CSF RHINORRHEA

• Truama• Tumour• Congenital• SITES OF LEAK• Cribriform plate• Ethmoid cells• Sphenoid sinus• ETube

Diagnosis

• Clear fluid –nose• d/d-allergic rhinitis• How to differenciate? – History– Flow bending continuous – straning – Suger- >30 <10– B2 tranferrin present absent

Localisation of leak

• Fluorescein ,radioisotope• Olfactory slit• middle meatus• sphenoethmoidal recess • Et opening• CT• MRI• TARGET SIGN

TREATMENT

• Conservative management• Surgical approach-– Endoscopic – intracranial

Benign tumours nasopharynx

• Juvenile angiofibroma• Teratoma• Pleomorphic adenoma• Chordoma• Hamartoma

Juvenile angiofibroma

• Testosteron dependent• 10 -20 yr, male• Site of origin-– Sphenopalatine foramen

• Spread– Nose, nasopharynx– Pterygopalatine fossa,– Pterygomaxillary and infra temporal fossa

• Cranial cavity-middle cranial fossa• Ant cranial fossa• Orbit,PNS

c/f

• EPISTAXIS• Hearing loss• Denasal speech• Mass nasopharnx-pinkish purple,firm• 2nd 3rd 4th 6th nerve palsy• proptosis

PATHOLOGY

• Blood vessels, fibrous tissue• Lack of muscular coat-

Inv

• X ray- nasopharyx, PNS• Skullbase• Ct scan,MRI• angiography

treatment

• Lateral rhinotomy• trans palatine /combined• Intracranial• To reduce blood loss- – Embolisation – Oestrogen– RT– cryotherapy

RT-in fraction/intensity modulated hormonal-diethyl stilboesterol chemtherapy