Disease of the nose and paranasal sinuses Flashcards
Allergic rhinitis PE findings
• Pale, boggy, hypertrophic turbinates w/ whitish or clear discharge
• ≤ septal deviation
• Cobblestoning posteriorto pharyngeal wall
• Wheezing, if w/ asthma
Allergic rhinitis complications
• Asthma
• Otitis media
• Rhinosinusitis
• Tonsillopharyngitis
• Laryngitis
• Bronchitis
• Conjunctivitis
Cancer of the nasal cavity common site is
- Lateral wall—50%
- Septum
- Vestibule
- Turbinate
May present as a unilateral persistent and progressive nasal obstruction (depends on tumor size) and foul smelling nasal discharge (from necrosis) and it is usually right sided
Cancer of the nasal cavity
May present as a unilateral persistent and progressive nasal obstruction (depends on tumor size) and foul smelling nasal discharge (from necrosis) and it is usually right sided
Cancer of the nasal cavity
Level ll: upper internal jugular (deep cervical) chain parts
• superiorly: base of the skull at the jugular fossa
• inferiorly: inferior border of the hyoid bone
• anteriorly: posterior border of the submandibular gland
• posterolaterally: posterior border of the sternocleidomastoid muscle
• medially: medial border of the internal carotid artery
Cancer of the paranasal sinus incidence
• 0.2% of all cancers of the body
• 3% of cancers of the URT
• More common in males with ratio of 2:1
• 80% affect the maxillary sinuses, 25% or more the ethmoids, the rest are rare 95% occurs over 40 years of age ~80% are squamous cell carcinoma
Chronic sinusitis leading to metaplasia of the normal respiratory epithelium can cause
Cancer of the paranasal sinus
Maxillary sinus tumours clinical parameters (Dental)
- Loosening of teeth
- Pain in the premolar or molar teeth
- Swelling of palate or alveolar ridge (late sign)
Maxillary sinus tumours clinical parameters (Nasal)
- Unilateral nasal obstruction and discharge
- Nasal mass – occasionally only a bulge on the lateral wall
Maxillary sinus tumours clinical parameters (Nasal)
- Unilateral nasal obstruction and discharge
- Nasal mass – occasionally only a bulge on the lateral wall
Maxillary sinus tumours clinical parameters (Face)
- Bulging of the cheek (usually a late sign)
- Numbness and paresthesia esp. of the area supplied by the infraorbital nerve
- Involvement of skin
For late stage maxillary sinus treatment
Orbital exenteration
Juvenile Nasopharyngeal Angiofibroma (Histopathology)
Grossly pedunculated tumor, smooth seemingly wellencapsulated bluish or pinkish in color
Sign and Symptoms are due to vascularity of the tumor, mechanical obstruction and pressure necrosis
• Frequent and profuse epistaxis
• Nasal obstruction
• Middle ear effusion
• Conductive deafness
• Proptosis and bulging of cheek
An imaginary line drawn from the inner canthus to the angle of the mandible for tumor prognosis
Ongren’s line
-Tumor below the line 71%
-Superior to this line 25%
An imaginary line drawn from the inner canthus to the angle of the mandible for tumor prognosis
Ongren’s line
-Tumor below the line 71%
-Superior to this line 25%
Means there’s no cancer, only abnormal cells with the potential to become cancer
Stage 0
Means the cancer is small and only in one area
Stage I
Mean the cancer is larger and has grown into nearby tissues or lymph nodes
Stage II and III
Means the cancer has spread to other parts of your body
Stage IV
Patterns of Tumor Spread
• Anteriorly -cheek and skin
• Posteriorly - pterygomaxillary fossa, pterygoid plates, nasopharynx, sphenoid sinus, base of skull
• Medially - nasal cavity
• Superiorly -orbits, ethmoid sinuses
• Inferiorly - palate, bucal sulcus
• Intracranial - ethmoid and cribriform plates
• Lymphatic - submandibular, upper jugular, retropharyngeal nodes
• Systemic - lungs occasionally
Tumor classification and staging (T1)
tumour limited to maxillary sinus mucosa with no erosion.
Tumor classification and staging (T1)
tumour limited to maxillary sinus mucosa with no erosion.
Tumor classification and staging (T2)
bony erosion, extension into hard palate, nasal meatus, except the posterior wall
Tumor classification and staging (T2)
bony erosion, extension into hard palate, nasal meatus, except the posterior wall
Tumor classification and staging (T3)
invading posterior wall, subcutaneous tissue, floor/ medial wall of orbit, pterygoid fossa, ethmoid sinus
ant.orbit, skin of cheek, pterygoid plates, cribriform plates, sphenoid, frontal sinus
T4
ant.orbit, skin of cheek, pterygoid plates, cribriform plates, sphenoid, frontal sinus
T4
orbital apex, dura, brain, middle cranial fossa, nasopharynx, cranial nerves other than maxillary division of Trigeminal (V2)
T4b
metastasis in single ipsilateral lymph nodes
N1
metastasis in single ipsilateral lymph nodes
N1
multiple ipsilateral nodes <6cms
N2b
Epistaxis (Acute nasal trauma)
- With or without Nasal Bone Fractures
- after Nasal / Sinus Surgeries
- after nasal intubations
Epistaxis (Chronic Nasal Trauma)
- Habitual nose rubbing & picking
- Foreign bodies
- Topical steroid nasal sprays
- Substance abuse
Epistaxis (Chronic Nasal Trauma)
- Habitual nose rubbing & picking
- Foreign bodies
- Topical steroid nasal sprays
- Substance abuse
Trotter’s method
make patient sit up, pinch the nose for 5-10 mins.
Anterior Nasal Packing
- using vaselinized or antibiotic ointment soaked
- using formed expandable sponges
Posterior Nasal Packing
- using foley catheter for the posterior nasal pack and antibiotic soaked gauze for the anterior pack
- using preformed double balloon catheter
Hemangioma
- Capillary haemangioma
- Bleeding polypus of the septum
- Soft, dark red , pedunculated or sessile mass arising from anterior aspect of septum.
- Epistaxis
- Excision
- Cavernous hemangioma-tubinates /lat nasal wall
Hemangioma
- Capillary haemangioma
- Bleeding polypus of the septum
- Soft, dark red , pedunculated or sessile mass arising from anterior aspect of septum.
- Epistaxis
- Excision
- Cavernous hemangioma-tubinates /lat nasal wall
Osteoma
- Most common in frontal sinus
- Usually asymptomatic
- Can obstruct ostium of frontal sinus and cause mucocele
- If symptomatic - excision
Fibrous Dysplasia
• Bone replaced by fibrous tissue
• Maxillary sinus -MC site
• Proptosis, nasal obstruction, facial disfigurement
• Surgical excision
Fibrous Dysplasia
• Bone replaced by fibrous tissue
• Maxillary sinus -MC site
• Proptosis, nasal obstruction, facial disfigurement
• Surgical excision
Sign and symptoms of Deviated Nasal Septum
- Difficulty of breathing thru the nosetrils
- Headache
- Facial pain
- Nasal congestion
- Snoring → sleep apnea
