1.

External examination Note the shape of the septum nasi, if found any septal deviation, polyps if there are signs of such phenomena frog nose, upper lip is no sign of maceration due to secretions from the maxillary sinus, looking for signs of allergy such as dark shadows around the eyes (Shinner), line across the dorsum nasi (Crease) or a scratch mark on the dorsum of nasal because of itching (Sallute) and find if there is edema and hyperemia in the fossa Canina. ook for nasal crackles due to fracture of the septum which can cause obstruction nasal, press the anterior wall of the maxillary sinus with the thumb toward mediosuperior, if the obtained difference value, the more pain is sinus sinus pathology. !hen palpation cause severe reactions that can be replaced with a percussion simultaneously with the index finger bare fingers. 2. Anterior rhinoscopy "s a process to look through the vestibule cavum nasi nasal. Necessary tools are light head, nasal speculum and xylocain ephedrine solution if necessary to mele #arkan cavum nasi. $n examination usually found unilateral polypoid mass that fills the pouch of nasal and cause obstruction. "nverted papilloma macroscopically visible irregular and fragile, bleed easily when touched. %apilloma color grayish red and filling the pouch of nasal, also extends into the vestibule to the nasopharynx. Septum often pushed toward the contralateral side. %roptosis and swelling of the face sometimes occur secondary to tumor lesion expansion. Chonca media and medial wall of the maxillary sinus is the place of origin of inverted papilloma common growth. "n the rare cases the tumor can be isolated in the sinus spenoid. &he involvement of the paranasal sinuses may increase recurrence rates.