Nasal Pathology

Question 1

what is a septal haematoma?

• what are the risks?

Answer 1

bleeding between the nasal septum + the perichondium which can cause ischaemic cartilage

ischaemia can lead to necrosis and then infection

therefore the blood needs evacuated ASAP

Question 2

when is a full nasal fracture assessment carried out?

Answer 2

5-7 days after the accident, when the swelling has gone down

Question 3

what are the potential complications of a nasal fracture? (4)

Answer 3

(severe) epitaxis
CSF leak! - normally settles in 10 days but can cause infection.
Meningitis
Anosmia if cribiform plate affected

Question 4

what can be done for a nosebleed in hospital that is more advanced that initial 1st aid? (4)

Answer 4

• cauterization with silver nitrate
• adrenaline cotton ball
• anterior nasal packing “Rapid Rhino”
• anaesthetic + ligation

Question 5

describe nasal polyps and common associated symptoms

Answer 5

multiple swellings prolapsing into the nasal cavity from nasal / sinus mucosa

CHRONIC RHINOSINITIS.
obstruction / snoring
headaches
nasal dripping

Question 6

are nasal polyps common in adults or children?

Answer 6

adults = MALE and > 40

rarely children = investigate CYSTIC FIBROSIS or other pathology

Question 7

when would you be worried about nasal polyps? (2)

Answer 7

in children - rare. so investigate CF and other pathology

single, unilateral polyp = could be cancer. urgent biopsy

Question 8

how are nasal polyps generally managed?

• initially
• long term
• still unresolved

Answer 8

1. shrinking = with topical steroids.
   - becolomethasone 2wks
   - fluticasone 3 months
2. may need long term ABs
3. unresolved = endoscopic sinus surgery

Question 9

what benign nasal tumour occurs in men > 50, and has three subdivisions

• oncocytic
• inverted
• exophytic

Answer 9

Schneiderian papillomas

Question 10

most common malignant nasal tumour?

- classic patient?

Answer 10

Squamous cell carcinomas

smoker + male + > 50

Question 11

what malignant nasal tumour is common in the far east, associated with EBV and formadehyde?

Answer 11

Nasopharyngeal carcinomas

Question 12

what are the 2 missing common cause of acute bacterial rhinosinsusitis?

1. strep pneumoniae
2. H influenza….

Answer 12

3. staph aureas

4. moraxella

Question 13

3 common way to aquire acute bacterial rhinosinusitis?

1 x internal
2 x external

Answer 13

1. direct spread from dodge water
2. from tooth infection
3. from nasogastric tubes in hospital

Question 14

complications of acute bacterial rhinosinusitis

• at eyes
• in brain
• frontal bone

Answer 14

1. orbital cellulitis
2. intracranial infection eg. meningitis/ cerebral abscess
3. osteomyelitis of frontal bone - may get an abscess (Pott’s puffy tumour)