13 - Head + Neck - Nose + Paranasal sinuses

Question 1

What is the function of the nose and nasal cavity?

Answer 1

• Smell
• Filter + humidify air
• Resonating chamber for speech
• Drainage of paranasal sinuses + nasolacrimal ducts

Question 2

Which bones form the root of the external nose?

Answer 2

• 2 x Nasal bones

- Maxilla

Question 3

Name the boundaries of the nasal cavity and the associated bones:

Answer 3

Roof: Cribriform plate - nasal + frontal + ethmoid + sphenoid
Floor: Hard + soft palates - maxilla + palatine
Lateral: Conchae
Medial: Nasal septum - ethmoid + vomer + septal cartilage

Question 4

What nerve gives general sensation to the nasal cavity?

Answer 4

Anterior-Superior = CN V1
Posterior-Inferior = CN V2

Question 5

What is a septal haematoma? What is the complication of this if it isn’t treated promptly?

Answer 5

Blood between the perichondrium + septal cartilage

Saddle deformity of the nose due to necrosis of cartilage

Question 6

What are the symptoms associated with nasal polyps?

Answer 6

• Blocked nose
• Watery rhinorrhoea
• Post-nasal drip = cough
• Decreased sense of smell
• Decreased sense of taste

Question 7

What is a nasal polyp?

Answer 7

Fleshy benign swelling of mucosa
Mobile + painless
Usually bilateral
Pale/yellow
Usually 40+ yrs

Question 8

What is rhinitis?

Answer 8

Inflammation of nasal mucosal lining, usually caused by viral infection or allergen

Question 9

What are the symptoms of rhinitis?

Answer 9

• Nasal congestion
• Rhinorrhoea
• Sneezing
• Nasal irritation
• Post nasal drip = cough

Question 10

Name the 4 paired paranasal sinuses:

Answer 10

1) Frontal
2) Sphenoidal
3) Ethmoidal
4) Maxillary

Question 11

Most paranasal sinuses drain into which meatus?

Answer 11

Middle meatus

Question 12

What is the epithelium lining the paranasal sinuses?

Answer 12

Ciliated pseudostratified columnar + goblet cells

Question 13

What are the symptoms associated with acute sinusitis?

Answer 13

• Pain + tenderness over affected sinuses
• Rhinorrhoea
• Fever
• Malaise
• Non-resolving cold/flu

Question 14

Which bacteria most commonly infect the paranasal sinuses?

Answer 14

• Haemophilus influenzae

- Streptococcus pneumoniae

Question 15

How can sinusitis cause orbital cellulitis?

Answer 15

Infections of the ethmoidal air cells can infiltrate into the medial wall of the orbit

Question 16

Name the area of the nose from which 90% nosebleeds occur:

Answer 16

Keisselbach’s plexus

Question 17

Which arteries supplying the nasal mucosa arise from the roof of the cavity?

Answer 17

• Anterior Ethmoid artery

- Posterior Ethmoid artery

Question 18

Which artery supplying the nasal mucosa arises from the posterior wall, and accounts for 5% nosebleeds?

Answer 18

Sphenopalatine artery

Question 19

Which arteries supplying the nasal mucosa arise from the floor of the cavity?

Answer 19

• Greater palatine artery

- Superior labial artery

Question 20

What is epistaxis?

Answer 20

Nose bleeds

Question 21

What is the management of epistaxis?

Answer 21

• Pinch in front of bridge of nose + lean forward
• Cauterise visible bleeding point
• Anterior packing
• Posterior packing
• Surgical ligation

Question 22

How can CSF reach the nasal cavity following trauma?

Answer 22

• Cribriform plate of ethmoid bone fractures
• Dura mater around christa galli ruptures
• CSF leaks into nasal cavity

Question 23

Why might a patient with sinusitis complain of toothache?

Answer 23

• Underlying cause of sinusitis may be tooth abscess, as some teeth roots are very close to maxillary sinus and can erode into the sinus
• Referred pain due to shared sensory innervation to the maxillary sinus and teeth, upper jaw + cheek (CN V2)