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FM 1030 > L1 --> Nasal cavity + paranasal sinuses > Flashcards

L1 --> Nasal cavity + paranasal sinuses Flashcards

1
Q

What makes up the external nose

A

Made of bones, cartilage and fibro-fatty tissue
- Cartilage: Nasal cartilages (including the septal cartilage + Major alar cartilage + Minor alar cartilage + lateral cartilage) – They’re hyaline cartilages and thus are flexible

  • Bones:
    –> Nasal bones
    –> frontal process of the maxilla
  • Fibro-fatty tissue
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2
Q

What divides the nasal cavities from each other? what is it made of?

A

The Nasal septum (medial wall)
It is made of:
- Septal cartilage (anteriorly)
- Perpendicular plate of the ethmoid bone
- Vomer bone

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3
Q

What is the dilated space internal to the nares called?

A

The nasal vestibule

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4
Q

What are the openings of the nasal cavity?

A

The Nares/Nostrils:
–>Opens into exterior

The choanae:
–> Opens into the interior - into the nasopharynx

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5
Q

What can deviation of the nasal septum lead to? How is it caused? How can it be corrected?

A
  • Deflection/deviation of the nasal septum to one side is a common injury
  • Can result from trauma to the nose
  • If severe can obstruct the nasal cavity on one side and result in its occlusion
  • Can be fixed thru surgery
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6
Q

What separates the nasal cavities from the following:
- From each other
- From the oral cavity
- From the cranial cavity and the sphenoidal sinus

A
  • From each other:
    Nasal septum
  • From the oral cavity:
    The hard palate ( maxilla and its palatine process and the palatine bone and its horizontal process)
  • From the cranial cavity and the sphenoidal sinus:
    Nasal spine of the frontal bone
    Cribriform plate of the ethmoid bone
    Sphenoid bone (contains the sphenoid sinus)
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7
Q

What forms the roof of the nasal cavity?

A

(NFC’S)
Nasal bone
Frontal bone (nasal spine)
Cribriform plate of the ethmoid bone
Sphenoid bone

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8
Q

What forms the floor of the nasal cavity?

A

The hard palate:
–> The maxilla and its palatine process
–> The palatine bone and its horizontal process

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9
Q

What forms the Lateral wall of the nasal cavity?

A

Lateral wall: (L-IME PLS)
- Inferior Concha
- Maxilla (frontal processs)
- Ethmoid bone (superior and middle conchae)
- Palatine (The perpendicular plate)
- Lacrimal
- Sphenoid bone (has 2 plates parallel to each other - a lateral and medial pterygoid plate –> the medial pterygoid plate forms the lateral wall)

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10
Q

What are the 3 curve shaped bones on the lat. wall called?
What are they and what’s their function?

A

Conchae:
Superior Concha (Ethmoid bone)
Middle Concha (Ethmoid bone)
Inferior Concha (It’s own bone)

Function:
–> Increase the surface area of the mucosae ( create turbulence of air flowing in and out - causes and increase in the temp of air, inc. trapping of dust particles and humidifies the air)
–> Also divide the nasal cavity into 4 air channels/spaces

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11
Q

What is the space under a concha called

A

A meatus

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12
Q

What are the 4 air channels the concha divide the nasal cavity into?

A
  • Sphenoethmoid recess
  • Superior meatus
  • Middle meatus
  • Inferior meatus
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13
Q

What is a sinus? How many paranasal sinuses are there? Name them and the bones their located in

A

Spaces or cavities within a bone. Paranasal sinuses surround the nose - they’re outgrowths of the nasal cavity and lead back into the nasal cavity.
Lined by mucosa (same as nasal cavity)

There are 4 paranasal sinuses:
- Frontal sinus (Frontal bone)
- Ethmoidal air cells (In ethmoid bone - together form a sinus)
- Maxillary sinus (Maxilla - Largest paranasal sinus)
- Sphenoid sinus ( Sphenoid bone)

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14
Q

Which sinus is the pituitary gland associated with? and what is its clinical importance?

A

The sphenoidal sinus
Located on the roof of the sinus

The plate of bone on the roof of the sphenoid sinus associated with the boundary of the pituitary gland is relatively narrow
Surgeons can thus access this gland by going thru these narrow plates of bone on the walls of the sphenoidal sinus.

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15
Q

Where do the sinuses drain into (where are there openings)?

A

Spheno-ethmoidal recess:
- Sphenoidal sinus

Superior meatus:
- Posterior ethmoidal sinus

Ethmoidal bulla of the middle meatus:
- Middle ethmoidal sinus

Middle meatus:
- Anterior ethmoidal sinus, frontal sinus, maxillary sinus

Inferior meatus:
- Nasolacrimal duct

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15
Q

What does the nasolacrimal duct open into? What is its significance?

A

Opens into the inferior meatus
Excess tears when crying drain into the inferior meatus thru the nasolacrimal duct and cause sniffling of the nose.

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16
Q

Which is the most commonly infected sinus and why?

A
  • The maxillary sinus
  • This is due to the positioning of the sinus’ openings – They’re located well above the floor of the sinus making it harder for natural drainage (as it’s against gravity)
  • The head may thus have to be tilted to the side to facilitate drainage
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17
Q

What are the sinuses lined with?

A

Lined with a mucous membrane that secretes a fluid to keep the lining moist.

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18
Q

Function of the sinuses?

A
  • Make the head lighter
  • Humidifying and heating inhaled air
  • Increasing the resonance of speech (someone with sinusitis will have a lower resonance of voice due to the spaces being filled with fluid)
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19
Q

What is sinusitis - explain the mechanism of disease

A
  • Inflammation of the sinuses due to a viral or bacterial infection
  • Is a common complication of a nasal infection
  • Irritation of the nasal mucosa causes closure of the drainage pores (due to swelling)
    –> This prevents mucous from draining out of sinuses
    –> Leads to accumulation of fluid in the sinuses
    –> Causes build up of pressure
    –> Leads to headaches

SINUS MEDICATION: Reduces swelling within the sinus - allows for drainage pores to be accessible again - so mucous can drain

20
Q

What locations are pressed when examining for tenderness in the different sinuses in someone with sinusitis?

A

Frontal sinus —> Upward beneath the medial end of the superior orbital margin
Ethmoid sinus —> medially against the medial end of the orbit
Maxillary sinus —> anterior wall of the maxilla below the inferior orbital margin
Sphenoid sinus —> not palpable

21
Q

What is the clinical relevance of the close proximity of the frontal and maxillary sinuses?

A

Since both the maxillary and the frontal sinus drain into the middle meatus, an infection in the frontal sinus could lead to fluid in this sinus draining into the maxillary sinus due to gravity.

22
Q

Infection of which sinus can lead to blindness? and how?

A

The ethmoidal sinus
Since it’s located on medial end of the orbit - infection in this sinus may invade the thin wall of bone forming the medial end of the orbit.
This could result in the infection spreading to the optic nerve causing blindness.

23
Q

Rhinitis

A

Rhinitis is an inflammation of the nasal cavity usually caused due to an allergic reaction or possibly hay fever (allergic reaction to pollen)
–> Diff to sinusitis in that it usually doesnt last for as long and is not due to an infection

24
Q

Where else can infection of nasal cavity (rhinitis) spread to?

A
  • Anterior cranial fossa via the cribriform plate thru the olfactory nerve sheath and cause meningitis
  • Can spread to the nasopharynx via the choanae
  • Middle ear infection via the auditory tube
  • Paranasal sinuses
  • Conjunctiva via nasolacrimal duct
25
Q

which sinus is located on the medial wall of the orbit? and what is its clincal relevance?

A

The ethmoid air cells
– could result in blindness if infection in this sinus spreads to the optic n.

26
Q

What are the nerves supplying the nasal cavity? And what are they responsible for/ what do they supply?

A

3 Cranial nerves:
1) Olfactory nerve (CN I)
– Innervate the roof of the nasal cavity and are responsible for smell sensation via the cribriform plate.

2) Trigeminal nerve (CN V)::
– Antero-superiorly = ophthalmic division (CN V1)
– Postero-inferiorly = maxillary division (CN V2)
– responsible for general sensation ( both the divisions are purely sensory)

3) Parasympathetic nerve fibres (of the facial nerve)
– supplies any secretory gland of the nasal cavity
– Preganglionic parasympathetic fibres of the facial nerve synapse at the pterygopalatine fossa
– The postganglionic fibres then run along with the maxillary nerve to reach the nasal glands.

27
Q

What nerve is responsible for detecting smell? Describe the pathway of this nerve

A

The olfactory nerve (CN I)

  • The olfactory epithelium is located at the roof of the nasal cavity.
  • There are olfactory receptors present here that detect smell and this area is innervated by the olfactory nerve
  • The axons of this nerve pass thru the multiple openings in the cribriform plate (of the ethmoid bone)
  • The axons meet at a widened area known as the olfactory bulb
  • The olfactory bulb then narrows to become the olfactory tract
  • The olfactory nerve cells (neurons) traveling thru this tract then go to the smell centre in the brain
28
Q

What is the role of the trigeminal nerve? how many divisions? what are they? Which ones innervate the nasal cavity and what areas?

A

Trigeminal nerve (CN V):
- Responsible for general sensation
—> Example: the sneeze reflex

It has 3 divisions:
- Ophthalmic division -V1 (sensory)
- Maxillary division - V2 (sensory)
- Mandibular division - V3 (sensory + motor)

Innervate the nasal cavity:
- V1 – Ophthalmic division –> antero-superiorly
- V2 – Maxillary division –> postero-inferiorly

29
Q

What do the parasympathetic nerves innervate? Describe the pathway of these nerves.

A

They innervate any SECRETORY glands of the nasal cavity

Pathway:
- Parasympathetic nerves in the facial nerve leaving the brainstem (preganglionic neurons)
- Go to the the pterygopalatine ganglion located in the pterygopalatine fossa
- Synapse with the postganglionic neurons at the ganglion
- The postganglionic neurons reach their destination by rejoining branches of the maxillary nerve.

30
Q

What is the medical term for a nose bleed

A

Epistaxis

31
Q

Which artery do the arteries supplying the nasal cavities branch off from?

A

They are all branches of the external and internal carotid arteries (terminal branches of the common carotid A.)
ECA –> Maxillary + Facial A.
ICA –> Ophthalmic A.

32
Q

What arteries supply the nasal cavity? what A. do they branch from? And what are their common branches?

A

Ethmoidal branches of the ophthalmic A. (ICA)
- Anterior + Posterior ethmoidal branches

Maxillary A. (ECA)
- Sphenopalatine A.
- Greater palatine A.

Facial A. (ECA)
- lateral nasal A.
- Superior labial A.

33
Q

What is the largest artery supplying the nasal cavity?

A

Sphenopalatine A.
– branch of the maxillary artery
– passes thru the sphenopalatine foramen in the superior nasal meatus

34
Q

Where does the The greater palatine A. pass thru in the nasal cavity?

A

the incisive canal

35
Q

What are the common sites for nosebleeds?
Which is the most common one? why?

A

Nose bleeds are common due to the rich blood supply of the nasal cavity
SITES:
1) Little’s area/ Kiesselbach plexus:
—> Most common area
—> Located at the anastomosis formed at the antero-inferior part of the nasal septum

2) Vestibule of the nose
– It’s the area that’s often traumatised when one puts their finger in their nose.

36
Q

Where is the little’s area? whats another name

A

At the anastomosis at the antero-inferior part of the nasal septum
Kiesselbach’s plexus/area

36
Q

What opening is located in the superior nasal meatus? what passes thru it?

A

The Sphenopalatine foramen
—> formed by the spenoid and palatine bones

Structures passing thru:
– Sphenopalatine A. (branch of the maxillary A.)
– Branches of the maxillary nerve (V2 - of trigeminal nerve CN V) pass thru here

37
Q

What structures pass thru the openings in the cribriform plate?

A

Cribriform plate - in ethmoidal bone
– The axons of the olfactory nerves

38
Q

Where is the incisive canal? What passes thru it?

A

Located in the floor of the nasal cavity and opens into the oral cavity – behind the incisors

Structures that pass thru:
- The greater palatine A.
- Branches of the maxillary nerve (V2)

39
Q

What passes thru the small foramina in the lateral wall?

A

branches of the maxillary nerve - V2

40
Q

Name the gateways for the nerves and vessels in the nasal cavity

A
  • Cribriform plate –> olfactory n.
  • Sphenopalatine foramen (in sphenoid and palatine bones) –> sphenopalatine A. + maxillary n. - V2
  • Incisive canal (hard palate - palatine process of maxilla) –> greater palatine A. + branches of V2
  • Small foramina in the lateral wall –> Branches of V2 nerve
41
Q

Referred pain

A

Maxillary sinusitis – via infra-orbital and alveolar branches of the maxillary nerve –> pain to the upper jaw and teeth

Frontal sinusitis – via supra-orbital branch of opthalmic nerve –> pain to area of forehead and scalp

42
Q
A

Lacrimal bone

43
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A
44
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A
45
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46
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A
47
Q

What regions is the nasal cavity divided into?

A

Olfactory area superiorly (containing the olfactory receptors)
Respiratory area (rest of the nasal cavity)
Nasal vestibule/nares – opening of nasal cavity to the exterior.

FM 1030 (18 decks)

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