H&N 8.1- the nose and paranasal sinus'

Question 1

What are the main functions of the nose and nasal cavity?

Answer 1

• sense of smell
• route for air to get from the atmosphere into the lungs
• warms and humidifies inspired air
• filters inspired air (nasal hair and mucus)
• resonating chamber for speech

Question 2

Why does your mouth get dry when you breath through your mouth?

Answer 2

It is not designed to warm and moisten the air like the nose is, so the air dries the mouth out.

Question 3

What different structures are found in the nasal area?

Answer 3

• external nose
• nasal cavity
• nasopharynx

Question 4

What is the external nose made of?

Answer 4

cartilage and bone

Question 5

What are the features of the external nose?

Answer 5

• the root (the bony part of the nose between the eyes)
• the bridge (the point at which the bone becomes cartilage)
• the tip/apex.
• the nares/nostrils

Question 6

What bones contribute to the external nose?

Answer 6

• nasal bone

- frontal part of maxilla

Question 7

Why are broken noses common?

Answer 7

The external nose is prominent so susceptible to trauma

Question 8

How do you treat a broken nose?

Answer 8

• sometimes just left to heal on their own

- if there a deviated midline then surgery may be required to reallign the nose (only after swelling has gone down)

Question 9

If someone has a broken nose, what must you bear in mind?

Answer 9

They will have experienced trauma, so there is also the risk of head injuries and neck injuries which need to be considered.

Question 10

How can you further divide the nasal cavity?

Answer 10

• Vestibule- Just surrounding the external opening to the nasal cavity
• respiratory region- where the air travels, it is lined with pseudostratified clilliated mucosa which has goblet cells.
• olfactory region- located at apex, contains the olfactory receptors

Question 11

What are the boundaries of the nasal cavity?

Answer 11

• superior- ethmoid bone (cribriform plate, crista galli), frontal bone, nasal bone, sphenoid bone
• lateral- maxilla and conchae
• medial- nasal septum
• floor- hard palate and soft palate

Question 12

What is the nasal septum made from?

Answer 12

• the perpendicular plate of the cribriform plate
• vomer
• septal cartilage.

Question 13

What makes up the hard palate?

Answer 13

-the palatine bones and the palatine process’ of the maxilla.

Question 14

What lies immediately superior to the nasal cavity?

What is the significance of this?

Answer 14

The anterior cranial fossa, which is attached to the crista galli via the falx cerebri,

Trauma to the nose can cause tearing of the falx cerebri, resulting in cerebral rhinorrhoea.

This could later result in an increased risk for meningitis/brain abcess.

Question 15

What is a septal haematoma?

Answer 15

Can result after trauma to the nose, where there is a build up of blood between the perichondrium and cartilage.

Question 16

What symptoms would someone with haematoma present with?

Answer 16

feelings of a blocked nose
painful swelling
congestion
change in the shape of the nose

Question 17

What complications can arise from a septal haematoma and why do these develop?

Answer 17

Saddle-nose deformity.

The cartilage normally get’s its blood supply from the overlying perichondrium, so when this is stripped away the cartilage undergoes avascular necrosis, and the septum can loose it’s shape resulting in a concave appearance.

infection within the heamatoma due to stasis.

Question 18

How would you treat a septal haematoma?

Answer 18

drain the blood from it and pack the nose, to push the 2 layers (perichondrium and cartilage) back together, to stop blood from building up between them again and to return blood supply to the cartilage.

Question 19

What are conchae and what is their function?

Answer 19

bony projections on the lateral walls of the nasal cavity.

They act to increase surface area, to air with warming and humidifying inspired air and slowing the flow.

Question 20

What is found beneath each conchae?

Answer 20

a corresponding meatus (here are where drainage from the paranasal sinus’ and the nasolacrimal duct occurs)

Question 21

What is the spheno-ethmoidal recess?

Answer 21

The area above the superior concha, therefore it is not a meatus.

The sphenoid sinus drains here.

Question 22

What appearance does the nasal mucosa have?

Answer 22

Very pink

you see this when looking up the nose, before the nasal mucosa you’ll see skin coloured epithelia and hairs.

Question 23

What membranes are found within the nasal cavity?

Answer 23

• olfactory mucus membrane (allow us to smell)

- respiratory mucus membrane (allow air to slow, warm and become humidified)

Question 24

what nerve innervates the sensation of the nasal cavity?

Answer 24

The trigeminal nerve

superior anterior-opthalmic branch
(inferior posterior- maxillary branch)

Question 25

What is a nasal polyp?

Answer 25

A benign fleshy swelling found within the nose which come from nasal mucosa. - often bilateral - often occur in people >40 - pale/yellow in appearance or fleshy and redenned.

Question 26

What symptoms might someone with a polyp complain of?

Answer 26

- a blocked nose - decreased smell and reduced taste - post-nasal drip (causing a tickly cough) - rhinorrhoea (runny nose)

Question 27

When might you be concerned about a polyp?

Answer 27

When it's unilateral / blood tinged/ in young people.

Question 28

How could you determine between a concha or a polyp?

Answer 28

- a polyp will be paler in colour, mobile, and not hurt when touched. - a concha will be pinker, be immobile and if poked will hurt.

Question 29

What is rhinitis?

Answer 29

inflammation of the mucosal lining.

Question 30

What is the most common cause of rhinitis?

Answer 30

actute infective rhinitis (the common cold, viral) Could also be allergic rhinitis.

Question 31

What symptoms do you get with rhinitis and why?

Answer 31

- rhinorrhoea (inflammed mucosa produces more secretions) - tickly coigh (these secretions trickle down the back of the throat) - sneezing - blocked nose (inflammed mucosa, especially over concha which already stick out, impeed airflow)

Question 32

Other than rhinitis, what other causes could lead to a runny nose?

Answer 32

- polyp - forreign body - cancer of the nose

Question 33

What is the medical term for a nose bleed?

Answer 33

epistaxis

Question 34

From what arteries does the blood supply from the nose come from?

Answer 34

- opthalmic artery (From ICA) | - Maxillary artery (from ECA)

Question 35

What is the rich anastomes area better known as? | What's the significance of this area?

Answer 35

Kiesselbachs area/Littles area. it's a common site of epistaxis.

Question 36

What 5 arterial branches supply the nose?

Answer 36

- Anterior ethmoid - posterior ethmoid - sphenopallatine - Greater pallatine - superior labial

Question 37

What should you do in a simple case of epistaxis and why?

Answer 37

-pinch the bridge of hte nose, this is proximal to kiesselbachs area, so will reduce blood flow to there, reducing the bleeding of the nose. (which often comes from this area)

Question 38

What are the names of the paranasal sinus'?

Answer 38

- frontal sinus - ethmoid sinus - sphenoid sinus - maxillary sinus

Question 39

What is the function of the paranasal sinus?

Answer 39

To help to humidify and warm inspired air (lined by respiratory mucosa) To reduce the weight of the skull

Question 40

Where do the paranasal sinus' drain?

Answer 40

``` frontal sinus'- middle meatus sphenoid sinus- sphenoidethmoidal recess ethmoid- anterior-superior meatus -middle- superior meatus - posteior- middle meatus Maxillary sinus-middle meatus ```

Question 41

What drains into the inferior meatus?

Answer 41

The naso-lacrimal duct

Question 42

What are the important clinical relations of the paranasal sinus?

Answer 42

ethmoid air cells- orbit frontal sinus- anterior cranial fossa maxillary sinus can somtimes communicate to the roots of the upper teeth

Question 43

What is sinusitis? What are it's causes?

Answer 43

acute Inflammation of the paranasal sinus' (mostly infective and mostly due to secondary viral infection) The inflammation of the mucosa reduce cilliary function, and make drainage of the sinus' impaired. this promotes infection. Could be due to blockage of the ostia- eg a polyp, deviated septum.

Question 44

What symptoms does sinusitis cause?

Answer 44

Painful sinus' and headaches which intensify upon leaning forward pyrexia blocked nose rhinorrhoea (May have purulent discharge) non resolving cold

Question 45

Which sinus is most commonly affected in sinusitis and why?

Answer 45

Maxillary sinus, it's drainage is quite superior so often collections of fluid can gather at the bottom of the sinus, which promotes infection

Question 46

What is the treatment for sinusitis?

Answer 46

Often it is self limiting so you may advise to give decongestants or pain releif but wont give specific medications (only supportive) If chronic (>4 weeks) or severe will prescribe antibiotics.

Question 47

What are some common bacterial causes of sinusitis?

Answer 47

streptococci | Haemophillus.

Question 48

What is the neural innervation of the paranasal sinus?

Answer 48

All innervated by the opthalmic nerve, except the maxillary sinus' which are innervated by the maxillary nerve.

Question 49

What is the clinical significance of the spenoid sinus?

Answer 49

It can be used to access the pituitary gland during surgery. insertion of surgical tools up the nasal cavity, through the nasal roof and the sphenoid sinus to the pituitary gland.

Question 50

Why might sinusitis result in toothache?

Answer 50

The maxillary sinus is most commonly affected, and is supplied by the maxillary nerve, which also innervates the maxillary teeth. Therefore, pain can be percieved as coming from the teeth.

Question 51

Where does the auditory tube open into?

Answer 51

The nasopharynx at the level of the inferior meatus.

Question 52

What is the venous drainage of the nose?

Answer 52

Facial vein, pterygoid plexus or cavernous sinus.

Question 53

What are some causes of epistaxis?

Answer 53

local- such as trauma systemic-such as hypertension,