Nose Flashcards
Infraorbital orbit carries which nerve?
Complications?
Infraorbit, carries sensation from cheek. If damaged will cause
Anastasia-
3 causes:
Maxillary sinus cancer
Maxillary fracture
Zygomatic fracture
1- Most commonly fractured facial bone?
2- 2nd most commonly fractured facial bone?
1- nasal bone
2- zygomatic bone( mallar prominence)
Has 3 points
1spine temporal bone
2 spine frontal bone
3 spine maxillary bone
Zygomatic bone fracture
Tripod fracture
Flattening of mallar eminence + infraorbital nerve injury (anasthesia of cheek)
Rx of tripod fracture
ORIF
Concha classification
Divided into three
Covered with mucosa are called turbinates space below turbinates called meatus, also 3.
Superior
Medial
(Part of ethmoid bone)
Inferior (Independent bone)
Space which lies above sup. Turbinate
Spheno-ethmoidal recess
Or supreme meatus
As it is present between the sphenoid bone and ethmoid bone
Longest meatus
Inferior meatus
Inferior meatus sinus drainage
Nasolacrimal duct-
Downwards, outwards and backwards
Through the Valve of Hasner
Middle meatus sinus drainage
1 frontal
2 maxillary
3 anterior ethmoidal air cells
Sinuses
Is the largest meatus.
Open into the ethmoidal infundibulum
Superior meatus sinus drainage
Posterior ethmoidal air cells
Supreme meatus sinus drainage
Sphenoid sinus
Most constant and the largest anterior ethmoidal air cell
Bulla ethmoidalis
Anterior most ethmoidal air cell
Agger nasi
Ectopic ethmoidal air cells
1 Most common- Concha bullosa- inside the middle turbinate
2 Holler cell- orbital floor
3 Onodi cell- along the optic nerve
Neonate, preterm, cyanotic at birth, then turns pink as soon as he starts crying
Dx?
Rx?
Dx- Bilateral choanal atresia/ persistence of BNS
At the posterior end of the nasal cavity an opening called Choana is formed usually before birth.
BuccoNasal septum (separates the nasal- oral cavity) is present, then obliterates to form the choana. If it persists there is no passage of air.
Rx-
1st line- McGoverns technique- insert a wide bore nipple to keep oral pathway open for breathing-
Can also use godels airway (orophagyngeal airway)
Definitive- SURGICAL resection of the BNS
Paranasal sinuses
Hollow cavities inside bone
Decrease weight of bone
Responsible for resonance
1- frontal- most irregular
2- sphenoid
3- ethmoidal- also called air cells.
4- maxillary- largest, vol is 15ml. Also called antrum of hymor
Nasal congestion, rhinorrhea, post nasal drip, headache.
Dx
Dx- sinusitis
(sinuses lined by mucosa, drain into the meatus, if blocked cause congestion…infection)
Retro orbital pain- sphenoid sinus
Office headache/ periodic- frontal sinus
Most common- strep pneumonia
Investigations-( diagnostic nasal endoscopy if present)
OR
X-ray paranasal sinuses
OR
CT paranasal sinus(best radiological investigation) check air fluid levels
X-RAYS
1- All sinuses- skull lateral view/ best for sphenoid sinus
2- Waters view X-ray/ occipitomental view
(Best for maxillary sinus)
open mouth wala also called Pierre’s view
closed mouth also present
Done to check the extra sphenoid sinus
3- Caldwells view- best for frontal and ethmoidal sinus. Laterally, pt looking 15-20• downward
Treatment of sinusitis
Medical-
Antibiotic for 3 weeks
NASAL decongestant- for one week w one week gap
Or steroid spray
Surgical-
FESS functional endoscopic sinus surgery. Sone if no relief after 3 weeks of antibiotics.
FESS surgery Complications
Synechiae formation due to fibroblast action after you scrape out the sinuses
To prevent: apply mitomycin C (anti fibroblastic action)
All sinuses are visible on which view of x-ray?
X-ray skull lateral view.
Best view of the X-ray for all sinuses?
Waters view
Post. Ethmoidal air cells not visible tho
Complications of sinusitis
- Pain redness, swelling- periorbital
Called orbital cellulitis
Commonly associated with ethmoidal sinusitis - Potts puffy tumour-
Subperiosteal abscess of frontal sinus
plus damage to the frontal bone (osteomyelitis)
Mucocele complication of a which sinusitis?
Frontal sinusitis
Aspergilloma complication of which sinusitis?
Maxillary sinusitis
Fungal.
Most common cause aspergillosis fumigatus
Fungal hyphae combine together they form a ball called aspergilloma.
1- Most common sinusitis in adult
2- most common sinusitis in children
1- Maxillary
2- Ethmoidal
Sequence of development of paranasal sinuses
M
E
S
F
PRESENT AT BIRTH- Maxillary and ethmoidal
Most developed sinus at birth- ethmoid sinus
Most common benign tumour paranasal sinus
Osteoma
Most commonly in frontal sinus
Most common sinus associated with malignancy
Malignancy = Maxillary
Maxillary sinus carcinoma
Investigation
Investigation - CT scan with no air fluid level, will be eroding born, no biopsy.
What is Ohngrens line + role
An imaginary line that divides the maxillary sinus into 2
extends from the medial canthus of the eye to the angle of mandible
Used for prognostic evaluation:
If cancer is in lower half better prognosis
If cancer is in upper half poor prognosis ( early orbital involvement)
Maxillary sinus carcinoma treatment
Total maxillectomy
Webber fergusson approach followed by radiotherapy
What is Inverted papilloma nose?
Rx
Also called ringertz tumour
Arises from the lateral wall of nose
Grows inside the wall, from mucosa towards submucosa
Unilateral
Locally, invasive,
benign, but aggressive
Rx
FESS
Pt taking nasal congestants for 3 month
Stop and develops rebound congestion
Dx
Rx
Rhinitis medicamentosa
Rx stop taking nasal decongestants
Start steroid nasal spray.
Sneezing,
increased watery discharge,
Nasal irritation ,
nasal obstruction,
mucosa is pale, swollen or bluish, inferior turbinate hypertrophy
Allergic rhinitis
Types of allergic rhinitis
Seasonal- pollen
Penennial- house dust mites
Less common after 50 years
Allergic rhinitis
Patho
Type 1 hypersensitivity
Increased Ig E levels and eosinophilia
Pale then later Bluish mucosa due to venous stasis.
Mucosa may become edematoud to form polyp esp in ethmoidal air cells
Generalised mucosal thinkening
Increased nasal discharge on cold exposure
Vasomotor rhinitis
Rx
Antihistamines
What are Nasal polyps?
Prolapsed pedunculated edematous mucosa
Nasal polyp types
Antrochoanal polyp / killians polyp
Ethmoidal / nasal polyp
Antrochoanal polyp / killians polyp
Grows from maxillary sinus towards The choana
Age- children
Most common cause- redcurrant/ chronic infections
Type- unilateral and single
Rx- FESS/ endoscopic polypectomy
Ethmoidal/ nasal polyp
Arises from the ethmoidal air cells
Age- adults
Most common cause- chronic allergy
Type- bilateral and multiple
Rx- steroid spray. If fails then FESS
Pt. Is known case of bronchial asthma, develops ethmoidal nasal polyp, he will be allergic to which drugs?
ASPIRIN
SAMTER’s TRIAD - BAN
B- bronchial asthma
A- allergy to nsaids (aspirin)
N- ethmoidal nasal polyp
Aspirin-exacerbated respiratory disease (AERD)
also known as Samter’s Triad, is a chronic medical condition that consists of three clinical features: asthma, sinus disease with recurrent nasal polyps, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) that inhibit an enzyme called cyclooxygenase-1.
Mucormycosis/ ROC MM
Also called rhino orbital cerebral mucormycosis
MCC- rhizopus/ mucor (rhizomycetes species)
Since the fungus is ANGIO INVASIVE (damage to blood vessels)
it will penetrate and cause ischemia
Leading to necrosis and BLACKENING OF EVERYTHING.
== BLACK ESCHAR on nose eyes or pallate
In mostly immunocompromised pt. And on steroids
Life threatening
Investigations- MRI head (rule of cerebral involvement)
Nasal swab for mucor
DRUG OF CHOICE- LAMP (liposomal amphoterecin B)
Rx of choice- debridement +- exenteration (enucleation plus bones also)
Pt w c/o infertility and history of anosmia
Dx-
Kallman’s syndrome
(Hypogonadotropic hypogonadism) low fsh and lh
Esthesioneuroblastoma
Malignancy of olfactory nerve
Complete loss of sense of smell
Investigation- MRI
Rx- surgical excision
1st and smallest cranial nerve- olfactory nerve