Atresia Joán — the violation of passability of a cavity of a nose connected with its full or partial zarashcheniye a connecting, cartilaginous or bone tissue. The atresia Joán can be congenital defect or the acquired state owing to injuries and inflammatory diseases of a cavity of a nose. The leading symptom of a disease is violation of nasal breath of various degree of expressiveness. Diagnostics of an atresia Joán includes survey of the otolaryngologist, a rinoskopiya, a kateterization of a nasal cavity and a X-ray contrast research. Treatment of an atresia Joán perhaps only in the surgical way. Operation consists excess of bone or webby tissue with formation of a hoanichesky opening and restoration of natural air circulation in a nose cavity at a distance.
Joana or internal nostrils represent openings of a back wall of a nasal cavity through which it is reported with a throat. Through Joana the air inhaled by a nose gets into the top airways. Closing of hoanalny openings at an atresia Joán is especially hard transferred by babies as nasal breath is at them prevailing.
Congenital atresia Joán rather rare anomaly of pre-natal development. In 90% of cases it is connected with a nose cavity zarashcheniye a bone tissue and in 10% of cases with formation of a soyedinitelnotkanny membrane. Thickness of an atresia can fluctuate from millimeter to 1-1,5 cm. The congenital atresia Joán is, as a rule, diagnosed in the period of a neonatality or at early children's age. In many cases it is combined with other malformations: curvature of a nasal partition, Gothic sky, congenital Colomba of an iris, doubling of a trestle of an ear, "hare lip" or "a wolf mouth". The acquired atresia Joán can develop at any age and has post-traumatic or post-inflammatory character.
Causes of an atresia Joán
The congenital atresia Joán is connected with violation of an embryonal development in the first months of pregnancy. It develops as a result of a delay or interruption of process of separation of a nasal cavity from a throat. Originally division of a nose and throat happens the mesenchymal membrane which is formed between them which in the subsequent resolves, leaving behind openings — nasal Joana. Preservation of a membrane or its replacement with a bone tissue are led to emergence of an atresia by Joán.
To the reasons capable to cause pre-natal formation of an atresia Joán, in otolaryngology carry the chronic diseases of mother (chronic pyelonephritis, bronchitis, diabetes and so forth) transferred it during pregnancy of an infection (measles, a rubella, flu, clamidiosis, toxoplasmosis, mycoplasmosis), reception of medicines with embriotoksichesky action (barbiturates, antibiotics, etc.), impact of ionizing radiation and other teratogenny factors. Also genetic predisposition to emergence of an atresia Joán is traced.
The acquired atresia Joán most often is observed after serious injuries and burns of a nose. It is caused by development in the course of healing of tissues of cavity of a nose of soyedinitelnotkanny hems. In certain cases the atresia Joán develops as a result of scarring after the postponed pyoinflammatory process in nose cavities. It can arise owing to syphilis, diphtheria, scarlet fever, measles, a system red volchanka.
Classification of an atresia Joán
On prevalence of a zarashcheniye on one or both half of a nose distinguish one - and a bilateral atresia Joán. If unions completely block a nose cavity, then speak about a full atresia Joán. If the existing partition has openings or short Joán partitions off a nasal cavity, then an atresia classify as partial. Depending on character of fabric from which the zarashcheniye of a hoanichesky opening is created allocate the bone, webby and mixed (bone and webby) atresia Joán. The last has an appearance of a bone ring with a membrane inside. In some cases the bone atresia has islands of cartilaginous tissue.
Clinical manifestations of an atresia Joán
The full congenital atresia Joán is most dangerous. The newborn child breathes only a nose. Therefore at a full atresia Joán shout is the only way at which air gets into airways of the child. As a result at the newborn the hypoxia and respiratory insufficiency quickly develops, there can come the asphyxia leading to a lethal outcome.
The clinic of a partial congenital atresia Joán depends on degree of their zarashcheniye and is more expressed at bilateral character of an obliteration. In such cases an atresia Joán can lead to a chronic hypoxia which consequence the wrong formation of a facial skeleton, violation of growth of teeth, lag of the child in mental development is. The broken nasal breath can cause in newborn difficulty when sucking, provoke refusal of the child of a breast and malnutrition with development of a hypotrophy.
At adults the unilateral atresia Joán is most often observed. The main complaints at the same time are: decrease in sense of smell, violation of nasal breath in one of half of a nose and periodic office from it plentiful amount of muddy and dense slime. The congestion of slime happens because of impassability of a hoanichesky opening in the struck half of a nose. Slime gathers in depth at a back wall of a nose and forms a big lump. Its involuntary izlity occurs at a ducking of the patient. The bilateral atresia Joán is followed by emergence of twang of a voice.
Diagnostics of an atresia Joán
The full congenital atresia Joán is diagnosed at once after the child's birth. The partial atresia depending on expressiveness of violations of breath can be found at later age. Suspicion on existence of an atresia is the indication to immediate survey of the child by the otolaryngologist. The main method confirming the diagnosis of an atresia Joán is sounding of a nasal cavity. When carrying out a research the probe entered into a nose does not pass in a throat, and rests against the dense education blocking a back wall of a nasal cavity.
In diagnostics of an atresia Joán also apply a contrast radiological research. It consists in performance of a X-ray analysis of a skull in a side projection after introduction to a cavity of a nose of X-ray contrast solution. The contrast congestion in a nasal cavity and lack of its passing to a nasopharynx confirms the diagnosis of an atresia Joán. At a partial atresia on the roentgenogram it is possible to observe partial passing of contrast to a throat in the form of narrow strips.
When carrying out a rinoskopiya at patients with an atresia Joán comes to light dryness and atrophic changes mucous a nose. In certain cases the underdevelopment or an atrophy of nasal sinks, shortening of the lower nasal sink, lack of its back end and increase forward is found. The nose partition at a unilateral atresia Joán is rejected towards an atresia, at bilateral — is on the middle.
The differential diagnosis of an atresia Joán needs to be carried out with a foreign matter of a nose, traumatic damage of the nasal courses, benign tumors of a cavity of a nose, big growth of adenoides, a hoanalny polyp.
Treatment of an atresia Joán
Elimination of an atresia Joán is carried out by a surgical way. The full congenital atresia Joán with threat of asphyxia is the indication to urgent carrying out intervention. The troakarny puncture in the place of a zarashcheniye of Joana and introduction to the received opening of a catheter through which nasal breath is carried out can be a temporary measure in such cases. At the partial atresia Joán which is not followed by the expressed respiratory violations, operation can be postponed until more advanced age and is usually carried out in the preschool period.
Correction of an atresia Joán consists the fabrics interfering the message of a nasal cavity with a throat and to restoration of natural passability of pneumatic ways at a distance. Operation can be performed by access through a nose (transnazalno) or through a section in the sky (transpalatalno). The first access is simpler, however it has bigger risk of postoperative closing of the nasal courses. The bone atresia Joán of big thickness is bored through in the beginning, and then expand an opening with a chisel, bone nippers or a saw. The webby atresia Joán is excised. For preservation of the created opening enter a drainage tube which withdrawal is possible not earlier than in 3 weeks after operation into it. At formation of solderings in the postoperative period make their section and for several days enter the special plate interfering their repeated emergence into a nose cavity.
Unfortunately, Joán often leads surgery at an atresia to a disease recurrence due to postoperative cicatricial changes, and repeated surgeries only aggravate an atresia. For the prevention of postoperative scarring after excision of excessive fabrics on a wound surface impose a thin rag on a leg which is taken from face skin. The rag is hemmed special seams which hold it on a surface of wound defect and at the same time do not squeeze edge.