Chapter 12: Diseases of the Nose Flashcards
1
Q
Indicative of suppurative disease in the maxillary antrum, anterior ethmoid cells or frontal sinus
A
Purulent discharge in the middle meatus
2
Q
Indicate an infection in the posterior ethmoid cells
A
Discharge in the superior meatus
3
Q
Is valuable to visualize abnormalities such as choanal polyps, hypertrophic turbinates and purulent discharge from the nose and paranasal sinuses which has been swept posteriorly through the action of the cilia
A
Posterior rhinoscopy
4
Q
Are obligate nose-breathers and may need an alternate airway established at birth
A
Neonates
5
Q
Nasal deformities
A
- Septal deflections
- Asymmetric lower lateral cartilage and soft tissues of the nasal alae
Results in…
Nose with inadequate tip projection
Acute nasolabial angle
Sagging of the nasal ala on the cleft side
Irregularities in the position of the nostril sills
6
Q
Contain all elements of skin: hair follicles, hair, sweat glands, sebaceous glands, connective tissue
Arise out of ectodermal elements of the fetal trilaminar septum which fail to degenerate
A
Nasal dermoid cyst
7
Q
Then sinus opening of the nasal dermoid cyst when present is located at
A
Osteocartilaginous junction of the nasal dorsum
8
Q
Diagnostic tool of choice for nasal dermoid cyst
A
CT scan
9
Q
Therapy for nasal dermoid cyst
A
Complete excision
Optimum age: 5-6 years
10
Q
Rare lesion
Composed of extradural glial tissue
A
- Nasal glioma: not connected to CNS
- Encephalocele: connected to CNS
Therapy: excision
11
Q
- Solid, noncompressible, nonpulsatile gray or purple mass
- Negative Furstenberg sign
- Noticed at, or shortly after birth
- 60% extranasal (along the nasomaxillary suture or near the midline)
- 30% intranasal
- 10% both components
A
Glioma
12
Q
- Associated with other midline fusion defects such as cleft lip or palate
- Extracranial herniation of meninges and brain (cranial degect is always present
- Bluish, compressible, pulsatile
- Positive Furstenberg sign
A
Encephaloceles
13
Q
Associated with genetic syndromes or may result from teratogenic influences
A
Uncommon nasal anomalies
14
Q
Is a frequent prodromal syndrome of measle, rubella and chickenpox
A
Rhinitis
15
Q
Is a frequent precursor to suppurative rhinitis
A
Viral rhinitis
16
Q
- An extensive and invasive infection of sebaceous glands or hair follicles with some involvement of subcutaneous tissues
- Caused by Staphylococcus aureus
A
Furuncle or boil
17
Q
Causative organism for nasal vestibulitis, a mild inflammation with recurrent crusting and pain
A
Staphylococcus aureus
18
Q
Bacterial infection secondary to a traumatic or surgical hematoma
Treatment: I and D with appropriate systemic antibiotic
Complications of delayed treatment: saddling of the nasal dorsum and columellar retraction
A
Septal abscess
19
Q
- Primarily associated with the use of vaginal tampoons during menstruation
- Also reported after nasal packing
- Caused by sStaphylococcus aureus
- Headache, lethargy, myalgia, nausea and vomiting, fever, hypotension, tachycardia, generalized erythema of the skin and mucous membranes, delayed desquamation of the epithelium of the hands
A
Toxic shock syndrome
20
Q
- Occur as a chronic granulomatous infection of the paranasal sinuses, nose, middle ear and external auditory canal
- Debilitated or immunosuppressed
- Green-brown discharge
A
Aspergillosis
21
Q
Treatment of Aspergillosis
A
Chronic, noninvasive: debridement and topical antifungal drugs
Acute, life-threatening: debridement and systemic antifungal drugs (amphotericin B)
22
Q
- Malignant, opportunistic infection
- Caused by Rhizopus oryzae
- Diabetic acidosis, debilitated or immunosuppressed
- Inhalation of the microorganism inoculates the nasal turbinates or ethmoid sinuses, where it spreads along the blood vessels to the retro-orbital areas and cerebrum
- Headache, fever, internal and external ophthalmoplegia, paranasal sinusitis, thick, dark bloody nasal discharge
- Black or brick-red nasal turbinate
A
Mucormycosis
23
Q
Treatment of Mucormycosis
A
- Immediate IV or even intrathecal administration of amphotericin B
- Debridement of necrotic tissue
24
Q
- Granulomatous disease of the nose
- Caused by Klebsiella rhinoscleromatis
- Involves the nose primarily but may later extend to involve any area of the upper respiratory regions, including larynx
- Begins with an early acute inflammatory reaction with a purulent, foul smelling rhinorrhea
- Followed by nasal crusting and slow growing, hard, insensitve nodules that may eventually obstruct the nose
- Lower nose and upper lip become prominent if left untreated, causing extensive disfigurement
A
Rhinoscleroma
25
Diagnostic finding of rhinoscleroma
Mikulicz cells and rod shaped,bacteria within the cytoplasm
26
1. Activity of the parasympathetic nerves cause engorgement of the vascular bed with resultant congestion and increase mucous production
1. Activity of the sympathetic nerves causes vasoconstriction with its resultant nasal patency and decreased mucous production
Vasomotor rhinitis
27
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Characterized by:
1. Soft tissue swelling
2. Excessive secretion
Long standing cases:
1. Hypertrophy of mucosa
2. Thickening of periosteum
3. New bone formation
Result from:
1. Repeated acute nasal infections
2. Recurrent attacks of suppurative sinusitis
3. Vasomotor states independent of local disease
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Chronic hypertrophic rhinitis
28
1. Form of hypertrophic rhinitis
| 2. Psychosomatic factors
Vasomotor rhinitis
29
1. Form of hypertrophic rhinitis
| 2. Overuse of topical nasal medication
Rhinitis medicamentosa
30
1. Includes elements of hypertrophic rhinitis
| 2. Associated with nasal polyposis
Chronic hyperplastic rhinitis
31
1. Disorder of altered nasal physiology
| 2. Related to environmental changes particularly dry inspired air
Rhinitis sicca
32
True atrophy of intranasal structures with secondary crusting
Atrophic rhinitis (ozena)
33
Chronic nasal symptoms from a variety of causes
Nasal "catarrh"
34
Consequences of prolonged use of topical decongestants
1. Rebound vasodilation (rhinitis medicamentosa)
| 2. Congestion
35
May cause nasal congestion
1. Antihypertensive drugs
| 2. Sympathetic blocking agents
36
Drugs implicated in vasomotor rhinitis
1. Rauwolfia serpentina
2. Alcohol
3. Tobacco
4. Hashish
37
Stimulate vascular congestion of the nasal membranes as well as engorgement in the uterus
Estrogen
38
Levels of estrogen rise, symptoms of nasal congestion usually begin during the 4th to 5th month and progress to term, paralleling the increased production of estrogen
Pregnancy
39
Another endocrine cause of nasal congestion
Hypothyroidism or myxedeme
40
Fear and dejection result in...
Shrinkage and pallor of the nasal mucosa
41
Anxiety, conflict, frustration and resentment result in...
Hyperemia, swelling and hypersecretion
42
1. Focal necrotizing, granulomatous lesion in the upper and/or lower respiratory tracts
2. Systemic vascular focal necrosis
3. Focal necrotizing glomerulitis
Wegener's granulomatosis
43
1. Long standing cold
2. Recurrent sinusitis
3. Epistaxis
4. Progressive nasal obstruction
5. COM
6. Hearing loss
Unresponsive to treatment
Wegener's granulomatosis
44
Treatment of Wegener's granulomatosis
1. Corticosteroid
| 2. Cyclophosphamide
45
1. Rare disease
2. Local inflammation and destruction of the tissues of the
midface
3. Symptoms and clinical findings are very similar with Wegener's granulomatosis
4. Biopsy: dense, midpxed lymphoid infiltration
Polymorphic reticulosis
46
1. Rare connective tissue disease
| 2. Episodic inflammation and subsequent destruction of the cartilaginous structures of the body
Relapsing polychondritis
47
1. Associated with pulmonary manifestations
2. Generalized granulomatous disorder primarily affecting young adults
3. Crusting and thickened mucosa on the inferior turbinate and septum
4. Biopsy: noncaseating granuloma
5. Other systemic signs: hypergammaglobulinemia, reduction of serum albumin
Sarcoidosis
48
1. Formation of vascular lesion around the lips, oral cavity and nose
2. Common presenting symptom: recurrent epistaxis (requires multiple transfusion)
Osler-Weber-Rendu syndrome (hereditary hemorrhagic telagiectasia)
49
1. Dye eyes
2. Dry mouth and nasopharynx
3. Chronic arthritis
Sjögren's syndrome
50
Keystone to proper treatment of nasal hemorrhage
Application of pressure to the bleeding vessel
51
90% of episode of anterior epistaxis are easily treated by firm, continuous pressure applied to both sides of the nose just superior to the nasal alar cartilages
With the patient sitting in an upright position (reduces the vascular pressure, patient can more easily expectorate any blood in the pharynx)
Nasal hemorrhage
52
Nasal blood supply: 2 major contributors
1. Internal carotid artery
| 2. External carotid artery
53
1. Derived from the internal carotid artery
2. Give rise to the anterior and posterior ethmoid vessels
3. They supply the superior portion of the nose
Ophthalmic artery
54
Brings blood to the lower half of the lateral nasal wall and the posterior part of the septum
Sphenopalatine artery
55
A vascular plexus along the anterior portion of the cartilaginous septum incorporates many of the anatomoses
Little's area or Kiesselbach's plexus
56
Nasal examination in patient with recurrent minor epistaxis
Prominent vessels traversing the anterior septum, with small amounts of clotted blood
57
Avoid cauterizing both sides of the septum
As cilia are destroyed and squamous epithelium overlying scar tissue replaces normal respiratory mucosa, stowage points in the flow of the mucous blanket develop
58
Posterior epistaxis is believed to exist when:
1. Majority of the blood loss is occurring into the pharynx
2. Anterior pack fails to control the hemorrhage
3. It is evident from nasal exam that the hemorrhage is posterior and superior
59
1. Dyskeratosis
2. Lesions: mucocutaneous junction in the anterior noses, esp. on the anterior caudal margin of the septum
3. Treatment: excision
Squamous papilloma
60
1. Most originate on the lateral nasal wall
2. Treated like premalignant tumor
3. May resemble a common nasal polyp but may contain areas of carcinoma
Inverted papilloma
61
Two reasons why inverted papilloma is treated like a premalignant tumor
1. Locally invasive, at times it involves extensive bone erosion, and if conservatively removed, shows a high incidence of local recurrence
2. Focal areas of squamous cell carcinoma are found within the papilloma in approx. 10% of the cases
62
Treatment of inverted papilloma
Wide surgical excision, with selected approach having the capability of further extension to provide wide exposure to the paranasal sinuses when required
Most often chosen route: lateral rhinotomy (starts with an incision in the nasal-alar fold and can be carried upward along the nasal-facial groove)
63
1. Is a primary tumor of lymphoid tissue
| 2. Solitary mass confined to soft tissues
Extramedullary plasmacytoma
64
1. Nonencapsulated fibro-osseous tumors involving the facial bones with frequent impingement on the paranasal sinuses of the nose
2. Slow-growing tumor
3. Rarely associated with pain and tends to appear around the time of puberty
4. Patient presenting for cosmetic reasons due to facial asymmetry
Fibrous dysplasia
65
1. Benign tumor
2. Originates in the nasal chambers near the sphenopalatine foramen
3. Diagnosis should be considered: young boy with a long history of epistaxis and nasal obstruction
Juvenile nasopharyngeal angiogibroma
66
Symptoms of nasal perforations
1. Nasal crusting
2. Whistling
3. Bleeding
67
1. Special type of foreign body usually observed in adults
| 2. Insoluble salts of the nasal secretions form a calcareous mass
Rhinoliths
68
Red thickening of the nasal tip with hypertrophy of the sebaceous glands associated with acne rosacea
Rhinophyma
