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Head and Neck > Anatomy and Physiology of The Nose > Flashcards

Anatomy and Physiology of The Nose Flashcards

1
Q

What is the principal function of the nasal airway?

A

Humidify and warm inspired air
Also removes noxious particles form air and protects delicate distal lower resp. tract

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2
Q

What is the olfaction of the nose?

A

Sense organ, housing olfactory apparatus
Dysfunction can result in poor QoL

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3
Q

What is the role of the olfaction of the nose?

A

Small substances
Important role in protection from danger
Central in forming positive and negative memories
Taste - identify food flavours

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4
Q

Describe choanal atresia

A

Failed recanalization of the nasal fossae during foetal development
This is emergency as neonate will be unable to breathe
Requires surgery

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5
Q

What are the immune functions of the nose?

A

Mucus consists of compounds able to neutralise antigens
Immunoglobulin A and E
Smoking can reduce cilia and change mucus viscosity

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6
Q

What is the function of the nose for speech?

A

Nasal airflow modifies speech and produces nasal clicks or click consonants
Paranasal sinuses also contribute to vocal resonance

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7
Q

Describe the nasal aerodynamics as airflow enters nasal vestibule

A

Nasal airflow is laminar when enters nasal vestibule - no mixing of different air layers at low velocity

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8
Q

Describe nasal aerodynamics when in nasal valve

A

Is narrowest site of resp. tract
Turbulent flow with different air layers swirling together
Velocity reduces so prolonged contact with nasal mucosa

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9
Q

What are paranasal sinuses?

A

Air filled and arise from the nasal cavity
Maxilla, sphenoid, ethmoid and frontal

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10
Q

What are some paranasal sinus functions?

A

Reduce skull weight, physical buffer, vocal resonance, humidification, heat insulation, and immune barrier

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11
Q

Describe the external nose

A

Visible component
Pyramidal shape with base continuous with forehead and apex at nasal tip

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12
Q

What is the dorsum of the nose?

A

Surface between root of nose and tip

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13
Q

What is the opening of the nose called and what is it separated by?

A

Nares
Separated by columella

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14
Q

Describe the nasal skeleton

A

Bony and cartilaginous components
There is small minor cartilages and main cartilage is supported by septal cartilage

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15
Q

What are the types of nasal bones?

A

Paired, symmetrical and oblong bones

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16
Q

What are the main cartilages?

A

2 paired lateral cartilages
Upper lateral
Lower lateral - alar

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17
Q

Explain a nasal bone fracture

A

Most common facial fracture
Can result in permanent deformity
Most often surgery performed under local anaesthesia
Beware of septal haematoma

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18
Q

Describe saddle node deformity

A

Cartilage has no blood supply of own so relies on surrounding perichondrium by diffusion
Haematoma results in ischaemia and necrosis of septum
Support to nose is lost

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19
Q

What arteries supply the skin of external nose?

A

Supratrochlear and dorsal nasal arteries - branches of ophthalmic artery
Infraorbital - branch of maxillary artery

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20
Q

What arteries supply septum and alar cartilages?

A

Angular and lateral nasal artery - branch of facial artery

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21
Q

What is the venous drainage of external nose?

A

Facial vein then IJV

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22
Q

What is the danger triangle?

A

Highly anastomotic venous system of nose allows retrograde spread of infection to cavernous sinus via ophthalmic veins
Is life and sight threatening

23
Q

What can the danger triangle and cavernous sinus thrombosis cause?

A

Ptosis, chemosis, cranial nerve palsies
Sensory defects of ophthalmic and maxillary branches
Papilledema, retinal haemorrhages and decreased visual acuity
Headache with neck stiffness

24
Q

Describe the sensory innervation of the external nose

A

Derived from trigeminal nerve CN V
Infratrochlear and external nasal nerves for skin, nasal alae and vestibule
Infraorbital nerve for lateral aspects

25
Q

Describe the motor innervation of the external nose

A

To nasal muscles
Facial nerve (CN VII)

26
Q

Describe the nasalis muscle

A

Paired muscle covering dorsum of nose
Innervated by buccal branch of facial nerve
Alar part depresses and dilates nostrils
Transverse part wrinkles dorsum

27
Q

Describe the procerus muscle

A

Small pyramidal muscle occupying glabella
Innervated by lower zygomatic or buccal of facial nerve
Depresses medial ends of eyebrows and wrinkles skin, creates facial expression of frowning

28
Q

What are the 3 parts of the nasal cavity?

A

Vestibule - entrance lined hair bearing skin
Resp. region - ciliated pseudostratified epithelium with mucus goblet cells
Olfactory region - at apex, olfactory cells with receptors

29
Q

Describe the nasal septum

A

Vertical wall dividing left and right nasal passages
Consists of bony and cartilaginous parts - quadrangular cartilage, vomer, perpendicular plate of ethmoid, maxillary crest and palatine bone

30
Q

What are the nasal turbinate/ conchae?

A

3 paired bony projections from lateral nasal walls -
Superior turbinate, Middle and Inferior
These form the superior, middle and inferior meati

31
Q

Why does the internal nose have rich vascular supply?

A

Allows humidification and warming of inspired air
Supplied from both internal and external carotid arteries

32
Q

Describe epistaxis

A

Nosebleeds
Commonest site - Littles area (Kiesselbach plexus) on anterior septum - can control under local anaesthesia

33
Q

Where does posterior bleeding come from?

A

Woodruff plexus - needs nasal packing

34
Q

What is nasal packing?

A

Can be rapid rhino (inflatable) or merocel (inflates in fluid)
Foley catheter and ribbon gauze

35
Q

What is the surgical management for epistaxis?

A

Endoscopic ligation of sphenopalatine artery
If nasal fracture then anterior ethmoid likely source so external approach

36
Q

What are the paranasal sinuses lined in?

A

Respiratory epithelium

37
Q

Describe the frontal sinuses

A

2 frontal sinuses
Most superior and pyramidal/ triangular in shape

38
Q

What is the arterial supply, venous drainage and innervation of frontal sinus?

A

Arterial - anterior ethmoidal artery
Nerve - supraorbital nerve
Drainage - frontonasal duct into hiatus semilunaris

39
Q

What is the arterial supply, venous drainage and innervation of sphenoid sinus?

A

Artery - sphenopalatine and posterior ethmoidal artery
Nerve - posterior ethmoidal nerve
Drainage - spheno-ethmoidal recess

40
Q

Describe trans-sphenoidal surgery

A

Most often for pituitary adenoma
Avoids transcranial approach
Joint procedure with ENT and neurosurgery

41
Q

What are the risks of trans-sphenoidal surgery?

A

Bleeding as close to internal carotid artery
CSF leaks

42
Q

Describe the maxillary sinuses

A

Cheek sinuses
Largest of sinuses, pyramid shape and lateral to nasal cavities

43
Q

What is the arterial supply, drainage and innervation of maxillary sinuses?

A

Artery - branches of facial and maxillary arteries
Drainage - hiatus semilunaris
Innervation - superior alveolar nerves and greater palatine nerve

44
Q

Describe the ethmoid sinuses

A

2 ethmoidal sinuses/ group of air cells
Anterior - opens into hiatus semilunaris via ethmoid bulla
Posterior - opens into lateral wall of superior meatus

45
Q

What is the arterial supply and innervation of the ethmoid sinuses?

A

Innervation - anterior and posterior ethmoidal branches of naso-ciliary nerve
Arterial - anterior and posterior ethmoidal arteries

46
Q

Describe orbital cellulitis

A

Sight threatening emergency
Acute spread of infection from ethmoid or frontal sinuses
Differentiate from pre-septal cellulitis by clinical signs

47
Q

What is the treatment for orbital cellulitis?

A

IV antibiotics
Nasal decongestants
CT scans and possible surgical drainage

48
Q

Explain sinus drainage

A

Sphenoid - spheno-ethomoidal recess
Posterior ethmoid - lateral wall of superior meatus
Anterior ethmoid, frontal and maxillary - ostiomeatal complex in middle meatus

49
Q

Where does nasolacrimal duct open into?

A

Inferior meatus

50
Q

What is sinusitis?

A

Inflammation of lining of sinuses
Acute - viral
Chronic (more than 3 months) - with or without polyps
Static mucus can get infected

51
Q

What are the contents nasopharynx?

A

Adenoids and tubal tonsils
Eustachian tube opening

52
Q

What is the position of nasopharynx?

A

Interchangeable
Area posterior to nasal choanae, extending down to soft palate

53
Q

What can enlarged adenoids or other post nasal space obstruction cause?

A

Obstruction of Eustachian tube
Glue ear
Unilateral in adults can be sign of nasopharyngeal mass

Head and Neck (14 decks)

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