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Year 2- Head and Neck > Anatomy and Physiology of the Nose > Flashcards

Anatomy and Physiology of the Nose Flashcards

1
Q

What are the main functions of the nose?

A

Nasal airway
Olfaction (smell)
Immune
Speech

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2
Q

What does the nose do to inspired air?

A

Warms and humidifies it

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3
Q

After which surgeries may a patient need need to humidifier to prevent drying out of the lower airways?

A

Tracheostomy
Laryngectomy

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4
Q

What in the function of the cilia on the walls of the nasal cavity?

A

Trap dust and harmful particles.

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5
Q

Why do we smell?

A

For pleasure and to warn against danger e.g. fire

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6
Q

How does smell link to taste?

A

While chewing, chemicals from food activate olfactory receptors to indentify food flavour.

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7
Q

What is choanal atresia of the nose?

A

Failed recanalization of the nasal fossae during foetal development

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8
Q

Why is choanal atresia an emergency in neonates?

A

They are obligate nasal breathers so will be unable to breathe.

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9
Q

How is choanal atresia fixed?

A

Surgery

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10
Q

How does the nose play a role in immunity?

A

Mucus consists of compounds which can neutralize antigens.

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11
Q

Which immunoglobulins are found on the mucosal surfaces of the nose?

A

IgA
IgE

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12
Q

What can reduce number of nasal cilia and changes mucus viscosity?

A

Smoking

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13
Q

How does the nose affect speech?

A

Provides vocal resonance and nasal clicks

->if bunged up because of a cold, voice is thicker and less easily understood

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14
Q

At which point does nasal flow turn from laminar to turbulent?

A

When it goes through the nasal valve

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15
Q

Why is it important that nasal laminar flow turns into turbulent flow?

A

Decreases velocity so there is prolonged exposure to nasal mucosa

->this is probably to give more time to trap dust, neutralize pathogens, smell, etc.

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16
Q

What are the paranasal sinuses?

A

Air filled cavities

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17
Q

What is the function of paranasal sinuses?

A

Debated but suggested decreases weight of skull?
Possible heat insulation?
Humidification?

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18
Q

What is meant by the dorsum of the nose?

A

Surface between root of nose and tip

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19
Q

What is the name of the openings of the nose?

A

Nares

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20
Q

What are the two nares separated by?

A

Columella

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21
Q

There are two parts of the nasal skeleton- bone and cartilage. Describe the bones of the nasal skeleton.

A

Paired, symmetrical and oblong

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22
Q

Name the two main paired cartilages of the nose.

A

Upper lateral cartilage
Lower lateral (alar) cartilage

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23
Q

Which bones do the nasal bones articulate with:
1. superiorly
2. laterally

A
  1. Frontal bones
  2. Maxilla bones
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24
Q

What are the two paired cartilages of the nose attached to and supported by?

A

Septal cartilage

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25
Q

What is the most common facial fracture?

A

Nasal fracture

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26
Q

What can a nasal fracture result in?

A

Permanent deformity

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27
Q

How can a nasal fracture be corrected?

A

Via surgery but has to be quick before bone heals

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28
Q

When assessing nasal injury, what trauma-related issue must you look out for?

A

Septal haematoma

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29
Q

What can untreated septal haematoma result in?

A

Saddle nose deformity

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30
Q

What is a septal haematoma?

A

Collection of blood between the perichondrium and cartilage of the nasal septum.

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31
Q

What happens if the septal haematoma is not correctly drained?

A

Mucal perichondrium is not replaced onto cartilage leading to ischaemia and necrosis of septum.

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32
Q

What does the saddle provide the nose with?

A

Support, therefore, in a saddle nose deformity, the support to the nose is lost.

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33
Q

Where does the skin of the external nose receive blood from?

A

Supratrochlear and dorsal nasal arteries.
Infraorbital artery.

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34
Q

Which artery are the supratrochlear and dorsal nasal arteries branches of?

A

Ophthalmic artery

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35
Q

Which artery is the infraorbital artery a branch of?

A

Maxillary artery

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36
Q

Where do the septum and agar cartilages receive arterial blood from?

A

Angular artery
Lateral nasal artery

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37
Q

Which artery are the angular and lateral nasal artery branches of?

A

Facial artery

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38
Q

Describe the venous drainage of the nose.

A

Drained by facial vain into internal jugular vein.

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39
Q

Describe what is meant by the danger triangle of the nose.

A

Highly anastomotic venous system of nose allows retrograde spread of infection to the cavernous sinus via ophthalmic veins.
Life and sight threatening.

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40
Q

What are some of the clinical signs of Cavernous sinus thrombosis?

A

Ptosis (drooping of eyes)
Chemosis (eye irritation)
Cranial nerve palsies

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41
Q

Which nerves are are danger of cranial nerve palsies in cavernous sinus thrombosis?

A

III- Oculomotor
IV- Trochlear
V- Trigeminal
VI- Abducens

42
Q

What are some of the potential consequences of cavernous sinus thrombosis?

A

Papilledema (swelling of optic disc)
Retinal haemorrhages
Decreased visual acuity
Blindness

43
Q

What may be present clinically in those with cavernous sinus thrombosis?

A

Fever
Tachycardia
Sepsis
Headache w neck stiffness

44
Q

Which nerve is the innervation of the external nose derived from?

A

Trigeminal nerve

45
Q

Which nerve supplies motor innervation to the muscles of the nose?

A

Facial nerve

46
Q

Which nerves supply the skin of the dorsum of the nose, nasal alae and nasal vestibule?

A

Intertrochlear and external nasal nerves- both branches of the ophthalmic nerve.

47
Q

Which nerve supplies the lateral aspects of the nose?

A

Infraorbital nerve, branch of maxillary nerve

48
Q

What are the main two muscles of the nose?

A

Nasalis
Procerus

49
Q

Which muscle covers the dorsum of the nose?

A

NasalisW

50
Q

Which muscle is a small pyramidal shape superior to the dorsum occupying the glabella(between eyebrows)?

A

Procerus

51
Q

What is the innervation of the nasalis muscle?

A

Buccinator branch of facial nerve

52
Q

What is the action of the nasalis muscle?

A

Alar part- depresses ala laterally, dilates nostrils
Lateral part- wrinkles skin of dorsum

53
Q

What is the innervation of the procerus muscle?

A

Temporal, lower zygomatic or buccal branches of facial nerve.

54
Q

What is the action of the procerus muscle?

A

Depresses medial ends of eyebrows
Wrinkles skin over glabella (between eyebrows)
Creates frowning expression when exposed to bright light or eye irritants

55
Q

Name the three parts of the nasal cavity.

A
  1. Vestibule
  2. Respiratory region
  3. Olfactory region
56
Q

What is the vestibule of the nose?

A

Entrance to nasal cavity, lined with hair bearing skin

57
Q

Describe the histology of the respiratory region of the nasal cavity.

A

Lined by ciliated pseudostratified epithelium with mucus secreting goblet cells.

58
Q

Describe the olfactory region of the nasal cavity.

A

Apex of nasal cavity, lined with olfactory cells w olfactory receptors.

59
Q

What does the nasal septum do?

A

Divides right and left nasal passages

60
Q

Name the three paired bony projections from the lateral nasal wall.

A

Turbinates/conchea

  1. Superior turbinate
  2. Middle turbinate
  3. Posterior turbinate
61
Q

What does the presence of the three tubinates form?

A

Superior, middle and inferior meatus

62
Q

Why does the internal nose have a rich vascular supply?

A

Allows humidification and warming of air

63
Q

The internal nose has a rich blood supply from the internal and external carotid arteries. Name the branches of the internal AND external.

A

Internal Carotid:
-anterior ethmoidal artery
-posterior ethmoidal artery

External Carotid:
-Sphenopalatine artery
-Greater palatine artery
Superior labal artery
-Lateral nasal artery

64
Q

Epsitaxis?

A

Nosebleed

65
Q

Where is the most common area for epsitaxis?

A

Little’s area on the anterior septum

66
Q

Which plexus is found at the Little’s area?

A

Kiesselbach plexus

67
Q

Where would posterior nasal bleeding usually come from?

A

Woodruff plexus

68
Q

Which plexus is easier to access and cauterise under local anaesthetic?

A

Kiesselbach plexus

69
Q

Which type of bleed is more likely to require nasal packing?

A

Posterior bleeding via Woodruff plexus

70
Q

What is usual first aid for a noseblled?

A

Pinching of the nose

71
Q

Which type of bleed does not respond to nose pinching?

A

Posterior bleed via Woodruff plexus

72
Q

What are some surgical management options for epistaxis?

A

Endoscopic ligation of sphenopalatine artery

73
Q

What are paranasal sinuses?

A

Air filled cavities lined by respiratory epithelium.

74
Q

Name the four groups of paranasal sinuses.

HINT- named according to which bone they are located in

A

Frontal
Maxillary
Sphenoid
Ethmoid

75
Q

Which sinuses are the most superior?

A

The 2 frontal sinuses

76
Q

What is the arterial supply for the frontal sinuses?

A

Anterior ethmoidal artery

77
Q

What is the sensation supply for the frontal sinuses?

A

Supraorbital nerve (branch of ophthalmic nerve).

78
Q

What is the drainage for the frontal sinuses?

A

Frontonasal duct into hiatus semilunaris

79
Q

Which sinuses are most posterior?

A

Sphenoid sinuses

80
Q

What is the sensation supply for the sphenoid sinuses?

A

Posterior ethmoidal nerve (branch of ophthalmic nerve)

81
Q

What is the arterial supply for the sphenoid sinuses?

A

Sphenopalatine artery
Posterior ethmoidal artery

82
Q

What is the drainage for the sphenoid sinuses?

A

Spheno-ethmoidal recess

83
Q

Which type of surgery may be carried out for the resection of pituitary adenomas?

A

Trans-sphenoidal surgery

84
Q

What are the risks of a trans-sphenoidal surgery?

A

Close proximity to internal carotid artery so high bleeding risk.
Risk of CSF leak, which will need repaired.

85
Q

Which of the sinuses are the largest?

A

Maxillary sinuses

86
Q

What is the drainage for the maxillary sinuses?

A

Hiatus semilunaris

87
Q

What is the arterial supply for the maxillary sinuses?

A

Branches of facial and maxillary arteries

88
Q

What is the innervation for the maxillary sinuses?

A

Superior alveolar nerves
Greater palatine nerve

Both branches of maxillary nerve

89
Q

There are two ethmoidal sinuses on either side of the face; an anterior and a posterior.
What is the arterial supply for the ethmoidal sinuses?

A

Anterior ethmoidal artery
Posterior ethmoidal artery

90
Q

There are two ethmoidal sinuses on either side of the face; an anterior and a posterior.
What is the innervation for the ethmoidal sinuses?

A

Anterior and posterior ethmoidal branches of the nasociliary nerve

91
Q

What is orbital cellulitis?

A

Sight threatening emergency!
Acute spread of infection from the sphenoid or frontal sinuses.

92
Q

What are some of the clinical signs of orbital cellulitis?

A

Proptosis (eye swelling)
Chemosis (eye irritation)
Ophthalmoplegia (weakness/paralysis in eye movements)
Loos of colour vison and decreased visual acuity

93
Q

In those with orbital cellulitis, which colour will they lose vision of first?

A

Red

94
Q

What is the treatment of orbital cellulitis?

A

IV antibiotics
Nasal decongestants

95
Q

Which imaging will be done in those with orbital cellulitis?

A

CT scan

96
Q

Sometimes surgery can be done in treatment of orbital cellulitis…what can be done?

A

Drainage

97
Q

What is sinusitis?

A

Inflammation of lining of sinuses

98
Q

What is the cause of acute sinusitis (<3months)?

A

Usually viral

99
Q

Chronic sinusitis is diagnosed when it’s been present for >3months. It can be with or without polyposis.
Describe the symptoms of chronic sinusitis.

A

Nasal obstruction
Chronic nasal discharge
Affect on smell

100
Q

What is the post-nasal space/ nasopharynx?

A

Area posterior to nasal cholanae extending down to the soft palate

101
Q

What are the contents of the post-nasal space/nasopharynx?

A

Adenoids
Tubal tonsils
Eustachian tube opening

102
Q

What may enlarged adenoids or eustachian tube obstruction result in?

A

Glue ear (otitis media with effusion).

Year 2- Head and Neck (13 decks)

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