MUHAMMAD ZAEED AMIRULLAH

BIN MOHD RAZALI

1 ) FRACTURE NASAL BONE

2 ) FOREIGN BODY NOSE

3 ) CEREBROSPINAL FLUID,CSF RHINORRHEA

4 ) ORO-MAXILLARY FISTULA
(ORO-ANTRAL FISTULA)

5 ) SEPTAL HEMATOMA
1) Traumatic, 80%
Casual Trauma: car accident, personal assault
Surgical Trauma,Iatrogenic: after surgical
operations, hypophysectomy or endoscopic
sinus surgery
2) Non Traumatic or Spontaneous, 20%
Hydrocephalus
Brain Tumors particularly pituitary tumors
Syphillis
Meningocele or Meningo-Encephalocele
 Unilateralclear watery discharge
Commonly possitional on leaning forwards
Not reduced by antihistamines or local
vasoconstrictors
Does not stiffen in the handkerchief
May be mixed with blood in fresh traumatic
case. Usually passed unnoticed. Can be
detected by Halo Test
Complete diagnosis of a case of CSF-Rhinorrhea
should include the answer for three questions:
1) Is this CSF-Fluid
2) Why does it leak?
3) Where does it leak?
Common sites are :
Ethmoid Roof
Cribriform Plate of Ethmoid
Sphenoid Sinus
Posterior Table of Frontal Sinus
1. Fluid Analysis

2. CT-Scan

3. MRI

4. IntraThecalFluorescin Injection
 Undiagnostic - Presence of glucose or
reducing substances in the fluid
Diagnostic detection of 30 mg/dl glucose or
more in the leaking fluid
Detection of beta-2-transferrin detection in
the fluid considered as diagnostic due to this
substance present only in CSF as well as the
perilymp and aqeous humor.
1. Fluid Analysis

2. CT-Scan

3. MRI

4. IntraThecalFluorescin Injection
 With intrathecal contrast may demonstrate
the dye leaking to the nose, defining the site
and detect any underlying cause.
False negative result is not rare
1. Fluid Analysis

2. CT-Scan

3. MRI

4. IntraThecalFluorescin Injection
 Moresensitive and better than CT with
contrast
1. Fluid Analysis

2. CT-Scan

3. MRI

4. IntraThecalFluorescin Injection
 Followed by endoscopic examination to
detect yellowish green color of the dye.
To ensure the diagnostic and define the site
of leak.
1. Fluid Analysis

2. CT-Scan

3. MRI

4. IntraThecalFluorescin Injection
 Closure of the CSF fistula is indicated to
avoid spread of infection through it,
Meningitis or air on blowing of the nose,
Pneumo-Cephalus

1) Fresh Traumatic Cases

2) In Spontaneous Cases and Persistent

Traumatic Cases
 Conservativesmanagement as most fistula
close by spontaneous healing
Includes
Rest in bed better in semi-sitting position
Avoid straining, treat any cough and give a mild
laxatives
Sulphonamides, Rifampicin or 3rd-Generation-
Cephalosporins-Antibiotic
 Closure of the CSF fistula is indicated to
avoid spread of infection through it,
Meningitis or air on blowing of the nose,
Pneumo-Cephalus

1) Fresh Traumatic Cases

2) In Spontaneous Cases and Persistent

Tramatic Cases
 Surgical closure or fistula either through :
Trans-cranial approach
Extra-Cranial or Endo-Nasal-Endoscopic Approach
 Closure of the CSF fistula is indicated to
avoid spread of infection through it,
Meningitis or air on blowing of the nose,
Pneumo-Cephalus

1) Fresh Traumatic Cases

2) In Spontaneous Cases and Persistent

Tramautic Cases
TERIMA KASIH BANYAK