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Head And Neck > 9.1 Nose, Nasal Cavity And Paranasal Sinuses > Flashcards

9.1 Nose, Nasal Cavity And Paranasal Sinuses Flashcards

1
Q

What are the functions of the nose/nasal cavity?

A

Olfaction
Filtering inspired air - trapping particles in nasal hair or mucous
Humidifying and warming inspired air
Drainage of secretions from paranasal sinuses and nasolacrimal ducts
Inspiration of air
Resonating chamber for speech

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2
Q

Describe the composition of the nose

A

Mainly cartilaginous

But also has a bony part: Frontal process of the maxillae and two nasal bones form its root

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3
Q

What can injuries to the nose cause?

A

Septal Haematomas
Septal deviations
Nasal bone fractures

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4
Q

Describe the structure of the nasal cavity

A

Extends from the anterior nasal apertures (nostrils) to the posterior nasal apertures (choanae). Opens into the nasopharynx.
Has a medial and lateral wall, roof and floor.

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5
Q

What forms the medial wall of the nasal cavity ?

A

The nasal septum

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6
Q

What does the nasal septum consist of?

A

perpendicular plate of the ethmoid bone
septal cartilage
vomer

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7
Q

Describe the pathology of a septal haematoma

A

Cartilaginous portion of the septum relies on the overlying perichondrium for its blood supply. Blood collects in space between perichondrium and cartilaginous septum. Perichondrium lifted off the cartilage.
Lack of blood supply and increasing pressure from accumulating blood causes ischaemia of cartilage. Irreversible necrosis of cartilage leading to saddle deformity.

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8
Q

How is a septal haematoma treated?

A

Blood between the perichondrium and cartilaginous septum drained.
Tamponade placed to keep perichondrium pressed to the cartilage, preventing reaccumulation of blood

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9
Q

Why is it important to inspect the nasal septum after any sort of nasal trauma?

A

Septal haematoma

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10
Q

What are the 4 major paranasal sinuses?

A

Maxillary
Frontal
Ethmoidal
Sphenoid

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11
Q

Which of the paranasal sinuses are not paired?

A

Sphenoid air sinus

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12
Q

What is the largest paranasal sinus?

A

Maxillary sinus

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13
Q

What makes up the ethmoidal sinuses?

A

Anterior, middle and posterior air cells

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14
Q

What are paranasal sinuses?

A

Air filled spaces within the skull lined with respiratory mucosa (ciliated pseudostratified columnar with goblet cells) . All communicate with the nasal cavity

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15
Q

How do most of the paranasal sinuses communicate with the nasal cavity?

A

Middle meatus

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16
Q

What can an obstruction of drainage of a paranasal sinus result in?

A

Accumulation of mucosal secretions
Development of infection
Acute sinusitis

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17
Q

What are the presenting symptoms of acute sinusitis?

A

Pain and tenderness over the sinus involved
Nasal discharge
General systemic upset (fever/feeling unwell)

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18
Q

What are the causes of acute sinusitis?

A

Infections of the nose (cold)

Dental infections

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19
Q

How do dental infections cause acute sinusitis?

A

the roots of some of the upper teeth lie in the floor of the maxillary sinus

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20
Q

What is sinusitis?

A

Sinusitis is an inflammation of the lining of the sinuses

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21
Q

How do upper respiratory tract infections cause sinusitis?

A

Mucosal oedema
Impedance of ciliary function
Increasing mucosal secretions
Cause obstruction of drainage and increased stagnant pooling of mucus in sinus.

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22
Q

What is the most commonly affected sinus in sinusitis?

A

Maxillary sinus

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23
Q

How is sinusitis diagnosed?

A

History and clinical examination alone

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24
Q

How is sinusitis treated?

A

Self limiting, simple analgesics, should improve within 1-2 weeks
Secondary bacterial infection may require antibiotics (suggested by prolonged, severe symptoms)

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25
Q

How might orbital cellulitis be a complication of sinusitis?

A

Ethmoidal sinusitis can break through thin medial wall of orbit.
Infection spreads into orbit causing orbital cellulitis

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26
Q

Why is orbital cellulitis a cause for concern?

A

Potentially sight threatening if optic nerve involved.

May track back to involve other intracranial structures.

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27
Q

What is the vestibule of the nose?

A

The prominent external nose

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28
Q

Describe the lining of the vestibule

A

Respiratory epithelium (ciliated pseudo-stratified columnar with goblet cells)
Sebaceous glands
Sweat glands
Hair

29
Q

What is the floor of the nasal cavity?

A

Hard palate (roof of oral cavity)

30
Q

How might nasal bone fractures present?

A

History of facial injury
Swelling of area around nose
Evidence of deviation of the nose

31
Q

What is the medial wall of the nasal cavity?

A

Nasal septum

32
Q

Describe the the structure of the lateral wall of the nasal cavity

A

3 bony projections (conchae/turbinates)
-superior, middle and inferior conchae
3 meatuses underneath each conchae

33
Q

What structure forms the superior and middle conchae of the nasal cavity?

A

Ethmoid bone

34
Q

What are the nasal meatuses?

A

Superior middle and inferior meatuses are spaces under the conchae of the lateral wall of the nasal cavity.

35
Q

What is the function of the conchae and meatuses of the later wall of the nasal cavity?

A

To slow inspired air by creating turbulence of airflow through vestibule.
Increase surface area over with air passes.
Allows us to better warm, filter and humidify inspired air

36
Q

What structures communicate into the meatuses of the lateral wall of the nasal cavity

A

Paranasal air sinuses (mostly communicate with the middle meatus
Nasolacrimal duct - tears drain into the nasal cavity (opens into inferior meatus)

37
Q

What bones form the roof of the nasal cavity?

A 
From anterior to posterior:
Nasal bone
Frontal bone 
Ethmoid bone
Sphenoid bone
38
Q

How do surgeons access the pituitary gland?

A

Transsphenoidal surgical approach

Endoscope enters through anterior nasal apertures into nasal cavity. Passed through sphenoid bone to access pituitary

39
Q

What forms the posterior component of the nasal septum?

A

Perpendicular plate of ethmoid bone

Vomer bone

40
Q

Where does blood accumulate in a septal haematoma?

A

Sub-perichondrium

41
Q

What causes a saddle nose deformity?

A

Untreated septal haematoma leading to avascular necrosis of the cartilaginous septum

42
Q

Which cranial nerve carries general sensation from the nasal cavity?

A

Trigeminal nerve

43
Q

What nerve supplies general sensory to the nasal cavity?

A

Ophthalmic and maxillary division of the trigeminal nerve

44
Q

What lines the olfactory region of the nasal cavity?

A

Specialised olfactory mucous membrane

- contains dendrites of olfactory nerves on roof of nasal cavity

45
Q

Where are odours detected by the nose?

A

By dendrites of the olfactory nerves within the mucous membrane covering the olfactory region of the superior nasal cavity. Trigger action potentials related back to the brain.

46
Q

What is the function of the respiratory mucous membrane in the nasal cavity?

A
  • Filters (mucous/cilia)
  • Humidifies (watery secretions)
  • Warms (rich blood supply- very vascular)
47
Q

How do nasal polyps present?

A 
Fleshy, benign swellings of the nasal mucosa
Usually bilateral
Common in over 40 years
Pale or yellow in appearance
Usually occur within the meatuses
48
Q

What are the symptoms of nasal polyps?

A 
Blocked nose
Watery rhinorrhoea
Post-nasal drip
Decreased smell and reduced taste 
Mouth breathing 
More prone to acute sinusitis (block drainage of sinuses into nasal cavity)
49
Q

What symptoms would suggest a nasal tumour?

A

Unilateral polyp

Blood tinged secretion

50
Q

What is rhinitis?

A

Inflammation of the nasal mucosal lining

51
Q

What are the symptoms of rhinitis?

A 
– Nasal congestion 
– Rhinorrhoea (“runny” nose) 
– Sneezing 
– Nasal irritation 
– Postnasal drip
52
Q

What are common causes of rhinitis?

A

Simple acute infective rhinitis (viral)

Allergic rhinitis

53
Q

What is epistaxis?

A

Nose bleed.

54
Q

What provides the arterial supply to the nasal mucosa?

A

Branches from the ophthalmic artery (anterior ethmoid and posterior ethmoid artery)
Branches from the maxillary artery (Sphenopalatine and greater palatine artery )
Form rich anastomoses

55
Q

What is Kiesselbach’s plexus?

A

Arterial anastomoses in the anterior septum

56
Q

What is the most common source of bleeding in epistaxis?

A

Kiesselbach’s plexus

57
Q

How is anterior epistaxis treated?

A

Pinching nose in front of nasal bone

58
Q

What is the venous drainage of the nasal cavity?

A

Into pterygoid venous plexus in the infratemporal fossa (also drainage to cavernous Indus and facial vein)

59
Q

What type of epistaxis are more difficult to treat?

A

Bleeds from the sphenopalatine artery (back of nasal cavity and difficult to treat, higher pressure of blood)

60
Q

What is the functions of the paranasal air sinuses?

A

Humidify and warm inspired air

Reduce weight of skull

61
Q

What are Ostia?

A

Small channels draining the paranasal air sinuses into the meatus of the nasal cavity

62
Q

What important anatomical relation do the ethmoid air sinuses have?

A

Orbital cavity as in the medial wall of the orbit

63
Q

What are the important anatomical relationships do the paranasal air sinuses have?

A

Nasal cavity
Orbit
Anterior cranial fossa
Roots of the upper teeth

64
Q

What provides general sensory innervation to the paranasal sinuses?

A

Branches of the CN V

  • Va (frontal, ethmoidal and sphenoid sinus)
  • Vb (maxillary sinus)
65
Q

What often causes acute sinusitis?

A

Viral infection of nasal cavity

66
Q

How do we diagnose acute sinusitis?

A

clinical diagnosis based of history and examination
Recent URTI
Block nose and rhinorrhoea with yellow/green discharge
Pyrexia
Headache
Facial pain in area of infected sinus - worse of leaning forward

67
Q

How is sinusitis treated?

A

Symptomatically (analgesia, antipyretic, steam inhalation)

68
Q

What are the symptoms of an acute bacterial sinusitis?

A

Acute bacterial sinusitis more likely if
• Symptoms particularly severe at onset
• Symptoms >10 days without improvement (but <4 weeks)
• Symptoms that worsen after an initial
improvement (suggesting secondary
bacterial infection)

69
Q

What are the commonest bacteria. That cause acute bacterial sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenzae
Mortadella catarrhalis

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