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Nose
Nasal cavity, paranasal sinuses
| Term | Definition |
|---|---|
| What bones make up the nose? | Nasal bones (meet in superior midline), maxillae (meet to form lateral boundary), frontal bone |
| What cartilages make up the nose? | 2 lateral cartilages (middle), 4 major (anterior)/minor (posterior) alar cartilages, 1 septal cartilage |
| What is the external nasal aperture and its components? | Naris -> lateral is fibrofatty tissue, medial is major alar cartilage |
| What forms the nasal septum? | Superior - ethmoid perpendicular plate, posterior - vomer, anterior - cartilage |
| What forms the roof of the nasal cavity? | Anterior - nasal bones, medial - ethmoid cribriform plate (olfactory nerves), posterior - inferior sphenoid body |
| What forms the floor of the nasal cavity? | Anterior - maxillae palatine processes, posterior - horizontal plates of palatine bones |
| What forms the lateral wall of the nasal cavity? | Maxilla and 3 conchae -> superior/middle concha is ethmoid, inferior concha is own bone |
| What is the nasal cavity arterial blood supply? | Maxillary artery (ECA) -> sphenopalatine branch, greater palatine artery (inferior supply), ophthalmic artery (ICA) -> anterior/posterior ethmoidal arteries (superior supply) -> anastamose in Little's area (anterior supply) |
| What is the nasal cavity venous blood supply? | Drains into sphenopalatine (pterygoid vein plexus in infratemporal fossa -> maxillary -> EJV), ophthalmic (cavernous sinus), facial veins (IJV) |
| What is the histology of the nasal cavity epithelium? | Roof/medial/lateral walls -> columnar epithelium, rest is respiratory epithelium (stratified squamous) xcp vestibule |
| What is the nasal cavity innervation? | Special sensation -> CN I through cribriform plate, general sensation -> Va (anterosuperior)/b (rest of nasal cavity), parasympathetic secretomotor -> greater petrosal -> pterygopalatine ganglion -> nasopalatine nerve (Vb) -> mucus glands |
| What is the histology of paranasal sinuses? | Ciliated mucosal psuedostratified columnar epithelium |
| What are the functions of the paranasal sinuses? | Resonance chambers for speech, lighten bones of facial skeleton, warm and saturate inhaled air |
| Which sinuses drain into the middle meatus? | Frontonasal duct -> frontal/anterior ethmoid, semilunaris hiatus -> maxillary, ethmoidal bulla -> middle ethmoidal air cell |
| Which sinuses drain into the superior meatus? | Sphenoethmoidal recess -> sphenoid/posterior ethmoidal |
| What opens into the inferior meatus? | Nasolacrimal duct (tear drainage) |
| Where does the Eustachian tube open? | Lateral wall of nasopharynx |
| What is the management of epistaxis? | Packing -> promote blood clotting, tilt head forward -> prevent nausea/airway obstruction, ice -> vasoconstrictive medication |
| What is the investigation of epistaxis? | Nasal speculum -> pries open nostrils to allow visual, flexible nasendoscopy -> relatively safe w/ minimal bleeding and good visuals of nasal cavity/larynx/pharynx, operator dependent |
| What is the cause/diagnosis of CSF rhinorrhea? | Basilar skull fracture -> CSF leaks though fractured cribriform plate, beta-2 transferrin assay (only in CSF) |
| What are the short term complications of CSF rhinorrhea? | Spontaneous leak will cease but headache may persist |
| What are the long term complications of CSF rhinorrhea | Open communication btwn nasal cavity/CSF/CNS -> severe bacterial infections, severing of olfactory nerves -> permanent anosmia, intracranial hypotension -> neurological symptoms |
| What are the symptoms of maxillary sinusitis? | Pain over cheeks (CN Vb) -> worsens when bending over, maxillary teeth pain, referred otalgia -> irritation of CN VII |
| What is the management of maxillary sinusitis? | Rest w/ H2O -> thin mucus, Abx if patient unwell w/ fever from infection |
| What is the imaging for maxillary sinusitis? | Chronic cases -> X-ray with Water's view -> fluid in normally air-filled cavity, CT scan -> grey fluid obstruction in normally black air cavity |
| What is the innervation of the sinuses? | Maxillary -> CN Vb, frontal -> CN Va, ethmoidal -> CN Va nasociliary branch ethmoidal branch, sphenoid -> CN Va/b |
| What is the treatment of sinusitis? | FESS - functional endoscopic sinus surgery -> balloon catheter inserted into inflamed sinus -> balloon inflated to expand opening -> saline sprayed to flush out pus/mucus |
| What are the complications of FESS? | Functional endoscopic sinus surgery -> CSF leak, infection -> meningitis, haemorrhage -> orbital swelling/diplopia |
Created by:
vykleung
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