Nasal Passage and Sinus Disorders

Question 1

Clinical exam

Answer 1

Visually: externally and of the oral cavity

Percussion

Radio

Endoscopy: nasopharynx, guttural pouch and sinuses

Computer tomography

Question 2

Disorders of the Nasal passage

Answer 2

Symptoms:

Nasal stridor (usually insp)

Nasal discharge- epistaxis, serosanguineous

Fetid odour

Deformation

Head shaking

Question 3

Trauma of the nasal passage

Answer 3

Usually via NG tube

Bleeds for 5-10 mins

ALways use the ventral nasal meatus

Blunt trauma: impression fracture

Question 4

Progressive Ethmoidal Haematoma (PEH)

Answer 4

Aetiology is unknown

Caused by submucosal bleeding in the ethmoid turbinate region

Circumscribed red-brown mass that can invade into the sinuses

Question 5

Diagnosis of PEH

Answer 5

Endoscopy- try and get a biopsy

X-ray,

CT

MRI- for differentials

Question 6

Differentials of PEH

Answer 6

Neoplasia

Mycosis/ulcerative rhinitis

FB

Sinus cysts

Question 7

Treatment of PEH

Answer 7

Can be done 2 ways:

1. Transendoscopically: Formalin inj or laser- requires lifetime management
2. Sinusotomy: surgical extirpation, use laser!! danger of sever blood loss, often recurrent

Question 8

Sinuses

Answer 8

The frontal sinus is the biggest

They all communicate via the apertura nasomaxillaris

Rostral and caud maxillary are separated by a thin septum

Question 9

Sinusitis

Answer 9

Primary and secondary- that are often difficult to differentiate

Seldom: fracture, PEH, neoplasia, sinus cyst

Question 10

Symptoms of sinusitis

Answer 10

Often: nasal discharge- serous or mucopurulent

Swellings/deformations

Decreased airflow

Seldom: cutan fistula

Ocular discharge

Fetid odour

Question 11

Diagnosis of sinusitis

Answer 11

Inspection, percussion and exam of the mouth

Endoscopy through the apertura nasomaxillaris

Xray: lat will show fluid levels DV will show changes in radiopacity

Sinuscopy

CT/Scintigrpahy/ MRI

Question 12

Primary sinusitis

Answer 12

URT

Strep equi ssp equi

Trimethoprim sulphonamides for up to 2 weeks

Feed from the ground (is this to prevent asp)

Pasture

Dust free surroundings

Conservative has fair prognosis- if no response then do trepination and lavage in sedation and local anaesthesia

Question 13

Secondary sinusitis

Answer 13

Treat the primary disease first!!

Remove tooth

Sinustomy: remove tumour

Pyogen membrane curette- lavage

Question 14

Trepenation

Answer 14

Sinuses!

Frontal

Rostral and caudal maxillary sinuses

Question 15

Sinusotomy

Answer 15

Sinus flaps!

Large frontonasal

Maxillary

Frontal

Question 16

Landmarks for sinusotomy

Answer 16

Medial canthus

Inc nasalis

Infraorbital foramen

Facial crest

Caudo-dors orbit

Supraorbital foramen

Inc nasoincisiva

Question 17

Sinus cysts

Answer 17

Are rare!!

Yearling age up to adults

Symptoms: (very similar to sinusitis)

• Swelling
• Decreased airflow
• Nasal discharge
• Stridor

Diagnosis: X-rays, sinuscopy, diagnostic trepination- yellow, thick fluid

Treatment: Sinus flap and extirpation- must remove hole of cyst to avoid reoccurence

Question 18

Neoplasia

Answer 18

Seldom

Most common: platelet Epithelia Carcinoma (PEC)

Symptoms:

• Swelling
• Fetid odour
• Nasal discharge
• Stridor

Diagnosis: X-ray showing bony deformation, diagnostic trepination and biopsy

Bad prognosis as often metastasis

** must rule out tooth disorders

Question 19

Some other disorders

Answer 19

Suturitis

Facial paralysis

Atheroma/epidermal inclusion cyst