Lecture 15 - Nasal Cavity And Paranasal Sinuses

Question 1

What are the functions of the nasal cavity?

Answer 1

Olfaction
Warm/humidify air
Filter particles/trap incoming particles
Route for incoming air
Resonating chamber for speech

Question 2

What is the medical term for the nostrils?

Answer 2

Nares

Question 3

What is the structure marking the end of the nasal cavity and start of nasopharynx?

Answer 3

Choanae

Question 4

What important structure related to the ear is located in the nasopharynx?

Answer 4

Eustachian tube

Question 5

What are the 3 main regions of the nasal cavity?

Answer 5

Vestibule
Respiratory region
Olfactory region

Question 6

What is the function of the vestibule region of the nasal cavity?

What cells does it contain?

Answer 6

Filters particles entering the nasal cavity

Stratified squamous epithelium

Question 7

What cells line the respiratory region of the nasal cavity?

Answer 7

Ciliated Pseudostratified epithelium

Goblet cells

Question 8

What is contained in the olfactory region of the nasal cavity?

Answer 8

Olfactory nerves penetrating through the cirbiform foramina through the cribiform plate

Question 9

Go to the last slide and label the regions of the nasal cavity:

Answer 9

1 = olfactory region
2 = respiratory region
3 = vestibule
4 = nasopharynx

Question 10

What bones form the roof of the nasal cavity?

Answer 10

Frontal bone
Ethmoid bone
Sphenoid bone
Nasal bone

Question 11

What bones form the floor of the nasal cavity?

Answer 11

Palatine bone
Maxillary bone

Question 12

Go to the last slide and label the bones of the nasal cavity:
Image 2

Answer 12

1 = nasal bone
2 = frontal sinus
3 = ethmoid bone
4 = sphenoid bone
5 = maxilla bone
6 = palatine Bone

Question 13

What bone forms the lateral wall of teh nasal cavity?

Answer 13

Ethmoid bone

Question 14

What are the structures that slow down air flow in the nasal cavity?

Answer 14

Concha

Question 15

What bone do the 3 concha come from?

Answer 15

Ethmoid bone

Question 16

What are the 3 concha of the ethmoid bone?

Answer 16

Superior concha
Middle concha
Inferior concha

Question 17

What are the functions of the concha?

Answer 17

Slow down air flow
Increase the surface area of the nasal cavity

Question 18

What are the structures that are associated with each concha called?

Answer 18

Meatuses

Question 19

What are the functions of the superior, middle and inferior meatus?

Answer 19

Drainage

They connect to paranasal air sinuses + nasolacrimal ducts

Question 20

Go to the last slide and label the image labelled 3:

Answer 20

1 = superior concha
2 = middle concha
3 = inferior concha

4 = superior meatus
5 = middle meatus
6 = inferior meatus

Question 21

What forms the medial wall of the nasal cavity?

Answer 21

Ethmoid bone -> septal cartilage (septal cartilage is continous with the ethmoid bone)
Vomer bone

Question 22

What causes a septal haemotoma?

Answer 22

Trauma to the cartilage leads to the perichondrium becoming sheared off

Avascular necrosis of the cartilage then occurs since the cartilage relies on the perichondrial layer for blood

Question 23

What deformity does a septal haemotoma lead to?

Answer 23

Saddle nose deformity

Question 24

How is a septal haemotoma treated?

Answer 24

Drain the blood to prevent development of infections/abcesses

Repack the cartilage and perichondrium back together

Question 25

What part of the nose made of septal cartilage gets affected in saddle deformity?

Answer 25

Dorsum (undergoes Avascular necrosis)

Question 26

How does a nasal bone fracture present? What are 2 rare complications?

Answer 26

Lots of swelling Epistaxis CSF leak Anosmia

Question 27

Why cannn a nasal bone fracture lead to anosmia?

Answer 27

The olfactory nerves travelling through the cribiform foramina can get sheared

Question 28

What are the advantages of the nasal cavity having a rich blood supply?

Answer 28

Allows for the humidifcation of air

Question 29

How many arteries supply the medial wall of the nasal cavity?

Answer 29

5

Question 30

What are the 5 arteries that supply blood to the medial wall of the nasal cavity?

Answer 30

Anterior ethmoidal artery Posterior ethmoidal artery Sphenopalatine artery Greater palatine artery Superior labial/septal artery

Question 31

What is the name given to the area where all 5 arteries anastomose in the nasal cavity?

Answer 31

Littles area

Question 32

Go to the last slide and label image 4 of all the arteries of the medial wall of the nasal cavity:

Answer 32

1 = anterior and posterior ethmoidal arteries 2 = sphenopalatine artery 3 = greater palatine artery 4 = superior labial artery 5 = littles area

Question 33

What is the most common area for epistaxis in the nasal cavity and why?

Answer 33

Littles area Where all 5 arteris supplying the medial nasal cavity wall anastomoses

Question 34

What artery is damaged in a posterior nose bleed? Why is it dangerous?

Answer 34

Sphenopalatine artery Blood can drip down throat and through both nostrils

Question 35

What are the 3 arteries that supply the lateral wall of the nasal cavity?

Answer 35

Anterior ethmoidal artery Posterior ethmoidal artery Sphenopalatine artery

Question 36

The anterior and posterior ethmoidal arteris branch from the ophthalmic arteries, What blood vessel is the ophthalmic artery a branch of?

Answer 36

Internal carotid artery

Question 37

The sphenopalatine artery and greater palatine arteries are branches of the maxillary arerty, What blood vessel is the maxillary artery a branch of?

Answer 37

External carotid artery

Question 38

What artery does the anterior and posterior ethmoidal arteries arise from?

Answer 38

Ophthalmic artery

Question 39

What artery do the Sphenopalatine and greater palatine artery branch from?

Answer 39

Maxillary artery

Question 40

What cranial nerve is responsible for sensation to the nose/nasal cavity?

Answer 40

Trigeminal nerve

Question 41

What branch of the Trigeminal nerve does the tip of the nose and anterior part of nasal cavity? What branch of the Trigeminal nerve does the posterior part of the nasal cavity?

Answer 41

Tip = ophthalmic division of Trigeminal Posterior nasal cavity = maxillary division of Trigeminal

Question 42

What are nasal polyps?

Answer 42

Benign swellings int he nasal mucosa

Question 43

How do nasal polys present?

Answer 43

>40yrs More male Normally bilateral Nasal congestion Rhinorrhea Hypo or anosmia Snoring Post nasal drip

Question 44

What is post nasal drip?

Answer 44

Rhinorrhea drip down from teh nasopharynx to oropharynx to the larynx which irritates the vocal cords

Question 45

What genetic condition are nasal polyps common in?

Answer 45

Cystic fibrosis

Question 46

What are red flags that suggest a nasal polyp may actually be nasal cancer?

Answer 46

Unilateral polyp Bloody discharge

Question 47

What is Rhinitis?

Answer 47

Inflammation of the nasal mucosa

Question 48

What are some symptoms of rhinitis?

Answer 48

Nasal congestion Rhinorrhea Sneezing Post nasal drip Nasal irritation

Question 49

How does the h treatment for infective rhinitis differ to allergic rhinitis?

Answer 49

Infective = conservative Allergic = Intra nasal antihistamines and maybe intranasal steroids

Question 50

What is the likely diagnosis for this child: Summers day 6yr old 1 week Hx runny nose Discharge from R nostril Last few days discharge smelly and blood stained Other wise well 1 = infective rhinitis 2 = nasal cancer 3 = foreign body 4 = allergic rhinitis 5 = nasal polyp

Answer 50

3. Foreign body 1 would be bilateral 2 is to young and symptoms are acute 4 the blood not common 5 is benign so would have blood

Question 51

What are paranasal air sinuses?

Answer 51

Air filled spaces that are extensions of the nasal cavity

Question 52

What cells line the paranasal air sinuses?

Answer 52

Respiratory mucosae Pseudostratified Ciliated epithelium Goblet cells

Question 53

What is a nasal cavity infection involving sinuses called?

Answer 53

Sinusitis

Question 54

What are the functions of the paranasal air sinuses?

Answer 54

Humidify and warm inspired air Reduce weight of skull

Question 55

What are the names of the small channels which drain the sinuses back into the nasal cavity through 1 of the meatuses?

Answer 55

Ostia

Question 56

What is the most commonly affected paranasal air sinus in sinusitis?

Answer 56

Maxillary sinus

Question 57

Why is the maxillary air sinus the most commonly affected in sinusitis?

Answer 57

It’s Ostia drain the highest meaning theres a longer distance for contents to drain through

Question 58

Go to the last slide and label the sinuses: Image 5

Answer 58

1 = frontal sinus 2 = ethmoid sinus 3 = nasal cavity 4 = maxillary sinus 5 = sphenoid sinus 6 = pharynx

Question 59

What is the main meatus through which most of the paranasal air sinuses drain through?

Answer 59

Middle meatus

Question 60

What paranasal air sinuses does the middle meatus drain into the nasal cavity?

Answer 60

Frontal sinus Maxillary sinus Anterior and middle ethmoid sinus

Question 61

What does the inferior meatus drain into the nasal cavity/

Answer 61

NASOLACRIMAL duct

Question 62

What does the roof of the nasal cavity drain

Answer 62

Sphenoid sinus

Question 63

What nerve supplies sensation to the frontal, ethmoidal and sphenoid sinus?

Answer 63

Ophthalmic division of the Trigeminal nerve

Question 64

What nerve supplies sensation to the maxillary sinus?

Answer 64

Maxillary division of the Trigeminal nerve

Question 65

Go to the last slide and label the paranasal air sinuses on image 6:

Answer 65

1 = frontal sinus 2 = orbit 3 = maxillary sinus 4 = frontal sinus 5 = sphenoid sinus

Question 66

Go to the last slide and label image 7:

Answer 66

1 = middle and inferior meatus 2 = middle and inferior conchae 3 = maxillary air sinus

Question 67

What is acute sinusitis?

Answer 67

Where a viral upper respiratory tract infection spreads to the sinuses Resolves in less than 12wks

Question 68

What is the pathophysiology of acute sinusitis?

Answer 68

Inflammation of resp mucosa causes swelling reduced cilia movement of mucus and increased mucus production Ostia get blocked Fluid builds up in sinus Secondary bacterial infection can occur

Question 69

Why aren’t Abx usually given with acute sinusitis?

Answer 69

Mostly caused by virus Only a small amount of people develop secondary bacterial sinusitis

Question 70

How does a patient usually present who has acute sinusitis?

Answer 70

Recent URTI Blocked nose and Rhinorrhea with green/yellow discharge Pyrexia Headache /facial pain in affectd area Facial pain gets worse leaning forward

Question 71

How does acute bacterial sinusitis present?

Answer 71

Symptoms for over 10days of acute sinusitis without improvement Discoloured/purulent nasal discharge Fever >38 Severe local pain Symptoms that worsen after initial improvement

Question 72

What are some causative organisms for acute bacterial sinusitis?

Answer 72

HSM (High School Musical) Streptococcus pneumonia Haemophilus influenzae Moraxella catarrhalis Organisms that can cause pneumonia

Question 73

How do you manage someone with a massive nosebleed?

Answer 73

Clamp the tip of the nose Cauterise the blood vessels Put head forwards to prevent swallowing Nasal tampons

Question 74

What signs are often seen in a patient with a base of skull fracture like the ethmoid bone?

Answer 74

Periorbital ecchymosis Halo sign

Question 75

What is the halo sign seen in base of skull fractures?

Answer 75

When there’s Rhinorrhea containing both blood and CSF

Question 76

What nerve moves the soft palate?

Answer 76

Vagus nerve

Question 77

What nerves are important in the gag reflex?

Answer 77

Glossopharyngeal Vagus