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Full text of "Diseases Of The Nose Throat And Ear"

134                  THE PHARYNX AND NASOPHARYNX

and nasal or aural complications demand relief, it is possible to remove the
upper part of the adenoid mass, thus leaving a lower ridge of adenoid tissue
against which the defective palate may continue to make contact (Fig. 54).

Reactionary haemorrhage shows itself shortly after the operation by
persistent bleeding from the nose. This does not, as a rule, respond to sedation
by diamorphine injection. Very frequently there is a copious vomit containing
much fresh blood. The pulse rate increases and the blood pressure drops.

Fig. 54. Palatographs showing, on left, a short stubby insufficient palate dependent upon a large
adenoid mass for closing the nasopharynx. On right, the result of a modified removal of adenoids
showing the palate closing the nasopharynx against the adenoids left at the operation.

Experience shows that the best treatment is to return the child to the theatre
where a postnasal pack is inserted under anaesthesia, and is removed on the
following morning, again under anaesthesia. If blood loss is severe or
prolonged before being controlled a blood transfusion will be required.

Secondary haemorrhage from the adenoid bed may occur, although un-
commonly, 4-10 days after the operation. It is usually not sufficiently severe
to justify a postnasal pack, and it generally responds to sedation with an
injection of diamorphine in a dosage suitable to the age and weight of the
child.

NASOPHARYNGEAL ANGIOFIBROMA

This interesting tumour is rare in Britain, but is relatively common in some
Middle Eastern and Far Eastern countries. It occurs typically in young males,
the usual age range being 10-25 years. If it appears before puberty it often
undergoes spontaneous regression at that milestone. It is probably of con-
genital origin and arises from the periosteum of the sphenoid, or the basi-
occiput. It is a simple tumour in that it never gives rise to metastases, but it
may be highly locally invasive, often spreading to the ethmoidal cells and
orbit, the maxillary antnim and the sphenoidal sinus, and it may erode
through tlie base of the skull. The rate of growth is variable, and this may
depend upon the predominance of either fibrous tissue or a more vascular
strotna. Mkroscopically, it consists of a variable amount of dense fibrous