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1、耳鼻咽喉科医院鼻部先天性疾病鼻部先天性疾病耳鼻咽喉科医院l鼻部脑膜脑膨出l先天性后鼻孔闭锁鼻的先天性疾病鼻的先天性疾病耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出分类l囟门型l颅底型脑膜脑膨出：鼻腔顶见粉红色光滑新生物耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出囟门型 鼻额型 鼻筛型 鼻眶型颅底型 蝶眶型 蝶颌型 鼻咽型耳鼻咽喉科医院耳鼻咽喉科医院箭头示左侧筛板骨质缺损，脑组织膨出于鼻腔耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出 病理类型（按膨出内容物分类） l 脑膜膨出（meningocele）l 脑膜脑膨出（encephalomingocele）l 脑室脑膨出（hydroencephaloce
2、le）耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出l临床表现 1 鼻外型：新生儿外鼻上方近中线处类圆形肿块，表面光滑，随年龄的增长而增大。 2 鼻内型：鼻腔或鼻咽部可见表面光滑肿块，其蒂位于鼻顶部。-鼻不通气，哺乳困难。耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出l诊断 新生儿鼻腔肿块，随着哭闹肿块大小有变化；或伴水样鼻分泌物；CT或MRI检查可明确诊断；一般不做肿块穿刺。耳鼻咽喉科医院鼻部脑膜脑膨出鼻部脑膜脑膨出l治疗：手术治疗 以23岁为宜。耳鼻咽喉科医院先天性后鼻孔闭锁先天性后鼻孔闭锁l单侧或双侧l膜性闭锁或骨性闭锁l常伴有其他畸形图示后鼻孔闭锁正常后鼻孔：可见鼻中隔后缘（箭头）后鼻孔上缘，
3、宽敞程度可窥及鼻咽结构耳鼻咽喉科医院先天性后鼻孔闭锁先天性后鼻孔闭锁病因l胚胎期鼻颊膜遗留或颊咽膜遗留；l后鼻孔被上皮栓块所堵塞；l后鼻孔周围组织增生形成闭锁。耳鼻咽喉科医院先天性后鼻孔闭锁先天性后鼻孔闭锁临床表现l新生儿闭口时呼吸困难，甚至窒息死亡。l单侧闭锁可无症状。耳鼻咽喉科医院先天性后鼻孔闭锁先天性后鼻孔闭锁 诊断l1 临床表现：新生儿呼吸困难，不能正常哺乳；l2 卷棉子或导尿管试探无法通过；l 鼻内镜或CT检查可明确诊断。耳鼻咽喉科医院先天性后鼻孔闭锁先天性后鼻孔闭锁 治疗l首先迅速建立经口呼吸，保证呼吸通畅，再择期手术；l手术：经鼻腔、经腭，经鼻中膈、经上颌窦；l内窥镜下后鼻孔修复
4、术视野清晰，优点突出。耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲l定义：指鼻中隔偏向一侧或双侧、或局部有突起，引发鼻腔功能障碍，如鼻塞、鼻出血和头痛等。l类型：C形偏曲、S形偏曲、棘突、嵴、粘膜肥厚等。耳鼻咽喉科医院C型偏曲嵴棘突C型偏曲并棘突耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲l病因： 组成鼻中隔的诸骨发育不均衡，形成不同的张力曲线，导致诸骨间连续异常所致。 儿童时期腺样体肥大、硬腭高拱可限制鼻中隔发育引起鼻中隔偏曲。耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲 临床表现：症状的轻重与偏曲的程度有关。l鼻塞l鼻出血：突出部粘膜薄，容易受气流冲击而糜烂出 血l头痛：突出部挤压同侧鼻甲l临近器官症状：如鼻窦炎等鼻中
5、隔棘突处粘膜易损伤鼻出血耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲 临床表现：症状的轻重与偏曲的程度有关。l鼻塞l鼻出血：突出部粘膜薄，容易受气流冲击而糜烂出 血l头痛：突出部挤压同侧鼻甲l临近器官症状：如鼻窦炎等鼻中隔棘突压迫右下鼻甲耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲 临床表现：症状的轻重与偏曲的程度有关。l鼻塞l鼻出血：突出部粘膜薄，容易受气流冲击而糜烂出 血l头痛：突出部挤压同侧鼻甲l临近器官症状：如鼻窦炎等鼻中隔偏曲引起左侧鼻塞 耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲 诊断： 临床上有症状，且经检查有鼻中隔偏曲者，方可诊断。 注意偏曲的类型、部位及其比邻关系。耳鼻咽喉科医院鼻中隔偏曲鼻中隔偏曲 治
6、疗：手术矫正。目前，多采用鼻内镜下手术。 鼻中隔粘膜下矫正术 鼻中隔粘膜下切除术耳鼻咽喉科医院鼻中隔前部粘膜切口剥离粘-软骨膜，暴露鼻中隔软骨切开鼻中隔软骨凿除鼻中隔腭嵴耳鼻咽喉科医院jVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u
7、*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7Ia
8、MdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#
9、s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H
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11、u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7J
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13、!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7Ia
14、LdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#
15、s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9L
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17、%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z08JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbN
18、fQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t
19、*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOfRjUmYp!s&w)z0C8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMe
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21、1D5G8JbNeQiTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTkWo%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmY
