrasonic ultrasonic disintegration of the lower parts of the turbinates is carried out. This method of treatment is based on the restoration of the vasomotor capacity of the blood vessels. With the help of an ultrasonic waveguide - apparatus “Lora-Don-3” - old sclerosed vessels are destroyed, which the body replaces with new ones. Their original ability to expand and contract is restored. With a successful operation, nasal breathing is normalized after 3-4 days.

In the postoperative period, decongestants (decongestants) - "Otrivin", "Nazivin" are used to reduce the swelling of the mucous membrane. They also reduce the likelihood of complications.

In addition, rehabilitation includes the use of antibacterial and antihistamines (anti-allergic) drugs (Tsetrin, Zodak, Fenistil, Loratadin, Zyrtec, etc.), daily tamponing of the nostrils for 3-5 days. It is recommended to rinse the nose with nasal sprays based on sea or mineral water for 15-20 days. They use "Aqua Maris", "Dolphin", "Aqualor", "Rhinorin", "Marimer".

Correct medical treatment and successful surgery prevent perforation (opening) of the nasal septum. If its curvature is the cause of the development of hypertrophy, then the resulting pathology is reversible.

3. Discontinuous (synovial) bone connections. Joint structure. Classification of joints according to the shape of the articular surfaces, the number of axes and function.

4. Cervical spine, its structure, connections, movements. The muscles that make these movements.

5. Connections of the atlas with the skull and with the axial vertebra. Features of the structure, movement.

6. Skull: sections, bones forming them.

7. Development of the cerebral section of the skull. Variants and anomalies of its development.

8. Development of the facial region of the skull. The first and second visceral arches, their derivatives.

9. Skull of a newborn and its changes at subsequent stages of ontogenesis. Sexual and individual characteristics of the skull.

10. Continuous joints of the bones of the skull (sutures, synchondrosis), their age-related changes.

11. Temporomandibular joint and muscles acting on it. The blood supply and innervation of these muscles.

12. The shape of the skull, cranial and facial markers, types of skulls.

13. Frontal bone, its position, structure.

14. Parietal and occipital bones, their structure, the contents of the holes and canals.

15. Ethmoid bone, its position, structure.

16. The temporal bone, its parts, holes, canals and their contents.

17. Sphenoid bone, its parts, holes, canals and their contents.

18. Upper jaw, its parts, surfaces, holes, canals and their contents. Upper jaw buttresses and their meaning.

19. The lower jaw, its parts, canals, holes, muscle attachment points. Lower jaw buttresses and their meaning.

20. Inner surface of the skull base: cranial fossa, holes, grooves, canals and their meaning.

21. The outer surface of the base of the skull: holes, canals and their purpose.

22. Eye socket: its walls, contents and messages.

24. Paranasal sinuses, their development, structure options, messages and significance.

25. The temporal and infratemporal fossa, their walls, messages and contents.

26. Pterygoid-palatine fossa, its walls, messages and contents.

27. The structure and classification of muscles.

29. Mimic muscles, their development, structure, functions, blood supply and innervation.

30. Chewing muscles, their development, structure, functions, blood supply and innervation.

31. Fascia of the head. Bone-fascial and intermuscular spaces of the head, their contents and messages.

32. Muscles of the neck, their classification. Superficial muscles and muscles associated with the hyoid bone, their structure, functions, blood supply and innervation.

33. Deep muscles of the neck, their structure, functions, blood supply and innervation.

34. Topography of the neck (areas and triangles, their contents).

35. Anatomy and topography of the plates of the cervical fascia. Cellular spaces of the neck, their position, walls, contents, messages, practical significance.

23. The nasal cavity: the bony basis of its walls, messages.

The nasal cavity, cavum nasi, occupies a central position in the facial region of the skull. The bony septum of the nose, septum ndsi osseum, consisting of a perpendicular plate of the ethmoid bone and a vomer, fixed at the bottom of the nasal ridge, divides the bony cavity of the nose into two halves. In front, the nasal cavity opens with a pear-shaped aperture, apertura piriformis, limited by the nasal notches (right and left) of the maxillary bones and the lower edges of the nasal bones. In the lower part of the pear-shaped aperture, the anterior nasal spine, spina nasalis anterior, protrudes forward. Through the posterior orifices, or choanas, choapae, the nasal cavity communicates with the pharyngeal cavity. Each choana is bounded from the lateral side by the medial plate of the pterygoid process, from the medial by the vomer, from above by the body of the sphenoid bone, from below by the horizontal plate of the palatine bone.

Three walls are distinguished in the nasal cavity: upper, lower and lateral.

Top wall the nasal cavity is formed by the nasal bones, the nasal part, the ethmoid plate of the ethmoid bone and the lower surface of the body of the sphenoid bone.

Bottom wall the nasal cavity consists of the palatine processes of the maxillary bones and the horizontal plates of the palatine bones. Along the midline, these bones form the nasal crest, to which the bony septum of the nose joins, which is the medial wall for each of the halves of the nasal cavity.

Lateral wall the nasal cavity has a complex structure. It is formed by the nasal surface of the body and the frontal process of the upper jaw, the nasal bone, the lacrimal bone, the ethmoid labyrinth of the ethmoid bone, the perpendicular plate of the palatine bone, the medial plate of the pterygoid process of the sphenoid bone (in the posterior part). On the lateral wall, three turbinates protrude, located one above the other. The upper and middle are parts of the ethmoid labyrinth, and the lower turbinate is an independent bone.

The turbinates divide the lateral portion of the nasal cavity into three nasal passages: upper, middle and lower.

Upper nasal passage, medtus nasalis superior, bounded from above and medially by the superior nasal concha, and from below by the middle nasal concha. This nasal passage is poorly developed, located in the back of the nasal cavity. The posterior ethmoid cells open into it. Above the posterior part of the upper nasal concha is a sphenoid-trellised depression, recesus sphenoethmoidalis, into which the aperture of the sphenoid sinus, apertura sinus sphenoidalis, opens. Through this aperture, the sinus communicates with the nasal cavity.

Middle nasal passage, medtus nasalis medius, is located between the middle and lower turbinates. It is much longer, higher and wider than the top. In the middle nasal passage, the anterior and middle cells of the ethmoid bone open, the aperture of the frontal sinus through the ethmoid funnel, infundibutum ethmoidale, and the lunar cleft, hiatus semilundris, leading to the maxillary sinus. Located behind the middle nasal concha, the wedge-palatine opening, foramen sphenopalatinum, connects the nasal cavity with the pterygo-palatine fossa.

Lower nasal passage, meat us nasalis inferior, the longest and widest, is bounded from above by the inferior nasal concha, and from below by the nasal surfaces of the palatine process of the upper jaw and the horizontal plate of the palatine bone. The nasolacrimal canal, canalls nasolacrimalis, starting in the orbit, opens into the anterior part of the lower nasal passage.

The space in the form of a narrow sagittally located slit, limited by the septum of the nasal cavity on the medial side and the turbinates, constitutes the common nasal passage.

The path through which the inhaled air passes begins with the nasal cavity.

The nose is a complex formation. It consists of an external nose and a nasal passage, its walls are formed by a series of bones of the skull, supplemented in front by cartilage and covered with skin on the outside and mucous membrane from the inside.

The outer nose (nasusexternus) has a root (radixnasi) located between the eye sockets and a back (dorsumnasi) facing down. The lower part of the nose, where two unequal sizes of each person's nasal openings - the nostrils (nares) and the septum (septumnasi) - open, is called the apex (apexnasi). On the lateral side, the nasal openings form the wings of the nose (alaenasi). Two nasal bones and cartilage (cartilaginesnasi) are involved in the formation of the outer nose. Cartilage is present in the nasal septum and complements the front of the opener (cartilagovomeronasalis). The lower edge of the cartilage of the nasal septum is connected to the soft tissues. The wings of the nose contain 3-4 thin plates of elastic cartilage (cartilaginesalares), connected by membranous connective tissue and covered with facial muscles. In newborns, the root and dorsum of the nose are not pronounced and are finally formed only by the age of 15. The shape of the outer nose is different for each person.

The nasal cavity is conditionally divided into the vestibule (vestibulumnasi) and the nasal cavity itself (cavumnasiproprium). The vestibule is lined with squamous epithelium, covered with short hairs that trap dust particles. The nasal cavity itself is covered with ciliated epithelium.

Nasal and oral cavity in a sagittal section

The nasal cavity is separated from the oral cavity from below by a septum, consisting of a hard and soft palate (this is the roof or ceiling of the oral cavity). The very same nasal cavity in the middle along the nose is divided by a septum formed by a vertical plate of the ethmoid bone and a vomer, into two halves - right and left. These two halves of the nasal cavity from the back are opened by two nasopharyngeal openings (choanae) into the nasopharynx. From the outer side walls of each half of the nasal cavity, three curved bone plates - shells - protrude into its lumen. With the help of the lower, middle and upper turbinates in each half of the nose, the upper, middle and lower nasal passages (meatusnasisuperior, mediusetinferior) are formed.

The sinuses of the air bones open into the nasal cavity: in the upper nasal passage - the posterior cells of the ethmoid, at the posterior end of the superior turbinate - the sinus of the main bone, in the middle nasal passage - the anterior and middle cells of the ethmoid labyrinth, the sinus of the upper jaw (maxillary cavity) and the frontal sinus. These sinuses are called the paranasal cavities. They are lined with a thin mucous membrane containing a small amount of mucous glands. All these septa and shells, as well as numerous accessory cavities of the cranial bones, dramatically increase the volume and surface of the walls of the nasal cavity. The nasal and pharyngeal cavities are the upper respiratory tract.

Inside, at the entrance to the nasal cavity, near the nostrils, there are tufts of hair that trap large dust particles of inhaled air. The entire inner surface of the nasal cavity is lined with a mucous membrane containing a large number of mucous glands; for 1 cm 2 of the nasal mucosa, about 150 glands open.

The mucus secreted by these numerous glands is of great importance in protecting the body from the harmful action of microbes; it weakens the activity of microbes, reducing their ability to reproduce. A large number of leukocytes emerge from the blood vessels through the cell gaps to the surface of the mucous membrane, which capture and destroy the microbial flora.

In the area of \u200b\u200bthe upper nasal concha and the part of the nasal septum facing it, special nerve olfactory cells are located in the mucous membrane, therefore the upper part of the nasal cavity is called the olfactory region.

Most of the cells of the mucous membrane of the nasal cavity (especially the upper part), as well as the paranasal cavities (frontal, maxillary sinuses, etc.) are equipped with the smallest filamentous cilia extending several dozen from each cell. These cilia oscillate continuously and in a wave-like manner, quickly bending towards the exit holes and slowly straightening again. With a strong increase, this mass of cilia resembles a grain field, along the ears of which wind waves run. As a result of the work of this ciliary epithelium, mucus and, along with it, dust particles and various kinds of small particles that enter with the outside air, gradually move and are removed from the nasal cavity.

Outside air during inhalation passes through all the passages of the nasal labyrinth, flowing around a large and, due to the abundance of blood vessels, a well-heated surface of the nasal cavity; the inhaled air is easily and quickly heated to almost body temperature. At the same time, it is moistened and largely cleared of dust and microbes, and since there are branches of the olfactory nerve in the upper part of the nasal cavity, the chemical composition of the passing air is also controlled by smell, which has a very significant effect on the strength and depth of respiratory movements.

Having passed the nasal cavity, the inhaled air through the choanae enters the nasopharynx, located behind the nasal and oral cavity. The lower part of the pharynx passes into two tubes: anterior - respiratory and posterior - esophagus. In the pharynx, the respiratory tract and the digestive tract intersect, due to which it is possible for air to pass in the pharynx and in another, albeit less convenient, way - through the mouth (in case of closure of the nasal passages for one reason or another). When breathing through the mouth, the air is not sufficiently warm and is not sufficiently cleaned. Therefore, a healthy person should always breathe through his nose.

Nasal cavity, cavum nasi, is the initial section of the respiratory tract and contains the organ of smell. In front, apertura piriformis nasi leads into it, in the back there are paired openings, choanas, communicate it with the nasopharynx. Through the bony septum of the nose, septum nasi osseum, the nasal cavity is divided into two not quite symmetrical halves. Each half of the nasal cavity has five walls: superior, inferior, posterior, medial, and lateral.

The upper wall of the nasal cavity formed by a small part of the frontal bone, lamina cribrosa of the ethmoid bone and partly by the sphenoid bone.

In the composition of the lower wall of the nasal cavity, or bottom, includes the palatine process of the upper jaw and the horizontal plate of the palatine bone, which make up the hard palate, palatum osseum. The floor of the nasal cavity is the "roof" of the oral cavity.

The medial wall of the nasal cavity constitutes the septum of the nose.

Back wall of the nasal cavity is present only for a small extent in the upper section, since the choanas lie below. It is formed by the nasal surface of the body of the sphenoid bone with a paired opening on it - apertura sinus sphenoidalis.

In the formation of the lateral wall of the nasal cavity the lacrimal bone, os lacrimale, and lamina orbitalis of the ethmoid bone, separating the nasal cavity from the orbit, the nasal surface of the frontal process of the upper jaw and its thin bone plate, delimiting the nasal cavity from the maxillary sinus, sinus maxillaris, are involved.

On the lateral wall of the nasal cavity hanging inward three turbinates, which separate three nasal passages from each other: upper, middle and lower (Fig. 5.18).

Nasal passages. Nasal concha.

Upper nasal passage, meatus nasi superior, is located between the upper and middle shells of the ethmoid bone; it is half the length of the middle course and is located only in the posterior part of the nasal cavity; sinus sphenoidalis, foramen sphenopalatinum communicate with it and the posterior cells of the ethmoid bone open.

Middle nasal passage, meatus nasi medius, goes between the middle and lower shells. The cellulae ethmoidales ante-riores et mediae and sinus maxillaris open into it.

Lower nasal passage, meatus nasi inferior, runs between the inferior concha and the bottom of the nasal cavity. In its anterior section, the nasolacrimal canal opens.

The space between the turbinates and the nasal septum is referred to as common nasal passage.

On the side wall of the nasopharynx is pharyngeal opening of the auditory tubeconnecting the pharyngeal cavity with the middle ear cavity (tympanic cavity). It is located at the level of the posterior end of the inferior shell at a distance of about 1 cm posterior to it.

Vessels of the nasal cavity form anastomotic networks arising from several systems. Arteries belong to the branches of a. ophthalmica (aa. ethmoidales anterior and posterior), a. maxillaris (a. sphenopalatina) and a. facialis (rr. septi nasi). Veins form networks located more superficially. Particularly dense venous plexuses, which look like cavernous formations, are concentrated in the submucous tissue of the lower and middle turbinates. Most nosebleeds originate from these plexuses. The veins of the nasal cavity anastomose with the veins of the nasopharynx, the orbit and the meninges.

Sensitive innervation of the nasal mucosa carried out by I and II branches of the trigeminal nerve, that is, the optic and maxillary nerves. Specific innervation is carried out by the olfactory nerve.

The human nose has a complex structure, its constituent elements are located both on the surface of the face and in its inner part. The nasal cavity is the initial section of the respiratory system, and the olfactory organ is also located in it. The anatomy of the organ assumes constant interaction with the external environment through the transport of air flows, therefore, it is also an element of the body's defense against foreign particles and pathogenic microflora.

The nasal cavity (cavum nasi or cavitas nasi) is the space in the middle of the upper section, which is located between the pear-shaped apertures and choans in the sagittal direction.

It can be conditionally divided into three segments:

• vestibule (located inside the wings of the nose);
• the respiratory area (covers the space from the bottom to the middle nasal concha);
• olfactory area (located in the upper posterior sector).

The space begins with the vestibule, which is covered with squamous epithelium and is a skin tucked inward, covering the sensory organ, retaining all its functions and having a width of 3-4 mm. On the eve there are sebaceous glands and bristle hair follicles, their intensive growth occurs. On the one hand, thanks to the hairs, large particles that come with the air are captured, on the other, the prerequisites for the development of sycosis and boils are created. The rest is covered with mucous membranes.

The septum (septum nasi) divides the nasal cavity into two unequal parts, since it is relatively rare that the dividing plate is located strictly in the center, more often it is rejected in one direction or another (according to various sources, in 95% of the population).

Due to the presence of the baffle, the air flow is divided into equal flows.

This contributes to its linear movement and the creation of the necessary conditions for the organ to perform its main tasks (cleansing, moisturizing and warming).

In the anatomy of the septum, three areas are distinguished:

• Webbed. Small in size and most mobile, it is located between the lower edge of the cartilaginous plate and the edge of the nostrils.
• Cartilaginous. The largest in size, it has the shape of an irregular rectangular plate. The posterior upper edge joins the angle between the vomer and the ethmoid plate, the upper anterior and lateral edges - to the nasal and palatine bones, respectively.
• Bone. Formed by a number of adjacent bones (frontal, ethmoid, vomer, sphenoid, upper jaw ridges).

Newborn babies have a membrane-like septum that hardens and fully forms by about 10 years of age.

The nasal cavity, more precisely, each half of it, is limited by five walls:

• Upper (arch). It is formed by the inner surface of the nasal bones, frontal, ethmoid (with 25-30 holes for arteries, veins and olfactory nerve filaments) and sphenoid bones.
• Lower. This is a bony palate, which includes the maxillary process and the horizontal plate of the palatine bone, with incomplete or improper fusion, defects appear (cleft lip, cleft palate). Separates the nasal cavity from the oral cavity.
• Lateral. It has the most complex anatomy, it is a volumetric system of a number of bones (nasal, upper jaw, lacrimal, ethmoid, palatine and wedge-shaped), which are connected to each other in different configurations.
• Medial. This is a nasal septum that divides the common chamber into two sections.
• Back. It is present only in a small area above the choans; it is represented by a sphenoid bone with a paired opening.

The immobility of the walls of the space provides full circulation of air in it, its muscle component is poorly developed.

The nasal cavity is connected by channels with all adjacent air bones containing (wedge-shaped, maxillary, frontal and ethmoid labyrinth).

On the lateral wall there are nasal conchas, which look like horizontal plates located one above the other. The upper and middle are formed by the ethmoid bone, and the lower is an independent osteostructure. These shells form corresponding paired passages under them:

• Lower. Located between the lower sink and the bottom of the chamber. In its vault, approximately 1 cm from the end of the shell, there is an opening of the nasolacrimal duct, which is formed at the birth of a child. If the opening of the canal is delayed, then cystic expansion of the duct and narrowing of the passages may develop. Through the lumen of the duct, fluid flows from the voids of the eye orbit. This anatomy leads to increased mucus separation during crying and, conversely, lacrimation with a runny nose. It is most convenient to puncture the maxillary sinus through a thin section of the stroke wall.
• Middle. It is located between the lower and middle shells, runs parallel to the lower one, but is much wider and longer than it. The anatomy of the lateral wall is especially complex here and consists not only of bone, but also of "fountains" (fontanelles) - a kind of duplication of the mucous membrane. There is also a crescent (lunar) fissure, here through the maxillary fissure the maxillary sinus opens. In its posterior section, the semilunar slit forms a funnel-shaped expansion, through which it is connected to the openings of the lattice anterior cells and the frontal sinus. It is along this path that the inflammatory process with a cold passes to the frontal sinus, and frontal sinus develops.
• Upper. The shortest and narrowest, located only in the posterior sections of the chamber, has a backward and downward direction. In its anterior segment it has an outlet, and in its posterior segment it reaches the palatine opening.

The space between the nasal septum and the turbinates is called the "common nasal passage". Under the shell of its anterior section (about 2 cm behind the nostrils), the incisal canal emerges, containing the nerve and blood vessels.

In children, all passages are relatively narrow; the inferior shell is lowered almost to the bottom of the chamber. Because of this, almost any catarrhal inflammation and swelling of the mucous membrane lead to a narrowing of the canal, which creates problems with breastfeeding, which is impossible without nasal breathing. Also, younger children have a short and wide Eustachian tube, so when sneezing or improperly blowing their nose, infected mucus is easily thrown into the middle ear, and acute otitis media develops.

Blood supply is carried out through the branches of the external carotid artery (lower posterior section) and the internal carotid artery (upper anterior section). The outflow of blood is produced through the accompanying venous plexus associated with the ophthalmic and anterior facial veins. The specificity of the blood flow often leads to intracranial and orbital rhinogenic complications. In front of the nasal septum is a small section of the superficial capillary network called the Kisselbach zone or bleeding zone.

Lymphatic vessels form two networks - deep and superficial. They both target the deep cervical and submandibular lymph nodes.

Innervation is divided into the following types:

• secretory - through the fibers of the parasympathetic and sympathetic nervous system;
• olfactory - through the olfactory epithelium, the olfactory bulb and the central analyzer;
• sensitive - through the trigeminal nerve (first and second branch).

Features of the structure of mucous membranes

Almost all the walls of the space, except for the vestibule, are lined with a mucous membrane, on average there are about 150 glands per 1 square centimeter of integument. The entire space can be subdivided into two sectors:

• Respiratory (lower half of the space). Covered with a cylindrical, multilayered ciliated epithelium with numerous filamentous cilia that flicker, i.e. quickly lean to one side and slowly straighten. Thus, mucus, together with bound dust and harmful particles, is excreted outside through the vestibule and the choanae. The membrane is thicker here, since there are many alveolar-tubular glands in the subepithelial layer that secrete mucous or serous secretions. The covering of the respiratory surface is rich in cavernous plexuses (cavernous bodies) with muscular walls, which enable the caverns to contract and better warm the passing air flow.

• Olfactory (upper shells and half of the middle shells). Its walls are covered with pseudo-stratified epithelium, which contains bipolar neurosensory cells that sense odors. Their front side bubbles outward, where it interacts with molecules of odorous substances, and the back passes into nerve fibers, which, intertwining into nerves, transmit a signal to the brain, which recognizes aromas. In addition to the specific olfactory layer of the epithelium, there are cylindrical cells, however, devoid of cilia. The glands in this area secrete a liquid secretion for hydration.

In general, the lamina of the mucous membrane, despite some differences, is thin and contains, in addition to mucous and serous glands, numerous elastic fibers.

The submucosa contains lymphoid tissues, glands, choroid and nerve plexuses, and mast cells.

Functions of the nasal cavity

The nasal chamber, due to its location and anatomy, is adapted to perform a large number of the most important functions of the human body:

Typical diseases of the nasal cavity

Diseases of the constituent parts of the space under consideration depend on many factors: structural features of each individual, disorders of certain functions of organs, exposure to pathogens or medications.

The most common ailment is a runny nose of various types:

Almost all types of rhinitis, except for hypertrophic, are amenable to conservative local treatment: irrigation, rinsing with medicinal solutions, turunda with ointments.

Other organ diseases include:

• Synechia. This is the formation of tissue adhesions, most often due to surgery or various injuries. When the problem is eliminated with a laser, relapses are rarely recorded.
• Atresia. Fusion of tissues of natural channels and openings. Most often it is congenital, but it can also be acquired, as a complication of syphilis, diphtheria. Thermal and chemical burns, abscess of the nasal septum, trauma, and unsuccessful operations also became the causes of older patients. As a result, accreted tissues partially or completely block the nasal passage, and a person can breathe only through the mouth. After fluoroscopy, an operation to form lumens is possible.
• Ozena. Disorders of tissue nutrition due to dysfunction of nerve endings, degeneration of the epithelium, which disintegrates and emits a fetid odor that is not felt by the patient due to the death of the olfactory receptor. The nose is very dry and the crusts can clog the passages, although they are very wide. The disease is still not well understood.
• Polyps. Chronic rhinosinusitis, changing the structure of the epithelium, can lead to the development of polyposis. It is usually treated promptly by destroying the leg of the polyp.
• Neoplasms. These may include papillomas, osteomas, cysts, fibromas. The strategy of their treatment is developed for each specific case, taking into account the data of additional studies.

• Injuries. Most often, there is a curvature of the nasal septum due to bone fracture or improper fusion. In addition to a cosmetic problem, in such cases, nighttime snoring, drying out, bleeding is observed, sinusitis, frontal sinusitis, allergic reactions can develop, immunity worsens and susceptibility to infections increases. The defect is corrected surgically.

Doctors recommend starting treatment of any nasal diseases immediately, since the resulting lack of oxygen negatively affects all body systems, oxygen starvation is especially dangerous for the brain. Switching to mouth breathing does not solve the problem, but only exacerbates it. Shortness of breath through the mouth:

• The entry into the lungs of unmoistened and unheated air. Less efficient gas exchange occurs in the alveoli, less oxygen enters the bloodstream.
• The body's defenses are weakened due to the exclusion of mucus from the process, the risk of respiratory infections increases dramatically.
• Long-term mouth breathing promotes inflammation of the pharyngeal tonsil - adenoiditis.

Techniques for examining the nasal chambers

In order to identify the disease and determine the stage of its development, modern medicine uses the following basic diagnostic methods:

• Anterior rhinoscopy is performed in each case using a special nasal dilator, the tip of the nose is lifted and the instrument is inserted into the nostril. Each nostril is visually inspected separately, sometimes a bulbous probe is used. On examination, problems such as inflammation of the walls, curvature of the septum, hematomas, polyps, abscesses and neoplasms can be detected. In case of tissue edema, the doctor first drips vasoconstrictors into the passages (for example, a 0.1% adrenaline solution). An autonomous light source or a head-mounted reflector is used to illuminate the surveyed area.
• Posterior rhinoscopy is used when indicated. In this case, the nasopharynx and nasal cavity are examined from the side of the choanas. The doctor in the open throat with a spatula pushes the root of the tongue and inserts a special mirror with a long handle into the throat.

Additional, more specialized, studies include:

Laboratory diagnostic methods:

• A general blood test is a routine general clinical study, carried out if any disease is suspected. Allows you to determine the signs of the inflammatory process.
• Bacteriological examination of separated mucus and smears. It makes it possible to accurately determine the causative agent of the disease and choose a rational antibiotic therapy.
• Cytological examination of secretions and smears. It is used when there is a suspicion of the presence of an oncological process.
• Immunological studies and allergy tests. Identification of allergens that provoke the development of ailments.

The nasal cavity is the beginning of the airway. It is through it that air enters the body through a special channel that connects the external environment and the nasopharynx. In addition to the main respiratory function, it performs a number of other tasks: protection, cleansing and hydration. With age, the size of the cavity increases, in the elderly it is approximately three times larger than in infants.

Structure

The nasal cavity is a rather complex formation. It consists of several parts, which include the immediate outer part of the nose and the nasal passage, a number of skull bones by which it is formed, cartilage covered with skin on the outside, and with a mucous membrane on the inside. This is just a general list of what the nasal cavity consists of.

Its structure is quite complex. So, the outer part of the nose is the wings (or the more popular name is the nostrils) and the back. The last component includes the middle part and the root, which goes into the frontal part of the face. From the side of the oral cavity, the nose is limited to a hard and soft palate. And from the inside, the cavity is formed by the bones of the skull.

The nose itself consists of two nostrils, between which a cartilaginous septum is installed. Each of them has a posterior, inferior, lateral, superior and medial walls. Also, the anatomy of the nose includes a special area that consists of blood vessels. By the way, this is one of the reasons for frequent bleeding in this area. The septum divides the nose into 2 parts, but not all of them are the same. It can be twisted as a result of damage, injury, or the appearance of formations.

The nasal passages are conventionally divided into the vestibule and the cavity itself. The first part is lined with squamous epithelium and covered with small hairs. And directly in the nasal cavity is the ciliated epithelium.

Outer course

Do not forget that air purification takes place in the nostrils. There are tufts of hair at the entrance, which are designed to trap large dust particles from the air. And the inner surface of the passage is lined with mucous glands that protect the body from incoming microbes, reducing their ability to reproduce.

The nose has a root that sits between the eye sockets. Its back is facing down. The lower part of the nose, where the air intakes - the nostrils - are located, is called the apex. By the way, the holes through which breathing is carried out are of different sizes for all people. This is due to the fact that the septum divides the nose unevenly, it does not pass strictly in the middle, but is deflected in one direction.

The wings of the nose are located on the lateral sides. The outer part of it is formed by two bones and cartilage. The latter are located in the septum of the nose and connect with their lower edge to the soft tissues located there. In the wings of the nose there are also up to 4 cartilaginous elastic plates, connective tissue is located between them, and they are covered with facial muscles.

Accessory cavities

The structure also includes the paranasal sinuses: wedge-shaped, frontal, maxillary, ethmoid labyrinth cells. They are divided into front and rear. This classification is necessary primarily for doctors, because their pathologies differ.

Paired maxillary sinuses of the nasal cavity are also called maxillary. They resemble a pyramid in shape. They got the second name due to their location. They border on one wall with the nasal cavity. There is a hole on it that connects the sinus with the middle nasal passage, it is its overlap that leads to the development of inflammation, which is called sinusitis. From above, the cavity is limited by the lower wall of the orbit, and its bottom reaches the roots of the teeth. In some, they may even pass into this sinus. Therefore, sometimes even ordinary caries becomes the cause of the appearance of odontogenic sinusitis.

The size of the maxillary cavities may vary, but each of them has additional depressions. They are called bays. Experts distinguish between zygomatic, palatal, frontal, alveolar depressions.

The human nasal cavity includes the paired frontal sinuses. Their posterior walls border on the brain, its frontal lobe. In the lower part of them there is an opening that connects them to the frontal-nasal canal leading to the middle nasal passage. With the development of inflammation in this area, the diagnosis of frontal sinusitis is established.

In the sphenoid bone is the sinus of the same name. Its upper wall rests against the pituitary gland, the lateral one against the cranial cavity and the carotid artery, the lower one extends to the nose and nasopharynx. Because of this proximity, inflammation in this area is considered dangerous, but, fortunately, it is quite rare.

Also, otolaryngologists distinguish ethmoid sinuses. They are located in the nasal cavity and are divided into posterior, middle and anterior, depending on their location. The front and middle ones are connected to the middle nasal passage, and the rear ones - to the upper one. In fact, it is a union of ethmoid bone cells of various sizes. They are connected not only to the nasal cavity, but also to each other. Each person can have 5 to 15 of these sinuses, which are arranged in 3 or 4 rows.

Formation of structure

In the process of human growth, starting from birth, the nasal cavity changes. For example, children have only two sinuses: the ethmoid labyrinth and the maxillary. Moreover, in newborns, only their rudiments can be found. They develop as they grow. The frontal cavities in babies are absent. But in about 5% of people, they do not appear over time.

Also, in children, the nasal passages are significantly narrowed. This often becomes the cause of difficulty breathing in crumbs. The back at the root of the nose in newborns is not particularly pronounced. Their final formation is completed only by the age of 15.

Do not forget that with age, nerve endings begin to die off - the neurons responsible for the sense of smell. This is why older people often do not hear many smells.

Breathing

In order for the air not only to enter the body, but also to be cleansed, moistened, it is provided that the nasal cavity has a specific shape. Its structure and functions provide a special passage of air.

The cavity consists of three shells, which are separated by passages. It is through them that air flows pass. It is worth noting that only the lower shell is true, because, unlike the middle and upper shell, it is formed by bone tissue.

The lower passage is connected to the orbit through the nasolacrimal duct. The middle one communicates with the maxillary and frontal sinuses, it forms the middle and anterior cells of the ethmoid labyrinth. The posterior end of the superior turbinate forms the sinus of the main bone. The upper course is the posterior cells of the ethmoid bone.

The sinuses are the paranasal cavities. They are expelled by a membrane containing a small number of mucous glands. All septa, shells, sinuses, accessory cavities significantly increase the surface of the walls related to the upper respiratory tract. Thanks to all the plexus, the nasal cavity is formed. Its structure is not limited to internal labyrinths. It also includes the outer part, designed for air intake, purification, heating.

How the upper respiratory tract works

When entering the external nasal passage, air enters a well-heated cavity. The high temperature in it is achieved due to the large number of blood vessels. The air warms up quickly enough and reaches body temperature. At the same time, there it is cleared of dust and germs thanks to the natural barrier of tufts of hair and mucus. The olfactory nerve also branches off in the upper part of the nasal cavity. It controls the chemical composition of the air and adjusts the strength of inhalation depending on it.

When the nasal cavity ends, the structure and functions of which are designed to provide breathing, the nasopharynx begins. It is located behind the nasal and oral cavity. Its lower part is divided into 2 tubes. One of them is respiratory, and the second is the esophagus. They cross in the throat. This is necessary so that a person can breathe air in an alternative way - through the mouth. This method is not very convenient, but it is necessary in cases where the nasal passages are closed. After all, it is for this that the oral and nasal cavities are connected, they are separated only by the palatal septum.

But it is worth noting that when breathing through the mouth, the air is not able to properly cleanse and warm up. That is why healthy people should always try to inhale air exclusively through their nose.

Mucous membrane

Starting from the outside of the nose, the inner surface of the cavity is lined with special cells. Each cm 2 contains about 150 mucous glands. They produce substances that have a protective function. The nasal mucosa is designed to protect the body from the harmful effects of microbes that enter it through the air. Their main action is aimed at reducing the ability of pathological organisms to reproduce. But besides this, a large number of leukocytes are secreted into the cavity through the cell gaps of the blood vessels. It is they who oppose the incoming microbial flora.

A huge part of the nasal cavity and the paranasal sinuses included in it is covered with small filamentous cilia. Several tens of such formations depart from each cell. They constantly fluctuate, making wave-like movements. They quickly bend towards the exit holes and slowly return in the opposite direction. If you enlarge them greatly, you get a picture that resembles a wheat field, which is agitated by the force of the wind.

In the nasal cavity, the air must be cleaned. And the ciliary epithelium just serves so that the detained microparticles can quickly be removed from the nasal cavity.

Cavity functions

In addition to providing breathing, the nose is designed to perform a number of other tasks. Scientists have found that proper breathing ensures the correct functioning of the whole organism. So, the main functions of the nasal cavity:

1) Breathing: it is thanks to the flow of air from that all tissues are saturated with oxygen;

2) protection: while passing through the nose, the air is cleaned, warmed, disinfected;

3) sense of smell: recognition of smells is necessary not only in a number of professions (for example, in the food, perfumery or chemical industry), but also for normal life.

The reflex call of necessary actions can also be attributed to the protective function: it can be sneezing or even a temporary stop in breathing. The nerve endings send the necessary signal to the brain when irritating substances hit them.

Also, it is the nasal cavity that performs the resonant function - it gives the voice sonority, tonality and individual color. Therefore, with a runny nose, it changes, it becomes nasal. By the way, it is full nasal breathing that stimulates normal blood circulation. It contributes to the normal outflow of venous blood from the skull, improves lymph circulation.

Do not forget that the nose and nasal cavity have a special structure. It is thanks to the large number of airways that the mass of the skull is significantly lightened.

Providing protective function

Many tend to underestimate the importance of nasal breathing. But without the normal performance of this function, the body is more susceptible to infections. The entire inner surface of the nose should be slightly moistened. It does this by producing mucus from the goblet cells and the corresponding glands. All particles that enter the nose stick to it and are excreted using the ciliary epithelium. The cleansing process directly depends on the state of this layer, which provides the main functions of the nasal cavity. If the cilia are damaged, and this can happen as a result of an illness or injury, then the movement of mucus will be disrupted.

Also, lymphatic follicles, which are located on the eve of the nasal cavity and perform an immunomodulatory function, serve as protection. Plasma cells, lymphocytes and sometimes granular leukocytes are intended for this. All of them are gateways for pathogenic bacteria that can enter the body through the air.

Possible problems

In some cases, the nasal cavity cannot perform all its functions in full. When problems arise, breathing becomes difficult, the protective function weakens, the voice changes, and the sense of smell is temporarily lost.

The most common condition is rhinitis. It can be vasomotor - at the heart of the problem it treats the deterioration of the tone of the vessels that are in the submucosa of the lower shells. Allergic rhinitis is just an individual body's response to potential irritants. These include dust, fluff, pollen and others. Hypertrophic rhinitis. Another problem that a patient may face is the appearance of neoplasms. There may be cysts, osteomas, fibromas, or papillomas in the nose.

Also, do not forget that it is often not the nasal cavity itself that suffers, but the paranasal sinuses. Depending on the place of development of inflammation, the following diseases are distinguished.

1. With the defeat of the maxillary sinuses, sinusitis develops.
2. Inflammatory processes in the sections of the ethmoid labyrinth are called ethmoiditis.
3. Frontitis is called pathological problems with the frontal cavities.
4. In cases when it comes to inflammation of the main sinus, they talk about sphenoiditis.

But it happens that problems begin in all cavities at the same time. Then the otolaryngologist can diagnose pansinusitis.

ENT doctors can diagnose the acute or chronic nature of the disease. They are distinguished by the severity of symptoms and the frequency of manifestations of the disease. Often, common colds that were not cured in time lead to problems with the paranasal sinuses.

Most often, experts are faced with sinusitis or frontal sinusitis. This is due to the structure and location of the frontal and maxillary sinuses. It is because of this that they are most often affected. Feeling painful sensations in the area of \u200b\u200bthese cavities, it is better to go to an otolaryngologist who can diagnose and choose an adequate treatment.

Hypertrophy (conchobullosis) of the turbinates is one of the main reasons for a long-lasting flow from the nose and its constant congestion. A normally located nasal septum and symmetrical development of both nasal halves are very important for correct and free breathing.

The manifestations of this pathology are similar to those of allergic or chronic rhinitis, so it is easy to confuse them.

The turbinates are three paired bony outgrowths located on the side wall of the nasal cavity. They are divided into upper, middle and lower and are designed to perform various functions, one of which is air flow direction and its regulation in the nasal passages.

The greatest load during breathing falls on the anterior edges of the middle shells and the posterior portions of the inferior shells. It is they who are called weak points, which, under the influence of the blows of the air stream, grow to large sizes, which, in turn, leads to difficulty in nasal breathing.

Diseases of allergic and viral etiology, as well as mechanical injuries of the nose, can provoke the asymmetric development of mucous membranes and turbinates.

Conchrbullosis of the turbinates is abnormal thickening and overgrowth of the mucous membranes of the nose with an increase in the amount of mucus secreted. Conchobullosis of the inferior turbinates is most often noted.

Hypertrophy of the nasal mucosa: what is it like?

The peculiarities of the anatomical structure of the nose and the direction of air flows in its cavity contribute to the greatest vulnerability of the anterior portion of the middle concha and the posterior edge of the inferior concha. It is in these places that hypertrophic anomalies occur most of all.

Conchobullosis of the turbinates is divided into the following types:

• Hypertrophy of the anterior end of the shells is less common. This pathology is caused by sluggish sinusitis.
• Hypertrophy of the posterior end of the turbinates is not uncommon. It occurs against the background of previous allergic or chronic rhinitis.

During a visual examination, a specialist observes neoplasms in the form of polypsthat block the lumen of the nasal opening. Although the process develops on both sides of the sinuses, it is not symmetrical. The mucous membrane in a normal state, not having damage, easily copes with the flow of inhaled air.

The development of a chronic inflammatory process and the asymmetric state of the nasal passages leads to disruption of the movement of air masses. The increased pressure on the mucous membrane creates an increased load, as a result of which the growth of the epithelium occurs.

The same is observed with with curvature of the nasal septum... The asymmetric structure of the nasal septum creates an obstacle to the passage of air flow in one half of the nose, while the other half is subject to a double load. Gradually, the mucous membrane in this place grows and thickens, which over time leads to difficulty breathing from the changed side. With a deviated nasal septum, there is an overgrowth of the nasal concha from the intact side.

Turbine hypertrophy can be caused by changes in general health and some external factors. The most common causes of the disease are the use of hormonal drugs, work in a smoky and dirty room, dusty air, and smoking.

Symptoms of the disease, how to recognize conchobullosis?

A change in the thickness of the mucous membrane of the nasal sinuses is a characteristic symptom of many pathologies. Often, thickening of the mucous membrane occurs with polyps, rhinitis, foreign particles getting into the nose. With rhinitis, foci of inflammation are localized in the pharynx, larynx, maxillary and frontal sinuses. Moreover, changes in the mucous membrane are different for each ailment.

Most often, thickening of the connective tissues occurs in chronic sinusitis, which can be necrotic, purulent, or parietal-hyperplastic in nature. Often, pathological changes in the nose indicate the development of allergies.

As a rule, the chronic form develops against the background of an acute inflammatory process. Inflammation lasting more than 1.5 months is already considered chronic. In such cases, regular exacerbations are observed.

Diagnosis of conchobullosis

The most common and popular diagnostic method is rhinoscopy. This procedure is used for the purpose of making a correct diagnosis, and is also used during surgery to monitor.

There are three options for rhinoscopy: anterior, middle, and posterior.

Anterior rhinoscopy

The doctor and the patient are located opposite each other, the lighting falls to the right of the patient's ear. The patient should sit upright, this position gives the specialist the opportunity to examine the nasal septum, the anterior section, as well as the lower and common nasal passages. The head is fixed and the doctor carefully inserts the nasal speculum into the nasal cavity. The distance is 3-20 mm, depending on the patient's age.

Then the clicks on the mirror gently slide apart. A probe is used if necessary. If the patient has wide nostrils, as well as in the case of the use of vasoconstrictors, the doctor has the opportunity to examine the posterior wall of the nasopharynx.

Middle rhinoscopy

To examine the ethmoid vesicle, the middle nasal septum, the middle turbinate, and the middle nasal passage, the patient should tilt his head back.

Posterior rhinoscopy

With the help of posterior rhinoscopy, the doctor examines hard-to-reach areas of the nasal cavity, the surface of the palate and the fornix of the pharynx.

For the procedure, a rhinoscope is used, which is a complex device that consists of two tubes. The device is presented in various modifications, differing in diameter and length of the tubes.

For rhinoscopy, children under two years old use ear funnels. To study the nasal cavity in older children, special mirrors are used.

Treatment of hypertrophy of the lower turbinates

As a rule, it is practically impossible to cope with such a disease as conchobullosis of the turbinates on one's own. Treatment is prescribed only by a specialist, after carrying out the necessary research and determining the cause of the pathology. In addition, conservative therapy gives only a short-term effect, and in such a disease, patients are usually shown surgery, with which one can permanently get rid of hypertrophy.

Surgical methods of treating conchobullosis

There are the following surgical methods:

As an adjunctive therapy in the treatment of conchobullosis also use folk remedies.

Conchobullosis is unpleasant and very serious illness, which requires compulsory treatment. Thanks to modern medical advances, the problem can be solved quickly and forever. Do not ignore the symptoms of pathology and when they appear, you should immediately consult a doctor.

Meanwhile, for correct and free breathing, the symmetrical development of the two halves of the nose and the correct position of the nasal septum are very important.

What is hypertrophy

The turbinates are three pairs of so-called "bony outgrowths" that are located in the nasal cavity on the side wall. They are divided into lower, middle and upper and perform various functions, one of which is to direct and regulate the air flow in the nasal passages. The inferior shells are especially important in this process and require a well-developed and intact mucous membrane.

In the course of various diseases of allergic, viral origin and mechanical trauma, asymmetry may occur in the development of both the turbinates themselves and the mucous membrane lining them. Hypertrophy of the turbinates is a thickening and proliferation of the nasal mucosa, as well as an increase in secretion of secretory fluid.

In this disease, the surface of the mucosa takes on a bumpy, uneven appearance, often growing in the form of a pineal formation. Hypertrophy of the inferior turbinate is one of the most common diagnoses.

Types of turbinate hypertrophy

The anatomical structure of the nasal passage and the movement of air flows lead to the fact that the anterior end of the middle concha and the posterior end of the inferior concha become the most vulnerable places. Most often, it is there that hypertrophic changes occur. Therefore, turbinate hypertrophy can be divided into the following types:

• hypertrophy of the posterior ends of the inferior turbinates - occurs quite often in people suffering from chronic rhinitis. The study reveals formations in the form of polyps that close the lumen of the internal nasal openings. Hypertrophy usually develops on both sides, but asymmetrically;
• hypertrophy of the anterior ends of the middle shells is less common. The cause of its occurrence is mainly sluggish inflammation of the concomitant nasal sinus.

Causes of the onset and development of the disease

If the mucous membrane is healthy and not damaged, it easily copes with the pressure of the passing air. But in the presence of chronic diseases or asymmetry of the nasal passages, the movement of the air flow changes. In the new conditions of the nasal mucosa it is necessary to adapt. As a result of compensation mechanisms, its growth occurs.

One of the reasons for the development of the disease is the curvature of the nasal septum. With its asymmetric position, the direction of the air flow changes. If the movement of air through one part of the nose is impeded, then the second works with increased load. Under new conditions, the mucous membrane of the shells becomes thicker and, over time, closes the movement of air in the second part of the nose.

Also, the curvature of the septum affects the growth of the shells themselves. In the event that the partition is deflected to the right, additional free space appears at the left shell, which it eventually fills. Other reasons include prolonged allergic rhinitis, harmful working conditions (dust and dirt in the air), smoking, and the use of hormonal agents.

Symptoms and diagnosis of hypertrophy

Symptoms of the disease do not always allow determining its presence, as they are in many ways similar to the symptoms of other diseases of the nose. The main complaint is nasal breathing difficulties. Difficulty can be both on inhalation and on exhalation, when the hypertrophied shell becomes, as it were, a valve that blocks the movement of air.

Speech can become nasal, possibly a foreign body sensation in the nasopharynx (this symptom is especially characteristic of hypertrophy of the posterior ends of the shells). Additional symptoms may include heaviness in the head, headache, severe and prolonged nasal discharge, tinnitus, and trouble smelling.

Making a correct diagnosis based only on symptoms is difficult enough. It is necessary for a doctor to conduct a special study - rhinoscopy, during which hypertrophic changes in the shells and mucous membranes are revealed.

In the study, the doctor pays special attention to which part of the nasal passage is the accumulation of mucous secretions:

• if they are localized mainly at the bottom of the nasal passage, then this indicates hypertrophy of the posterior ends of the inferior concha;
• if an accumulation of mucus is found in the anterior course, then hypertrophy of the inferior turbinate is most likely.

Curvature of the nasal septum can also indicate unilateral or bilateral hypertrophy.

Treatment of turbinate hypertrophy

Most often, it is not possible to independently cope with such a disease as hypertrophy of the lower turbinates - only a doctor can prescribe treatment based on the cause of the disease.

In addition, conservative therapy usually does not give a long-term positive effect. In most cases, surgery is indicated for patients: hypertrophy of the turbinates is treated with surgical methods quite successfully.

Operative methods of therapy include:

• galvanocaustic - the method consists in the fact that after local anesthesia, an electrode is inserted into the cavity of the shell. Heating it, it is carried out along the mucous membrane. As a result of the procedure, the mucous membrane increases even more and dies off, forming a scar. After its rejection, the rest of the shell is normalized and nasal breathing is restored;
• conchotomy (removal of the mucous membrane) - the procedure is carried out by removing the overgrown mucosal area with a wire loop. The excess part is cut off without affecting the bone base of the concha and removed from the nasal passage;
• submucosal resection of the bone plates of the turbinates - as a result of the operation, part of the bone tissue or cartilage is removed;
• nasal concha plastic - in this case, part of the bone plate and mucous membrane is removed. As a result of the procedure, the size of the turbinate is reduced and the obstacle to the movement of the air stream is removed;
• correction of the nasal septum - if hyperplasia is combined with curvature of the septum, surgical correction can lead to the normalization of the size of the turbinates.

Hypertrophy of the turbinates is an unpleasant disease that requires mandatory treatment, but today's methods of dealing with the disease allow you to get rid of the problem quite quickly. Nevertheless, it is worth paying attention to prevention: to be in the fresh air more and to promptly treat inflammatory processes in the nasal cavity.

performed only by a doctor!

• About the disease
  • Sinusitis
  • Varieties
  • Sinusitis
  • Rhinosinusitis
  • Frontit
• About symptoms
  • Runny nose
  • Snot
• About procedures
• Others ...
  • About drugs
  • Library
  • news
  • Questions to the doctor

Copying of materials is allowed only with indication of the source

Clinical anatomy of the turbinates

If we consider their anatomy, then, first of all, these are paired bones. They are given a place in the nasal cavity. Located on the sides of the walls. Depending on the place of localization, there are:

1. Inferior turbinate.
2. The middle turbinate.
3. The superior turbinate.

A functional feature of the turbinates in the human body is the provision of warmed or cooled air during inhalation, as well as its filtration. Their correct and balanced work protects the lungs from adverse environmental factors.

Side and front view of nasal concha

The turbinates are the formation of the ethmoid bone, which has an ethmoid or horizontal plate, a perpendicular or vertical plate, which are located on both sides. Lamina cribrosa (Latin for lattice plate), belongs to the upper part of the nasal cavity. It is located horizontally in the ethmoid region of the frontal bone. At the same time, it has a seam, which is called fronto-lattice. Lamina perpendicularis (translated from Latin "perpendicular plate"), is divided into two parts: a smaller one above, located above the lattice plate and a large one below, located under the lattice plate. All passages have numerous openings in contact with each other and with the nasal cavity.

Olfactory receptors are located in the nasal concha; not only humans, but also animals cannot live without them. They are localized in the olfactory epithelium, which is lined in the superior turbinate. They are arranged in several rows. They contain receptor cells and basal cells. The olfactory epithelium lies on a membrane cell, under which Bowman's glands are located, which are responsible for the production of mucus. The excretory ducts are responsible for the release of mucus, due to which olfactory reception occurs. It is in the mucus produced that odorous substances dissolve and are combined with the receptor cells responsible for the sense of smell.

The processes of the inferior turbinate:

1. Maxillary, forming an acute angle with the bone.
2. Lacrimal processes, due to which the inferior shell is reunited with the lacrimal bone,
3. Ethmoid bone passing through the jaw process and joining the sinuses above the upper jaw.

The structure of the turbinates

The turbinates are found in adults and children.

These are formations from a bone base, outside with a coating in the form of a mucous membrane. They are necessary for a person to prevent the formation of an inflammatory process in the nasal cavity and to ensure oxygen permeability.

Placement of the nasal passages

There are three shells in the nasal passages, a detailed description of which is given below. Between them there are passages along which oxygen moves.

This is how air passes through the nasal passages into the lungs of a person.

Also in the nasal cavity there are vestibules, which are covered with a membrane of mucus and the respiratory part, which has a coating in the form of an epithelium lined in many rows and having cilia.

The composition includes:

1. Cells with cilia that move towards the inhaled oxygen and due to which harmful microorganisms do not enter the body during respiration.
2. Goblet cells, which form bodies and bacteria in the form of mucus, removing them from the nose,
3. Cells with a factor of cambial elements.

The mucous membrane in the nasal passages is divided into two types: olfactory and with the content of small veins, capable of narrowing the nasal passages during the inflammatory process in any disease of the ENT organs, due to filling with blood and its own expansion.

Inferior turbinate (Latin "Concha nasalis inferior")

Location of the inferior turbinate

It joins the maxillary ridge

bones and bones of the palate. According to its anatomical features, it is an independent bone. In the anterior opening of the inferior turbinate there is a canal through which the tear fluid passes.

The nasal concha is coated with soft tissue. They react to changes in temperature and to inflammation.

Through the middle passages there are tunnels into the many paranasal sinuses. There is no passage through them to the main sinus. There is also a semilunar gap here. Its functional feature lies in the transition between the middle passage and the sinus above the upper jaw.

Inferior turbinate with rhinoscopy

It can be viewed by the ENT doctor during rhinoscopy.

Middle nasal concha (Latin "Concha nasalis media")

The middle concha is fixed to the process of the frontal bone and to the palatine bone. It is divided into two plates, sagittal and basal. A functional feature in the human body of the middle turbinate is the control of air flow. It sends the flow of oxygen into the nasal passage and prevents it from entering the middle passage.

Middle turbinate at endoscopy

Anatomical structure in several forms:

1. Curved shape with a cover for the smell gap.
2. With a bend of the lateral wall, contributing to the development of the disease in the form of rhinitis.
3. With a double end at the front.
4. When the anterior end has a large bladder of bone.

The middle turbinate can be viewed by the ENT doctor during a rhinoscopy.

Upper nasal concha (Latin "Concha nasalis superior")

The superior turbinate is smaller than the inferior and middle turbinates. It is shorter. It is localized in the far part of the upper passage of the nose, where the olfactory area is located. When an anterior ENT rhinoscopy is performed by a doctor, the superior turbinate is not visible.

Copying site materials is possible without prior approval in the event of an active indexed link to our site.

Vasotomy of the nose: laser, radio wave, submucosal resection

Vasotomy is an operation aimed at reducing the size of the nasal concha mucosa. It boils down to the destruction of part of the vascular plexus located between the epithelium and the bone. The main indication is chronic rhinitis and resulting mucosal hypertrophy.

Indications for the operation

The main disease in which a vasotomy is possible is chronic rhinitis or a runny nose. An important condition for surgical treatment is getting rid of the underlying infection and excluding the allergic nature of the disease.

Hypertrophy of the nasal mucosa can also be a reason for the appointment of a vasotomy. These two pathologies are related, but not directly. Hypertrophy can be the result of a persistent runny nose, taking vasoconstrictor drugs, which suppress its function, cause mucosal growth to compensate. But it can also occur as a result of the curvature of the nasal septum. Hypertrophy often worsens during adolescence.

Vasotomy can help with dependence on vasoconstrictor drugs. In this case, the edema does not subside without taking the appropriate drops. For some people, addiction can last for years, and only surgery helps to start breathing on their own.

Operating principle

The operation area is the inferior turbinates. Surgical intervention can affect only the left or right side or be bilateral. The latter option is most often performed because vasomotor chronic rhinitis affects both nostrils.

The inferior turbinates are bony protrusions that are covered with a multi-glandular epithelium. Because of them, the surface is constantly wetted with mucus and is therefore called mucous. It is characterized by increased blood circulation intensity. Therefore, another layer is usually isolated between the bone and epithelial tissue - the submucosa. It consists of choroid plexuses.

They are the ones that are destroyed during the operation. As a result, the nutrition of this part of the epithelium stops. He dies off, scars appear. The total volume of the hypertrophied mucous membrane decreases. This relieves swelling, reduces the activity of the glands, which ultimately eliminates the runny nose.

Operation types

Vasotomy of the inferior turbinates can be performed using one of the following methods:

• Instrumental. In this case, the surgeon acts directly with a scalpel, making an incision in the mucous membrane.
• Laser. The action of the beam is directed to the entire surface of the mucous membrane. The risk of infection is reduced, but the effectiveness does not always match the damage received.
• Radiocoagulation. The surgeon makes punctures, an instrument with a tip is inserted into them, through which radio waves pass.
• Vacuum resection. This is a new method that is currently being actively researched. The destruction of the submucosal layer is carried out by introducing a tube attached to a pump under the epithelium and creating negative pressure.
• Ultrasonic disintegration. The waves are focused exclusively on the affected area. The risk of additional damage is minimal.

Operation progress

Instrumental vasotomy

The procedure is performed under local anesthesia. It is carried out by lubricating the mucous membrane with 5% cocaine solution or 2% dicaine solution. They also infiltrate (soak) the entire nasal concha with lidocaine (1%) or novocaine (1-2%). Sometimes they are given by injection. The patient's face is covered with a tissue, leaving an opening for the nose. Thus, the patient does not see the actions of the doctor. The operation time is from 30 to 60 minutes.

After the onset of anesthetics, the surgeon makes a 2-3 mm incision to the bone. A raspator is inserted into it - a tool for separating tissues. The surgeon separates the mucous tissue in the required amount. As a result, scars appear at the site of the vascular plexuses, and the epithelial tissue decreases in size.

Sometimes it is necessary to carry out lateropexy - a shift of the nasal concha towards the maxillary sinus. The patient at this moment can hear a crunch, do not be frightened and try to move your head.

After the operation, the patient is given another injection with anesthetic to reduce the discomfort after the anesthesia stops. Bandages or tampons will be in the nose for a while. On the first day, the condition may resemble the flu - watery eyes, weakness, dizziness. Important! However, the temperature should not be - this is a sign of inflammation, infection. The patient will have to periodically rinse the nose in the morning to prevent crusting. This procedure is carried out until the mucosa is completely healed and begins to function normally.

Laser vasotomy

Before the operation, you must give up cosmetics. It is possible that the patient will be asked to change into disposable hospital pajamas. The operation is performed under local anesthesia. The pain reliever in most cases is delivered in the form of tudund, moistened with an analgesic, which is inserted into the nose. The patient's face is treated with alcohol.

Sometimes, as a result of changes in the mucous membrane, it loses its color and becomes pale. In such a situation, it is difficult for a doctor to carry out all the necessary manipulations, therefore, before the operation, the epithelium is stained with methylene blue. It also improves laser performance.

The patient lies on the couch, the head rests on the headrest. Important! It is highly undesirable to move during the operation, so you need to immediately take a comfortable position. If the patient is feeling overly agitated, it is best to ask the doctor to fix the arms and legs with elastic bandages. A bandage is put on the eyes. During the operation, the patient will feel an unpleasant singed smell. It will be optimal if he begins to inhale through his mouth and exhale through his nose.

The doctor inserts a mirror into the nose and controls the process with it. It is usually painless, but there may be a slight tingling or tingling sensation. Radiation can be carried out pointwise or continuously, when the doctor passes the laser along the mucous membrane. The first method is the most preferable because it less affects the epithelial membrane of the nose. Today, in medical centers, the least traumatic method is first used, and if it is ineffective, they switch to the second.

The actual operation is carried out with quartz fiber. It is inserted under the mucous membrane and forms channels there, producing tissue separation. The fiber is flexible, which allows it to follow all the contours of the turbinate and not come out on the surface of the epithelium.

After the operation, tamponade (insertion of tampons into the nose) is not required, since in most cases it is bloodless, since the vessels are not cut, but "sealed". This prevents the development of synechia - tissue adhesions. Laser vasotomy has good performance and safety records. According to doctors from Kharkov (OG Garyuk, A.B. Bobrus), who conducted a long-term study of patients with rhinitis medicamentosa in the period from 2006 to 2009, cure occurs in 96.8% of cases.

Video: laser vasotomy

Radio wave vasotomy

Patient immobility is one of the key parameters, therefore, in most cases, the patient falls asleep during the operation. The anesthetic is delivered through a vein. A tube is placed in the throat to drain the blood. The operation time is from 10 to 40 minutes. If the doctor uses local anesthesia, then the patient should maximally control his reactions during the radio wave vasotomy and try not to move even in case of severe pain.

The doctor inserts a probe into the submucosal area. A radio wave is generated between it and the transmitter. Due to the resistance to the wave, the surrounding tissues are heated, and their destruction occurs. One of the varieties of the method is the use of non-thermal energy. At certain frequencies, a cooling region occurs around the inserted probe, which causes tissue destruction. This method is considered somewhat less traumatic than the standard one, and safer for adjacent tissues.

The patient usually wakes up 1-2 hours after the end of the operation, already in the ward. The nostrils contain tampons and tubes through which you can breathe. The general condition of the patient is satisfactory. Typically, patients experience severe nasal pain and prefer to breathe through the mouth. Migraines, disorientation in space are possible. During the week, hygiene measures must be observed - rinsing the nose with saline solutions, such as Aquamaris, removing crusts from the nose with petroleum jelly or peach oil.

Ultrasonic disintegration

The operation is performed in the ENT office. It is performed under local anesthesia and lasts from 5 to 20 minutes. There may be some bleeding, so a special apron is likely to be worn on the patient. A waveguide is inserted into the submucosa of the patient's inferior turbinates. It looks like a needle with which the doctor "pierces" the epithelium.

The emitted ultrasound causes stenosis (clumping) of those blood vessels that provoke edema. After the operation is over, tampons are inserted into the patient's nostrils and he can go home. In the evening, the separation of the ichor is possible - this is a normal reaction. Nasal breathing is fully restored 3-7 days after surgery. It is necessary to see a doctor periodically to remove mucus crusts during the recovery period.

Vacuum resection

The operation is performed under local anesthesia and under the strict control of an endoscope. A device for performing vacuum resection was developed by Russian doctors and put into practice just a few years ago. It is a system of pipes with a pump attached to them.

The surgeon makes an incision with a scalpel after the onset of anesthesia. A tube is inserted into the submucosal layer. Its edge is sharp, and as it advances, it cuts off the tissue needed to be removed. Due to the action of the pump, they are sucked into the tube along with the blood.

After removing the device from the nose, a cotton ball is inserted into the nostril, which tightly presses the epithelial tissue. This is to prevent bleeding. It is in the nostril for only one minute. Tamponade is not required for vacuum resection.

The deleted content is sent for histological examination. This allows you to more carefully plan the further management of patients.

Vasotomy combined with septoplasty

stages of septoplasty

In addition to mucosal hypertrophy, another common cause of respiratory failure is the curvature of the nasal septum. This pathology is also corrected surgically. The operation is called septoplasty. Since chronic rhinitis and curvature of the septum are related diseases, it is often suggested to carry out this operation immediately together with a vasotomy.

This kind of surgery is more difficult than just excision of the submucosal layer of the nose and takes longer. Therefore, in this case, general anesthesia and hospitalization for 1-2 days after the operation are more often practiced. However, most surgeons recommend performing septoplasty and vasotomy together rather than in two stages. This reduces trauma to the mucous membrane and discomfort for the patient, which has to be experienced only once.

The recovery period after such an operation lasts longer than with a conventional vasotomy. Perhaps an increase in temperature, prolonged separation of the ichor from the nose. Important! If you feel unwell, you need to contact the treating ENT, only a specialist can distinguish the normal reaction of the body from the beginning of the infectious process.

Complications after a vasotomy

After the operation, the following undesirable consequences may develop:

1. Mucosal atrophy. This is the reverse process of hypertrophy, but also unpleasant. The lowest risk of its occurrence after laser exposure. The destruction of functionally important cells of the epithelium of the nasal passages leads to atrophy.
2. Inflammation. The risk of infection during surgery is quite low. All instruments are sterilized in both private and public clinics. However, any surgical intervention reduces the protective barrier of the epithelium, which makes the body more susceptible to various pathogens. The more invasive the technique is used, the more likely it is to get inflammation.
3. Loss of smell. This is usually a temporary phenomenon associated with postoperative edema.
4. Nasal congestion. Unfortunately, nasal vasotomy may not always help. It is extremely rare that swelling and congestion not only persist, but also become stronger. The reasons can be different from an allergic reaction to repeated hypertrophy.
5. Formation of synechiae or adhesions at the site of resection. These formations can seriously impede breathing. They form gradually, so the patient's well-being may not worsen immediately. Treatment is carried out only by reoperation.

Some authors do not consider the safety of the effect of physical radiation (radio or laser) on the human body as conclusively proven. Modern research is not the basis for predicting the patient's condition in the more distant future.

The cost

Submucosal vasotomy is free of charge, but you will have to queue to get the service. Patients usually have to wait 1 to several months. The operation is carried out mainly by the instrumental method. It is possible, if a polyclinic or hospital has special equipment, to carry out vacuum resection under the compulsory medical insurance policy, but so far this practice is extremely rare.

Other types of vasotomy cost approximately the same - with a grinder. In addition, you will have to pay for general anesthesia, if such are the indications of the doctor or the patient's desire. The cost of tests, biopsy of the contents, as well as hospitalization beyond the first day are not included in the indicated price. In the price lists of clinics, bilateral vasotomy is usually implied, although this is not indicated separately.

The most expensive will be an operation combined with septoplasty, mainly due to hospital stay. The average price in Moscow is rubles. But septoplasty itself can be performed free of charge under the compulsory medical insurance policy, however, combining this operation with a vasotomy performed by a minimally invasive method using modern equipment should not be expected.

Patient reviews about vasotomy

The first thing that patients who underwent surgery note is their poor condition on the first day after submucosal vasotomy. Difficulty sleeping, excruciating pain, disturbing turundas in the nostrils For some, local anesthesia does not help and the operation becomes extremely painful. In most cases, it is successful. Patients have written rave reviews about regaining the ability to breathe on their own. In rare cases, surgery results in a loss of smell, which significantly affects the quality of life of patients.

The uselessness of the operation or even more deterioration of nasal breathing can become quite difficult for patients. In this case, the rejection of vasoconstrictor drugs during the recovery period is mandatory. As a result, the patient sleeps very little or does not sleep at all, he suffers from nightmares. In elderly or overly sensitive people, blood pressure may increase, heartbeat may increase. It is not always possible to help in solving this problem. Usually doctors are limited to advice to wait until the end of the recovery period (1-3 months after surgery).

Vasotomy is an operation that has a high efficiency rate, 90-97% of operations are completed successfully. However, in some case, a long recovery period is possible, during which it will not be possible to breathe through the nose. Also, the patient should be aware that there is a risk of worsening his condition. Therefore, it is necessary to prepare for a bad result, especially in the first months after the operation, do not panic if there is swelling in the nose, learn to breathe through the mouth at night. Calmness and patience, as well as strict adherence to medical prescriptions, in the vast majority of cases, lead to the restoration of all functions of the nose.

The lower part of the medial wall of the labyrinth, located in the nasal cavity between the upper and lower turbinates.

1. Small Medical Encyclopedia. - M .: Medical encyclopedia. 1991-96 2. First aid. - M .: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M .: Soviet encyclopedia. - 1982-1984.

See what "Medium nasal concha" is in other dictionaries:

- (concha nasalis media, PNA, BNA, JNA) a thin curved plate of the ethmoid bone extending from the lower part of the medial wall of the labyrinth, located in the nasal cavity between the superior and inferior turbinates ... Big Medical Dictionary

TURBINATE - (nasal concha) any of three thin curved plates protruding on the lateral wall of the nasal cavity. The superior (superior) and middle (middle nasal conchae) shells are the processes of the ethmoid labyrinth of the bone of the same name; lower nasal ... ... Explanatory Dictionary of Medicine

Head bones (skull) - … Human anatomy atlas

Digestive system - ensures the assimilation by the body of the necessary energy as a source of energy, as well as for cell renewal and growth of nutrients. The human digestive apparatus is represented by the digestive tube, large glands of the digestive ... ... Human anatomy atlas

Lateral wall of the nasal cavity - Frontal bone (scales of the frontal bone); frontal sinus; cockscomb; ethmoid plate of the ethmoid bone; upper turbinate; middle turbinate; sphenoid sinus; wedge-shaped palatine opening; inferior turbinate; vertical ... Human anatomy atlas

The pharyngeal cavity (cavum pharyngis) on a sagittal section - tubal palatal fold; the pharyngeal opening of the auditory tube; pharyngeal tonsil; pharyngeal pocket; pipe roll; anterior arch of the atlas; soft sky; tubal-pharyngeal fold; uvula of the soft palate; palatal lingual arch; palatine tonsil; palatine ... ... Human anatomy atlas

Bones of the cerebral skull - The occipital bone (os occipitale) (Fig. 59A, 59B) is unpaired, located in the posterior part of the cerebral skull and consists of four parts located around a large foramen magnum (Fig. 60, 61, 62) in the anteroinferior part of the outer ... ... Human anatomy atlas

Respiratory system - The respiratory organs provide gas exchange, saturating the tissues of the human body with oxygen and freeing them from carbon dioxide, and also take part in the sense of smell, voice formation, water-salt and lipid metabolism, and the production of certain hormones. IN… … Human anatomy atlas

NOSE - Nose. Contents: I. Comparative anatomy and embryology. ... 577 II. Anatomy ................... 581 III. Physiology .................. 590 IV. Pathology ................... 591 V. General operative surgery of the nose ... 609 D. Comparative anatomy and ... ... Great medical encyclopedia

Ethmoid bone - Ethmoid bone, os ethmoidale, unpaired. Most of it lies in the upper parts of the nasal cavity, less in the anterior parts of the base of the skull. It has the shape of an irregular cube, consists of air cells and belongs to the group ... ... Human anatomy atlas

I Paranasal sinuses (sinus paranasales; synonym for paranasal sinuses) air cavities in the bones of the facial and cerebral skull, lined with a mucous membrane, which communicate with the nasal cavity; are voice resonators. To the subordinate clauses ... Medical encyclopedia