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ENT > Lesson 2 > Flashcards

Lesson 2 Flashcards

1
Q

Parts of the nose.

A

External nose
Nasal cavity
Nasal vestibule

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2
Q

Parts of the external nose.

A 
- Shape: triangular pyramid
Part
1. Root
2. Base
3. 2 nostrils
4. Median septum
5. Apex
6. Dorsum
7. Bridge
8. Ala nasi
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3
Q

Bones and cartilages of the external nose.

A

Osseous

  1. Nasal bone (Bridge)
  2. Frontal bone
  3. Frontal process of maxilla

Cartilaginous

  1. Paired
    a. Upper lateral / triangular
    b. Lower lateral / greater alar
    i. Lateral crus
    ii. Medial crus
    c. Lesser alar
  2. Unpaired
    a. Septal / quadrangular
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4
Q

Skin, muscles and AVNL of the external nose.

A

Skin character:

  • Sebaceous glands
  • Thick and adherent

Muscles

  1. Compressors of ala nasi
  2. Dilators of ala nasi

Nerve
1. Facial nerve

Blood Supply

  1. Maxillary artery
  2. Facial artery
  3. Opthalmic artery
Venous Drainage
1. Anterior facial vein
2. Opthalmic vein
3. Cavernous sinus
Lymphatic Drainage
1. Submandibular gland
2. Pre auricular gland
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5
Q

Nasal vestibule lining and structure.

A

Lining

  • Skin
  • Hair follicles

Structure

  1. Columella
  2. Internal nasal valve
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6
Q

Boundaries of the nasal cavity.

A

Boundaries

  • Inf:​maxilla & palatine bones
  • Roof:​lateral nasal bones
  • Sup:​cribriform plate
  • Post:​sphenoid bone

Roof

  • Front:​lateral nasal bones
  • Post:​sphenoid bone
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7
Q

Conchae, meatus and spaces in the nasal cavity.

A 
Conchae / Turbinates
They came from choana:
1. Superior turbinate
2. Middle turbinate
3. Inferior turbinate

Meatus

  1. Superior meatus​- post 3rd
  2. Middle meatus​- 2/3rd
  3. Infeiror meatus​- whole length

Space

  1. Spheno – ethmoidal recess
  2. General nasal meatus
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8
Q

Clinical importance of the meatus.

A
  1. Inferior meatus
    - nasolacrimal canal opens into its anterior end.
    - Communication btw paranasal sinuses & nasal cavity
  2. Middle meatus
    - frontal, anterior ethmoid, maxillary sinus opens into it
  3. Superior meatus
    - posterior ethmoidal sinuses drain into it
    - communication with sphenoidal sinus
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9
Q

Important structures of the middle meatus.

A

Important Structure In Middle Meatus

  1. Unciate process
  2. Bulla ethmoidalis
  3. Hiatus semilunaris
  4. Infundubulum

Hiatus semilunaris à Infundubulum à froonto-nasal duct.

  • In N, rarely can see unciate process & bulla ethmoidalis
  • In patho, fronto-nasal duct may open from anterior / ethmoid cells due to irregular development of frontal sinus & anterior ethmoid cells.
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10
Q

Parts and borders of the nasal septum.

A
  1. Osseous
  2. Cartilaginous

Border Of Nasal Septum

  1. Upper & Post​: ethmoid & vomer
  2. Anterior​: septal cartilage

Septa Cartilage Joint With

  • Above: Dorsum of nose
  • Below: nasal crest of maxilla & palatine bone
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11
Q

AVNL of the nasal septum.

A 
Blood Supply Of Nasal Septum
At Little’s area (epistaxis area)
1. Septal branch of spenopalatine aa
2. Greater palatine aa
3. Septal branch of sup labial aa
4. Anterior ethmoidal aa
5. Posterior ethmoidal aa

Blood Supply Of Lateral Nasal Wall
- Branches of the 5 arteries.

Venous Drainage

  1. Pterygoid plexus
  2. Superior ophthalmic vein
  3. Anterior facial vein

Lymphatic Drainage
Anteriorly
1. Submandibular glands
2. Superior deep cervical glands

Posteriorly
1. Medial deep cervical glands

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12
Q

Layers and lining of the nasal mucosa.

A

Layers

  1. Dense connective tissue
  2. Erectile / cavernous tissue
  3. Elastic tissue fibers

Lining

  • Surface epithelium: columnar ciliated
  • On BM: cuboidal cells.
  • Beneath BM: mucous glands
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13
Q

Nerve supply of the nasal mucosa.

A

Sensory

  1. Maxillary division of trigeminal nn
    - anterior dental branch of infra orbital nn
  2. Opthalmic divison of trigiminenal nn
    - lateral and medial internal nasal branch

Secretory
SNS: vasoconstriction, ¯ secretion
- superior cervical ganglion

PNS: vasodilatation, ­ secretion

  • greater superficial petrosal nn
  • nerve of pterygoid canal

Other Nerve: Olfactory nerve

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14
Q

Main physiological functions of the nose.

A
  1. Sense organ
  2. Respiraotry organ
  3. Physical protection
  4. Immunologic protrection
  5. Formation of speech sounds
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15
Q

Nose as an olfactory organ.

A
  • stimulate / decrease appetite
  • warn of rotten / poisonous food
  • essential in certain occupations.
  • To stimulate smell: need 10 – 15ml molecule of volatile substance.
  • Can adaptation.
  • Sensitivity depends on hunger.
Olfactory cells à 20 olfactory fibers à olfactory bulb (1° olfactory center) à olfactory tract à 2° OC à dentate & semilunate gyri (3° OC)
Theories Of Mechanism Of Action
1. Emission of scent corpuscles
2. Selective absorption
3. Specific receptors on sensory cells
4. Enzymatic controls
5. Molecular fibrations
6. Electrobiologic process
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16
Q

Olfactory pathology.

A
  1. Anosmia
    a. Respiratory anosmia
    b. Gustatory anosmia
    c. Central anosmia
    d. Essential anosmia
  2. Hyposmia

Anosmia

  1. Obliteration of olfactory cleft: respiratory anosmia
  2. Obstruction of nasal cavity / choana: gustatory anosmia
  3. D/o of CNS: central anosmia due to trauma of olfactory nn, cerebral contusion, cerebral dss.
  4. Local damage of olfactory epithelium: essential anosmia, due to influenza.
17
Q

Nose as a respiratory organ.

A
  • Average normal ventlation: 6L/min
  • Maximal ventilation: 50 – 70L/min

Air Stream

  1. Laminar
  2. Turbulent

Inspiration Airstream

  • Most high speed at internal nasal valve
  • Slowed down by nasal cavity between valve & turbinate head to increase turbulence

Expiration Airstream

  • less turbulence, so less heat & metabolic exchange
  • recovering of nasal mucosa (hydration).

Mouth Breathing

  • Exclusion of nose may lead to deep seated mucosal changes
  • Cause includes:
    1. Septal deviation
    2. Hypertrophy of turbinates
    3. Cicatrical stenosis
    4. Mucosal disease of nose & sinuses

Factors Of Nasal Patency

  1. Temperature
  2. Humidity
  3. Body position
  4. Body activity
  5. Body temperature change
  6. Cold influence
  7. State of pulmonary function, heart, circulation
  8. Endocrine disorder: pregnancy, hyperthyroidism, hypothyroidism
  9. Drugs
18
Q

Protective function of the nose.

A
  1. Warm and purify the inspired air. (31 – 34’C)
  2. Increase heat output when ext T fall

Normal Values

  • Temperature: 31 – 34
  • Optimal relative humidity – 50 – 60%
  • Water vapor saturation of inspired air: 80 – 85% on nasopharynx, 95 – 100% in lower airway
  • Water vapor secretion by RT /1L = 30g

Cleaning Function

  • Clean inspired air from FB, bacteria, duct, etc
  • Clean nose itself
  • Filter 85% particles >4.5mm
  • Removal of 5% of <1mm particles.

NASAL MUCOSA AS PROTECTIVE ORGAN
- Basic element: mucociliary apparatus

Resistance Factors Of 1st DZ

  1. Physical cleaning of mucociliary apparatus
  2. Nonspecific protective factors in secretions
  3. Specific protective factors (IgA,M,G)

Resistance Factors On 2nd DZ

  1. Non specific protective factors & structures
  2. Specific defensive factors
19
Q

Nose as reflex organ.

A

Specific

  1. Within nose & affect nose itself
  2. From other body part or ogans & affect nose
  3. In nose and affect other body parts.

Reflex

  • Nasal cycle: 2 – 6 hours.
  • Controlled by ANS à Nasopetal reflex

Type Of Reflex

  1. Nasopetal reflex
  2. Sneezing reflex
  3. Lacrimal reflex
  4. Cough reflex
  5. Respiratory arrest reflex
20
Q

Groups of paranasal sinuses.

A
  1. Anterior – comm. with middle meatus
    a. Maxillary sinus
    b. Frontal sinus
    c. Anterior ethmoid cells
  2. Posterior – comm. with sup meatus.
    a. Posterior ethmoidal cells
    b. Sphenoidal sinus
21
Q

Maxillary sinus.

A
  • Maxilllary antrum
  • Enlarge to max at 21 y.o
  • Reach floor nasal cavity at 7 y.o
  • Pyramidal shape

Boundaries / Wall

  • Roof:​floor of orbit
  • Floor:​root of 2nd dentition
  • Post:​pterygopalatine fossa
  • Med:​lat wall of nasal cavity
  • Ant/Lat: Superficial

Opening

  • Maxillary ostium
  • Accessory ostia
22
Q

Frontal sinus.

A

Open by nasofrontal duct
- Enlarge to orbital roof at 9 y.o

Wall

  • Ant:​Outer table
  • Post: ​Inner table
  • Floor:​Orbital roof
  • Med:​Septum separating 2 FS

Opening

  • Opening of nasofrontal duct
  • Located at its floor
  • Comm with middle meatus.
23
Q

Ethmoidal sinus.

A

Classification

  1. Anterior
  2. Posterior
Walls
- Med:​upper half of nasal cavity
- Lat:​orbit (by lamina payracea)
- Ant:​frontal process of maxilla
- Post:​sphenoid sinus
- Sup:​Frontal sinus &amp; anterior
cranial fossa
24
Q

Sphenoid sinus.

A
  • Opening at high up in cavity of sinus.
Wall &amp; Adjointments
Lat:​
1. Internal carotid artery
2. Cavernous sinus
3. 1st branch of 5th nn
4. 3rd, 4th, 5th, cranial nn

Roof

  1. Frontal lobe
  2. Olfactory tract
  3. Optic chiasma
  4. Pituitary gland in hypophysesal fossa

Floor

  1. Pterygoid canal
  2. Roof of nasal cavity
  3. Nasopharynx

Medial
1. Septum

Anterior
1. Ethmoidal cells

Posterior wall
1. Posterior cranial fossa

25
Q

Functions of the paranasal sinuses.

A
  1. Protection of cranial cavity
  2. Reduce weight of skull
  3. Ventilation & drainage
26
Q

Skeletopy and compartments of the pharynx.

A

Skeletopy

  • Fr base of skull to C6
  • 12 – 13cm long

Compartments

  1. Nasopharynx
  2. Oropharynx
  3. Hypopharnx
27
Q

Nasopharynx; boundaries, lining etc…

A 
NASOPHARYNX
Boundaries
- Sup:​skull base
- Inf:​imaginary plane through
soft plate
- Ant:​choanae
- AI:​soft palate
- Post:​prevertebral fascia
- PS:​adenoid
- Lat:​pharyngeal ostium of
eustachian tube &amp;
cartilaginous torus tubarius

Prevertebral fascia lies on:

  1. Longus capitis mm
  2. Deep mm of neck
  3. Arch of C1

On posterior wall may predispose to chronic inflammatin: embryonic pharyngeal bursa

Lining

  1. Respiratory ciliated
  2. Stratified squamous epithelium
  3. Transitional epithelium
28
Q

Oropharynx; walls, parts, lining.

A
  • Fr soft palate to superior edge of epiglottis
  • Continuous with oral cavity through faucial isthmus.
Walls
Posterior
- Prevertebral fascia
- C1 vertebrae
- C3 vertebrae

Lateral

  • Palatine tonsil
  • Anterior faucial pillars
  • Posterior faucial pillars
  • Supratonsillar fossa

Parts

  1. Anterior surface of soft palate
  2. Uvula

Epithelial Lining
- Nonkeratinizing stratified squamous epithelium

29
Q

Hypopharynx; parts, walls and relations.

A
  • Fr upper edge of sup epiglottis to inferior edge of cricoid cartilage
  • Opens anteriorly into larynx
  • Beside larynx – pyriform sinuses

Part

  1. Valleculae
  2. Base of tongue
  3. Lingular surface of epiglottis

Wall
Anterior
- Laryngeal inlet
- Posterior surface of larynx

Lateral

  • Inferior constrictor mm
  • Pyriform sinus

Posterior

  • Pharyngeal constrictor mm
  • Prevertebral fascia
  • Bodies of C3 – C6 vertebrae

Inferior
- Superior sphincter of esophagus

Relation Of It At Larynx Level

  1. Common carotid artery
  2. Internal jugular vein
  3. Vagus nerve
30
Q

Pyriform sinus.

A

Med:​aryepiglottic fold
- Lat:​internal surface of thyroid
​cartilage & thyrohyoid
​membrane

31
Q

Pharynx; lining,muscle layers, constrictions. Killian triangle.

A

Epithelial Lining
- Non keratinized stratified squamous epithelium

2 Muscle Layers Of Pharynx

  1. Circular
  2. Radiate

Constrictions In Circular Layer

  1. Superior​- at skull base
  2. Middle​- at hyoid bone
  3. Inferior​- at cricoid cartilage
    a. Sup thyropharyngeal part
    b. Inferior cricopharyngeal part

Constriction segments are inserted posteriorly to tendinous median raphe.

Killian’s Triangle
- From posterior wall of hypopharynx btw sup oblique & inerior horizontal fibers.

32
Q

Muscles and spaces of the pharynx.

A

Radiating Muscles

  • Fn: raising & lowering pharynx
    1. Stylopharyngeaus mm
    2. Salpingopharyngeus
    3. Palatopharyngeus

Also to elevate pharynx are:

  1. Stylohyoid mm
  2. Styloglossus mm

Spaces

  1. Parapharyngeal space
  2. Retropharyngeal space
33
Q

AVN of pharynx.

A
  1. Ascending pharyngeal artery
  2. Ascending palatine artery
  3. Tonsillar branch of facial artery
  4. Branches of lingual artery
  5. Descending palatine artery

VENOUS DRAINAGE
To internal jugular vein via:p
- Facial vein
- Pterygoid plexus

LYMPHATIC DRAINAGE

  • Retropharyngeal lymph node
  • Deep jugular lymph nodes
  • Paratracheal lymph nodes
NERVE SUPPLY
Pharyngeal Muscle
1. Glossopharyngeal  nn
2. Vagus nn
3. Hypoglossal nn
4. Facial nn

Nasopharynx
- Maxillary division of trigeminal nn

Oropharynx
- Glossopharyngeal nn

Hypopharynx
- Vagus nn

34
Q

Lymphoepithelial system of the pharynx.

A

They only have efferent lymph nodes. (No afferent).

  1. Pharyngeal tonsils (Adenoid)
  2. Tubal tonsil
  3. Palatine tonsil
  4. Lingual tonsil
  5. Tubopharyngeal plicae
  6. Lymphoepithelial collection in laryngeal ventricle.
35
Q

Characteristics of the tonsils.

A

Tonsils
Single Tonsils
1. Pharyngeal tonsils
2. Lingual

Paired Tonsils

  1. Tubal
  2. Palatine

Structure Properties Of Tonsil

  • Soft tissue lamella/septae
  • Fn: support framework of b.v,lymph, nn run.
  • Epithelial surface of one palatine tonsil = 300cm2.

Lacunae – broad flat niches

Crypts: branching clefts content

  1. cell debris & round cells
  2. bacteria & fungi
  3. pus
  4. encapsulated microabscesses.

Tonsils Of Waldeyer’s Ring

  • increase size at 1 – 3rd y.o
  • Peak at 3 – 7 y.o.
  • Atrophy at increasing age
36
Q

AV of the tonsils.

A

Blood Supply

  1. Ascending pharyngeal artery
  2. Descending pharyngeal artery
  3. Ascending palatine artery
  4. Lingual artery
  5. Direct tonssilar branches of ECA

Veins

  • Palatal vein à jugulofacial venous angle of IJV
  • Pterygoid venous plexus à internal jugualr vein
37
Q

Functions of the pharynx.

A
  1. Swallowing
  2. Lymphoepiothelial ring
  3. Articulation
  4. Area for RT & GIT
38
Q

Functions of the tonsils as mechanism of protection.

A
  1. Protection
  2. Produce lymphocyte
  3. Production of specific messenger & memory lymphocytes
  4. Produce specific AB (Ig)
  5. Shed topical immune stimulated lymphocyte
  6. Production & discharge of immunoactive lymphocytes into circulation

ENT (6 decks)

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