40. Diseases of the Nose Flashcards
bony nose on the nasal ridge, the rest is cartilage, some fatty tissue
relevant anatomy
inferior turbinate which is what you can see, middle turbinate, superior turbinate
internal structures of the nose
internal carotid > opthalmic artery > anterior ethmoidal artery and posterior ethmoidal artery
blood supply to the lateral wall
external carotid > maxillary artery > greater palatine artery, lesser palatine artery, and sphenopalatine artery > branches of sphenopalatine artery
blood supply to the lateral wall
facial artery > branches of the facial artery
blood supply to the lateral wall
very similar to lateral wall supply, kiesselbach’s plexus bracnes of the internal and external carotid
blood supply to the septum
upper part of nose/face drains via angular vein intracranially to the cavernous sinus, also drainage via fiacial to jugular vein
venous drainage of the nose
upper lip, philtrum, and nose, contains cavernous sinus, oculomotor nerve, trochlear nerve, opthalmic nerve, abducent nerve, maxillary nerve, internal carotid artery, sella turcia, sphenoid sinus, sphenoid bone, nasopharynx, pituitRY GLAND, optic chiasm
danger triangle
primarily respiratory epithelium, specialized olfactory area, some squamous epithelium at the nares
nasal mucosa
increased secretions, nasal obstruction, bleeding, foul odor, pain, altered sense of smell
symptoms of nasal pathology
nasal speculum opens up and down, or nasal endoscopy but needs topical anesthetic, can visualize nasopharynx
examination of the nose
palpate all the facial bones so you know it is isolated, no imaging if tender only at the nasal bridge, the nose is aligned, the nareas are patent, and there is no septal hematoma, management of most nasal fraftures is deferred until swelling resolves, for extensive facial trauma CT is the preferred imaging modality
isolated nasal trauma
can compress the septum and cause necrosis, can become infected, drainage followed by packing, with ENT follow up, remember image
septal hematoma
common complaint, usually not a sign of systemic disease, common causes include trauma, nosepicking, dry mucosa due to dry winters, allergies, less common causes include coagulopathy, thrombocytopenia, and cancer
epistaxis
not common 1:150,000 people is about 50/year in the US, primarily adolescent males, can present with massive epistaxis or mass effect, benign but grows aggressively
juvenile nasopharyngeal angiofibroma
personal history of bleeding issues, blood in the stool or urine, gum bleeding, anticoagulant medications, family history of bleeding disorders, prior episodes on the same side with what triggers them, if treatment was attempted
epistaxis history
management is done stepwise, apply pressure, add topical vasoconstrictor oxymetazoline, cautery only if you can see the source and only do one side of the septum, then tamponade, then surgical management
epistaxis history
pressure, topical vasoconstrictor oxymetazoline, cautery if you can see the source, only do one side of the septum, tamponade, surgical management
epistaxis management
if unable to control pressure +/- topical vasoconstri ction +/- cautery, proceed with packing, can be vaseline gauze or commercial products, packing remains for 24-48 hours, packing remains for 24-48 hours, oral antibiotics are not uniformly recommended but consider for prevention of sinusitis and toxic shock syndrome, may pack both sides if first doesn’t stop it, if still bleeding suspect posterior bleed
anterior expistaxis
when efforts to stop epistasis as already described don’t work you may have a posterior bleed, posterior pack and also anterior pack, will often need inpatient care
posterior epistaxis
uncontrolled bleeding or bleeding that recurs when pack is removed may need a surgical or interventional radiology approach
if all else fails
don’t touch your nose, don’t put anything in your nose like finger, tissue, or gauze, use a humidifier when sleeping, use saline spray, ENT referral if the patient needed more than anterior packing, assess for causes/sources
epistaxis after care
most common in children, can cause purulent drainage, foul odor, bleeding, and pain, acutely parents can see the child put it there, but subacutely can cause unilateral purulent drainage with bad smell, can be removed with parent’s kiss, balloon catheter, forceps, caveats with button batteries, concern for aspiration, check for other orifices, consider sinus infection
nasal foreign body
make sure there is only one foreign body, if subacute presentation with purulent discharger, treat with oral antibiotics for presumed sinus infection, consult ENT if injury
nasal foreign body aftercare
