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ESA 4 > Head And Neck Week 8 > Flashcards

Head And Neck Week 8 Flashcards

1
Q

What are the functions of the nose and nasal cavity?

A

Filtration, warming and humidification of air
Olfaction
Drainage of secretions from paranasal sinuses and nasolacrimal ducts
Route for inspired air
Resonating chamber for speech

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2
Q

Describe the external nose

A

Root - nasal bones and frontal processes of maxilla
Bridge
Cartilage - tip/apex
Nares/nostrils

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3
Q

Why are the nasal bones susceptible to fracture in facial injuries?

A

Prominent

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4
Q

How would a fractured nose be managed?

A

Investigate possible head (e.g. Crista gali can pierce dura ) and spinal injuries
Check for septal haematoma
Symptomatic treatment
Wait for the swelling to go down for 5-7 days
Surgery

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5
Q

What are the boundaries of the nasal cavity?

A

Lateral - maxilla and inferior concha- turbinates
Medial - Nasal septum - cartilage, vomer and perpendicular plate of ethmoid bone
Roof - Sphenoid, ethmoid, frontal and nasal bones
Floor - hard palate (maxilla and palatine bones), soft palate

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6
Q

What should be checked for in any patient with a nasal injury and why?

A

Septal haematoma
Can cause avascular necrosis of the septal cartilage leading to saddling of nasal dorsum and/or infection - abscess formation which increases risk of avascular necrosis

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7
Q

Where does the cartilaginous part of the septum receive blood from?

A

Perichondrium

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8
Q

What causes septal haematoma ?

A

Trauma to the nose leads to buckling of the septum and shearing of the blood vessels
Blood accumulates between the perichondrium and the cartilage

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9
Q

How would you manage a septal haematoma?

A

Aspirate and pack the nose to push the layers together and try and give the cartilage its blood supply back

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10
Q

What are the functions of the turbinates/conchae?

A

Increase the surface area in contact with the air

Slow airflow

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11
Q

Where is the olfactory mucosa and what are its functions?

A

Posterior roof of nasal cavity

Olfaction

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12
Q

What kind of epithelium covers the majority of the nasal cavity and what are its functions?

A 
Respiratory mucous membrane
Pseudostratified columnar ciliated epithelium
Cilia and mucous - filter
Water secretions - humidify
Rich blood supply - warm
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13
Q

Where does the nasolacrimal duct drain into?

A

The inferior meatus of the nasal cavity

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14
Q

Where do the paranasal sinuses drain into?

A

Most drain into the middle meatus of the nasal cavity
Posterior ethmoidal drains into the superior meatus
Sphenoid drains into sphenoethmoidal recess

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15
Q

Which cranial nerve carries general sensation from the nasal cavity?

A

Trigeminal (V)

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16
Q

What are nasal polyps?

A

Fleshy, benign swellings arising from nasal mucosa
Usually affect both sides of the nasal cavity (bilateral)
Pale or yellow - or fleshy and reddened
Common
Typically >40 years

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17
Q

What are the symptoms of nasal polyps?

A

Blocked nose and watery rhinorrhoea
Post nasal drip
Decreased smell and reduced taste

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18
Q

What would be your initial thought if you saw a unilateral polyp with or without blood tinged secretions?

A

A tumour

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19
Q

How can you differentiate between a polyp and a turbinate?

A

Yellow or pale instead of pink
Mobile instead of immobile
Patient wont feel too much if they are prodded

20
Q

What is rhinitis?

A

Inflammation of the nasal mucosal lining

21
Q

What are the symptoms of rhinitis?

A 
Nasal congestion (blocked nose)
Rhinorrhoea (runny nose)
Sneezing
Nasal irritation
Postnasal drip
22
Q

What are the common causes of rhinitis?

A 
Simple acute infective rhinitis - common cold
Allergic rhinitis (hayfever)
23
Q

What would be your first though if you are presented with a young child who has unilateral nostril discharge that has become smelly or bloodstained?

A

Foreign body

24
Q

Why is the nose susceptible to epistaxis / bleeding?

A

Rich blood supply for the humidification and warming of air

25
Q

Which arteries supply the nasal cavity ?

A

Anterior and posterior ethmoid from the ophthalmic artery - branch of internal carotid artery
Sphenopalatine from the maxillary artery - branch of external carotid artery

26
Q

What is the most common source of bleeding in epistaxis?

A

Kiesselbachs area

27
Q

What is another source of bleeding in epistaxis (other than kiesselbachs area)?

A

Posterior - sphenopalatine artery (10%)

28
Q

What is Kiesselbachs area?

A

A point of arterial anastomoses in the anterior septum - susceptible to injury and bleeding

29
Q

What are the paranasal sinuses?

A

Air filled spaces that are extensions of the nasal cavity - rudimentary or absent at birth

30
Q

Describe the paranasal sinuses and their functions

A

Air filled spaces that are extensions of nasal cavity - Rudimentary or absent at birth
Lined with respiratory muscosa (thus are also ciliated and secrete mucous)
Named according to bone in which they are found: four ‘pairs’

Functions:
Help humidify and warm inspired air
Reduce weight of the skull
Increase resonance of voice

All drain into the nasal cavity via small channels called ostia
Most into middle meatus
Infections in nasal cavity can involve sinuses (sinusitis)– Maxillary sinus most commonly affected - outflow against gravity

31
Q

How should epistaxis be managed?

A

Pinch the nose just anterior to the bridge and lean forwards
If doesnt work send for cauterisation, packing with nasal tampons (ENT)
If doesnt work embolisation

32
Q

What are some important anatomical relations of the nasal cavity?

A 
Sinuses
Eustachian tube to middle ear
Orbit
Mouth
Pharynx 
Anterior cranial fossa
33
Q

What are some important anatomical relations of the paranasal sinuses?

A

Orbits
Anterior cranial fossa
Roots of teeth can project into maxillary sinus

34
Q

Why can ethmoidal sinusitis spread into the orbits?

A

Forms the thin medial wall of the orbit

35
Q

Why can dental infections or abscesses cause maxillary sinusitis ?

A

Roots of upper teeth can project into maxillary sinus

36
Q

What is acute sinusitis?

A

An acute inflammation of lining of sinus lasting (<4 weeks)

Commonly infective and often secondary to viral infection of nasal cavity - i.e. common cold

37
Q

What are the symptoms of sinusitis?

A
  • Non-resolving cold or flu-like illness
    – Pyrexia
    – Rhinorrhoea +/- green/ yellow discharge
    – Headache/ facial pain (in area of affected sinus) worse on leaning forward
    – Blocked nose
38
Q

What conditions can increase the risk of sinusitis?

A

Conditions which may block ostia of sinuses e.g. nasal polyps,
deviated septum increase risk of sinusitis
Dental infection (involving upper teeth) may also lead to sinusitis

39
Q

Why is the maxillary sinus the most common site of sinusitis?

A

The entrance is angled against gravity - the most difficult to drain

40
Q

What are the common pathogens implicated in sinusitis?

A

Strep or Haemophilus

41
Q

Describe the pathophysiological process behind sinusitis

A

Primary infection (e.g. rhinitis) leads to reduced ciliary function, oedema of nasal mucosa and sinus ostia and increased nasal secretions
Drainage from sinus is impeded
Stagnant secretions within the sinus become ideal breading ground for bacteria-secondary infection (Commonly Strep or Haemophilus)

42
Q

How is acute sinusitis managed?

A

Acute sinusitis is usually self-limiting (usually 1 week; sometimes up to 2-3 weeks)
Symptomatic treatment e.g.nasal decongestants, pain killers may be helpful
Antibiotics only given for severe or prolonged episodes

43
Q

Describe the innervation and arterial supply of the nasal cavity

A

Antero-superior portion (+ most of paranasal sinuses) supplied by
– Ophthalmic nerve (CN Va)
– [Ophthalmic artery (branches of)]

Postero-inferior portion (including maxillary sinus)
– Maxillary nerve (CN Vb)
– [Maxillary artery (branches of)]

44
Q

Why might someone get toothache if they have maxillary sinusitis?

A

Alveolar branch of maxillary nerve (V2) supplies both the maxillary sinus mucosa and the upper teeth
Roots sometimes project into maxillary sinus

45
Q

Describe the location, structures forming, and function of Waldeyers ring

A

The ring acts as a first line of defence against microbes that enters the body via the nasal and oral routes. Waldeyer’s ring consists of four tonsillar structures (namely, the pharyngeal, tubal, palatine and lingual tonsils) as well as small collections of lymphatic tissue disbursed throughout the mucosal lining of the pharynx (mucosa-associated lymphoid tissue, MALT)
At the opening to the respiratory and alimentary tracts

ESA 4 (28 decks)

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