Nasal cavity, paranasal sinuses and pharynx and its clinical anatomy

Question 1

role of nose

Answer 1

olfaction - smell
respiration
filtration of dust
humidification and warmth
reception and elimination of secretions

Question 2

external nose

Answer 2

mostly cartilage
nares - nostrils
bounded by alae
skin extends into vestibule
has hairs for filtration

Question 3

bones of the external nose

Answer 3

nasal
maxillary
frontal
septum

Question 4

cartilage of external nose

Answer 4

5 main parts

Question 5

what makes up the septum?

Answer 5

ethmoid bone
vomer bone
cartilage
maxilla and palatine bones nasal crests

Question 6

walls of nose

Answer 6

floor, roof, medial and lateral walls

Question 7

Nasal cavity

Answer 7

divided by septum, entry through nares, exit to nasopharynx (choanae)
Lined by mucosa
except vestibule
continuous with pharynx and paranasal sinuses, lacrimal sac and conjunctiva
olfactory area - superior 1/3

Question 8

role of conchae/ turbinates

Answer 8

increased surface area for heat exchange

Question 9

nasal meatus

Answer 9

recess underneath conchae
common nasal meatus - nasal passageway
mucosa can swell blocking passages

Question 10

paranasal sinuses

Answer 10

air filled extensions of nasal cavity
named by the bones which they occupy
maxillary and sphenoidal small at birth, others develop later
can be hyperaerated

Question 11

vasculature of nasal cavity

Answer 11

5 sources
superior 3 have septal and lateral branches
Kiesselbach area 
external nose 
submucosal venous plexus

Question 12

venous drainage of the external nose

Answer 12

opthalmic veins
cavernous sinus
pterygoid plexus
facial vein

Question 13

nerve supply of external nose

Answer 13

maxillary and opthalmic branches
most of external nose by V1
olfactory nerve

Question 14

sphenoid sinus

Answer 14

only thin bone separating from optic nerves and chiasm. Pituitary gland, internal carotid arteries and cavernous sinus
trans-sphenoidal surgery

Question 15

Maxillary sinus

Answer 15

forms wall of nasal cavity and floor of orbit
posterior molar teeth can project into
drains via maxillary ostium into semilunar hiatus of middle meatus
most commonly infected - uphill drainage

Question 16

ethmoidal sinus

Answer 16

direct passage to anterior cranial fossa through cribriform plate
infection can spread from ethmoiditis
fracture of cribriform plate can lead to CSF rhinorrhoea
similar to otorrhoea
can test glucose content - highly unreliable
beta-2-transferrin
single best test - high sensitivity and specificity
no localising information though - use imaging .

Question 17

otorrhoea

Answer 17

discharge from the ear from ear canal or middle ear

Question 18

nasal and facial fractures

Answer 18

common

causing septal deviation

Question 19

rhinitis

Answer 19

Urticaria and allergy
sinusitis
infection can spread intracranially

Question 20

nasopharynx to middle ear

Answer 20

eustachian tube

Question 21

Pharynx

Answer 21

part of upper aerodigestive tract
cranial base to oesphagus
there are 3 parts

Question 22

what are the 3 parts of the pharynx?

Answer 22

nasopharynx
oropharynx
laryngopharynx

Question 23

nasopharynx

Answer 23

respiratory function
from nasal choanae to soft palate
eustachian tube orifice

Question 24

oropharynx

Answer 24

digestive function

soft palate to base of tongue

Question 25

laryngopharynx

Answer 25

epiglottis to oesophagus

Question 26

Pharyngeal muscle

Answer 26

longitudinal muscle internal to circular layer | opposite to rest of alimentary tract

Question 27

external circular layer

Answer 27

``` pharyngeal constrictors superior middle inferior inferior has sphincteric function involuntary sequential contraction to propel food bolus ```

Question 28

nerve supply of external circular layer of pharynx

Answer 28

pharyngeal nerve plexus from vagus, glossopharyngeal and sympathetic cervical ganglia gaps between the muscles allows passage of nerves and arteries

Question 29

internal longitudinal layer of pharynx

Answer 29

palatopharyngeus stylopharyngeus salpingopharyngeus they elevate the larynx and shorten and widen the pharynx during swallowing and speaking

Question 30

swallowing

Answer 30

deglutition | 3 phases

Question 31

what are the phases of swallowing

Answer 31

1. voluntary chewing and pushing into oropharynx 2. involuntary soft palate seals off nasopharynx, larynx elevates, widens pharynx 3. involuntary - sequential contraction of pharyngeal constrictors causes peristalsis into oesophagus

Question 32

tonsilar ring

Answer 32

pharyngeal tonsils - tubal tonsil palatine tonsils -

Question 33

tonsils

Answer 33

aggregated lymphoid tissue

Question 34

Pharyngeal tonsils

Answer 34

adenoid on roof and posterior wall of nasopharynx

Question 35

Tubal tonsils

Answer 35

- near eustachian tube orifice

Question 36

palatine tonsils

Answer 36

each side of oropharynx between palatine arches

Question 37

lingual tonsils

Answer 37

posterior part of tongue

Question 38

vessels

Answer 38

tonsilar branch of facial artery and others ascending and descending palatine, lingual, ascending pharyngeal large paratonsilar vein to pharyngeal venous plexus highly vascular can bleed a lot during or after surgery

Question 39

lymphatic drainage of tonsils

Answer 39

tonsilar lymphatic vessels to juugulodigastric cervical lymph node

Question 40

Nervous supply of tonsils

Answer 40

``` pharyngeal plexus vagus - motor glossopharyngeal - sensory some nasopharyngeal sensation from maxillary branch of trigeminal nerve gag reflex ```

Question 41

what muscles of the pharynx are innervated by the vagus nerve

Answer 41

all muscles of pharynx and soft palate except stylopharyngeus and tensor velipalatini some motor to inferior constrictor from external and recurrent laryngeal branches

Question 42

Eustachian tube

Answer 42

more horizontal in children can be associated with middle ear infections more difficult to equalise so painful during air travel

Question 43

ear cancer

Answer 43

nasopharyngeal mass/ cancer in adults can lead to middle ear obstruction

Question 44

foreign body

Answer 44

usually in piriform fossa lateral to laryngeal opening can damage internal and recurrent laryngeal nerves deep to here

Question 45

pharyngeal pouch

Answer 45

``` zenker diverticulum outpouching of hypopharynx just superior to upper oesophageal spchincter between 2 parts of inferior constrictor killian dehiscence pulsion pseudo diverticulum ```

Question 46

what can happen in the pharyngeal pouch?

Answer 46

``` trapped food and liquid dysphagia halitosis regurgitation cough aspiration infection ```

Question 47

orbital plate of ethmoid bone

Answer 47

fractures easily due to thin bone

Question 48

infection

Answer 48

can spread from ethmoid fracture upwards but CSF moves down

Question 49

epiglottis

Answer 49

start of larynx