Nasal Obstruction Flashcards
What are the 3 parts of the nasal septum
Septal cartilage
Perpendicular plate of ethmoid
Vomer
Most common site of epistaxis in children
Little’s Area or Kiesselbach’s plexus
The ophthalmic artery branches to what artery supplying the Little’s Area?
Anterior ethmoid artery
The maxillary artery branches to what arteries supplying the Little’s Area?
Sphenopalatine artery
Greater Palatine Artery
The little’s area is supplied by the septal branch of what artery?
Superior Labial Artery
This nasal turbinate can cause obstruction
Inferior turbinate
This nasal turbinate is where most of the drainage tracts from the surrounding paranasal sinuses drains into
Middle turbinate
This nasal turbinate is where the ethmoid roof and cribiform plate are located
Superior turbinate
Turbulent flow (speeds up/slows down) the flow velocity, (lessens/prolongs) contact of air with the mucosa
slows down
prolongs
T/F: Turbinate hypertrophy periodically alternates between the 2 sides of the nose, causing periodic unilateral obstruction every 1 hour
F
every 3 hours
Two methods to directly assess nasal obstruction
Routine anterior rhinoscopy
Nasal Endoscopy (rigid, flexible)
Paranasal sinus Xray is indicated to confirm what disease?
What parts are visualized in Occipito-mental projection (Water’s)?
How about in Occipito-frontal projection (Caldwell’s)?
Acute Rhinosinusitis
Maxillary sinus, sphenoid sinus
Frontal sinus, ethmoid cells
CT Scan is requested for patients who have ___________
nasal obstruction
T/F: CT Scan is used to diagnose chronic sinusitis
T
T/F: CT scan is not recommended for reconstructive surgery
F
It can be used in sagittal, coronal, and axial planes for 3D reconstruction of masses
T/F: MRI is inferior when visualizing bones
T
Preferred imaging modality for viewing paranasal sinuses
MRI
What is the CHARGE syndrome in unilateral choanal atresia?
Coloboma
Heart Disease
Atresia of the chloanae
Retarded growth, devt, CNS abnormalities
Genital hypoplasia
Ear anomalies or deafness
T/F: Unilateral chloanal atresia is life threatening
F - it’s bilateral that’s life threatening
T/F: In bilateral chloanal atresia, perforation of the plate can be done in the first weeks or months of life, whereas surgery can be postponed on unilateral chloanal atresia until school age
T
A 6-year-old patient has adenoid hypertrophy. He does not breathe through the mouth, no nasal discharge, does not snore, no anorexia, and normal voice. What treatment shall must be done?
NONE
- treated only if they are causing symptoms
Adenoid hypertrophy can cause what complication which could lead to conductive hearing loss?
Otitis media with effusion Or chronic impairment of the eustachian tube ventilation
T/F: Chronic mouth breathers can have maxillary deformity and dental malalignment (adenoid facies)
T
T/F: Anterior rhinoscopy or endoscopy can be done to diagnose adenoid hypertrophy. Ear evaluation and sharing test should likewise be done
F
All are true except Anterior rhinoscopy. Must be POSTERIOR
Tx of adenoid hypertrophy
Surgery
Myringotomy with ventilation tube insertion if with otitis media with effusion
This is the most common bilateral nasal mass
T/F: This disease is rarely observed in children
Nasal polyposis
T: except for those who have cystic fibrosis
This treatment is done for any deviation of the septum causing subjective complaints and functional impairment
Septoplasty
These cells/sinuses are usually involved in nasal polyps
Maxillary and Ethmoid
T/F: Nasal polyps could cause rhinophonia clausa
T (it causes hyponasal speech)
This is a mucocele that contains purulent material (superinfection)
Pyelocele
These adhesions obstruct drainage from the paranasal sinuses system
Post-inflammatory
Post-traumatic
Post-operative
T/F: Nasal polyps can cause mucocele formation
T
Since it can cause obstruction
Ranking of most common sinus involved in mucocele
Frontal > Ethmoid > Maxillary > Sphenoid
What sinus is involved if the orbital contents move inferolaterally?
Frontal sinus (Frontal mucocele)
What sinus is involved if the orbital contents move superiorly?
Maxillary sinus (Maxillary mucocele)
What sinus is involved if the orbital contents move laterally?
Ethmoid Sinus (Ethmoid mucocele)
T/F: Ethmoid mucocele causes headaches radiating to the vertex and occiput
F
it’s Sphenoid mucocele
T/F: Endoscopy is not useful to detecting mucocele
Best modality for mucocele detection
Tx:
T
CT Scan
surgical removal
Which of the following tumors of the nasal cavity and paranasal sinuses is benign?
Adenocarcinoma
Inverted papilloma
Adenoid Cystic Carcinoma
Squamous cell carcinoma
Inverted papilloma
It is the most common cause of unilateral nasal mass
What sinus is usually involved?
Inverted Papilloma
Maxillary sinus
Inverted papilloma can transform into what malignant disease?
Squamous cell carcinoma
What pattern in MRI is checked to diagnose inverted papilloma?
Imaging modality adequate for its diagnosis:
Cerebriform-columnar pattern
CT Scan
T/F: inverted papilloma can be endoscopically removed
T
other option: maxillectomy (open approach)
This is one of the most common causes of benign tumors in the adolescent/pediatric age group
Juvenile Angiofibroma
What is juvenile angiofibroma?
It is a benign tumor in the nasopharynx that is common among males age 10-18 years old. It is a vascular malformation commonly located in the pterygopalatine fossa
T/F: Juvenile angiofibroma can cause middle ear effusion and conductive hearing loss
T
other sx: nasal obstruction, recurrent epistaxis, headache
A 12yo male patient comes to the clinic with nasal obstruction. On endoscopy, a well-circumscribed vascular mass was found at the posterior nasopharynx. What is the diagnosis?
Should biopsy be performed to confirm its malignancy?
Can angiography be done?
Tx:?
Juvenile Angiofibroma
NO- biopsy should not be performed due to uncontrollable bleeding
Yes- to identify feeding vessel; preferred for adolescent males
Tx: Surgical removal or preoperative embolization of feeding vessels (usually the maxillary artery)
Osteomas most frequently occur in what sinus?
Frontal (80%) > Ethmoid > Maxillary > Sphenoid
This syndrome under osteoma has multiple colon polyp, osteoma of the skull, and multiple soft tissue tumore
Gardner’s Syndrome
T/F: osteomas are highly likely to transform into osteosarcoma
F
it rarely transforms to a malignant tumor
Main sites of malignant tumors
Nasal cavity and maxillary sinus
Followed by ethmoid > frontal > sphenoid
When CT is used to diagnose malignant tumors, it should include _________
T/F: Nasal endoscopy can be used to diagnose malignant tumors
the neck
- to check for neck node involvement and metastasis
T
