13 Nasal Cavity

Question 1

A patient had severe epistaxis (nosebleed). This area, known as Kiesselbach’s area, invovles mostly anastomoses between which arteries?

Answer 1

The Kiesselbach’s plexus is an anastomosis on the ant. nasal septum between 4 arteries:

1. ant. ethmoidal artery
2. sphenopalatine artery
3. sup. labial artery
4. greater palatine artery

• the 2 largest contributors are the septal branches of the sphenopalatine (from the maxillary artery) and superior labial arteries

Question 2

Examination revealed a carcinoma in a patient’s nasal cavity. In which location would the carcinoma block the hiatus of the maxillary sinus?

Answer 2

The maxillary sinus drains via the middle meatus, specifically into the semilunar hiatus.

The inf. meatus drains the lacrimal secretions carried by the nasolacrimal duct

The sup. meatus drains the posterior ethmoidal and sphenoid sinuses

Question 3

Examinatoin reveals that a herpetic lesion is affecting the dorsum of the nose and the eyeball. Which nerve is most likely responsible for transmission of the virus to the eye?

Answer 3

A herpes rash on the dorsum of the nose is known as Hutchinson’s sign. This indicates that the virus is located in cell bodies of the ophthalmic division of the trigeminal nerve. This nerve branches into nasociliary, lacrimal and frontal branches.

The nasociliary nerve has direct branches that carry sensory innervation from the eye and also gives off the ethmoidal nerves that innervate the superior nasal mucosa.

Question 4

Drainage from which structure is most likely obstructed by inflammation and edema of the inferior nasal meatus?

Answer 4

The nasolacrimal duct is the only duct that normally drains into the inf. meatus of the nose and therefore would be affected

Question 5

Anastomotic connections between which arteries make up Kiesselbach’s area?

Answer 5

GASS

Branches of the Greater palatine a., Ant. ethmoidal a., Sphenopalatine a., and Superior labial a. anastomose to make Kiesselbach’s area

Question 6

A patient with a brain tumor near the crista galli and cribiform plate of the ethmoid bone most likely experience which symptom?

Answer 6

The processes of the olfactory nerves pass through the cribiform plate and end in the olfactory bulbs, which lie on either side of the crista galli.

Question 7

Examination of a patient revealed an infxn in the ethmoid sinus. Wich structure is the most likely passage for the spread of infxn in this patient?

Answer 7

The ethmoid sinuses are groups of air cells located in the ethmoid bone. There are 3 groups of air cells:

1. posterior
   
   • drain into the sup. meatus
2. middle
   
   • drain into the middle meatus at the ethmoid bullae
3. anterior
   
   • drain into the middle meatus by way of the ethmoid infundibulum
     
     • ​this can spread infxns from the paranasal sinuses into the nasal cavity