Nose Flashcards
Shape of nose is ……., divided into 2 parts by …..
Pyramidal in shape
Nasal septum
Define the nasal septum
Perpendicular plate of :
Ethmoid: above and behind
Vomer: below and behind
Quadrilateral or septal cartilage- anteroinferior.
Structures in the lateral wall of nose
What is concha?
3 turbinates and 3 meatus in between
Bony part of nasal septum
Concha + mucosa + submucosa = turbinate
…….turbinate is a separate bone.
……&…….turbinates are part of ethmoid
………..turbinate is present above superior t
Inferior
Middle and superior
Supreme turbinate
Structures that the meatus receives from: (4)
- Inferior meatus: from nasolacrimal duct
- Middle meatus:
a. Frontal sinus
b. Ant & middle ethmoid sinus
c. Maxillary sinus
—these together form osteomeatal complex or Picadle’s circle. - Superior meatus: Receives posterior ethmoid sinus.
- Sphenoethmoidal sinus: receives sphenoid sinus.
Surgical opening for dacrocystitis:
Sphenoidal sinus lies in body of :……
Importance of sphenoid sinus
Middle meatus
Sphenoid bone
Has a depreession called sella turcica. Pituitary gland is on sella turcica.
Best surgical approach for pituitary adenoma
Transphenoidal endoscopic transnasal hypopysectomy.
What is Hasner’s valve?
Hasner’s valve: mucosal flap in distal end of nasolacrimal duct.
Importance of picadeli’s circle.
Area in middle meatus where sinus ostia open. Important site of pathogenesis in sinusitis.
Mc long term complication of nasal surgery:
Prevention is by …..
Adhesion formation.
Mitomycin C
Define concha bullosa
What is the dangerous area of face?
Pneumatization of middle turbinate
Area around nose,upper lip and vestibule.
Infection from here, drain into cavernous sinus via anterior facial and angular veins.
Intersection of frontal and nasal bones in the human skull is called….
Order of development of sinuses:
Nasion
Mastoid> ethmoid> sphenoid> frontal
- First sinus to appear is….
- Last sinus to appear is …..
- Sinus +ve at birth is ……
- Maxillary sinus
- Frontal
- Maxillary and ethmoid
- Most developed sinus at birth is ….
- Sinus that develops at 4 yrs age is ….
- Sinus that appears at 6 yrs age is …
- Ethmoid
- Sphenoid sinus
- Frontal sinus
Largest paranasal sinus is ….. Adult capacity is …..
Maxillary sinus aka Antrum of Highmore
15cc
Types of ethmoid air cells
Biggest anterior ethmoid hair cell is ….
Anterior: 2-8 nos
Posterior: 1-8
Bulla ethmoidalis
Anterior most hair cell is ……
Unusual locations of ethmoid air cells (3)
Aggarnasi
- Orbital floor: Haller cell
- Optic nerve: Onodi cells
- Inside middle turbinate: concha bullosa
……..can get obstructed in frontal sinus damage
……can be a source of persistent mucopurulent secretion
……should be identified to avoid optic nerve injury during FESS
Aggarnasi
Haller cell
Onodi cells in posterior ethmoidal air cells
Define choana
Features of choanal atresia
Posterior opening of nasal cavity
Neonatal emergency:
cyanosed at birth, turns pink on crying.
Secondary to deep inspiration with open mouth.
Dx of choanal atresia is by…(3)
- Presence of mucoid discharge in nose
- Absence of air bubbles in nasal discharge
- Inability to pass NG tube into the nose of newborn.
……is more common in choanal atresia.
Define CHARGE syndrome
Bony atresia
Coloboma
Heart defect
Atresia choana
Retarded growth
Genital abnormalities
Ear abnormalities
Rx for choanal atresia
Immediate mgt- mc grower technique- wide bore nipple into the mouth of neonate—> tracheostomy + recanalization after 1 year. - mitomycin C is given to prevent fibrosis
Most common organism for acute sinusitis
Sinuses involved in acute sinusitis
Strept pneumonia
Maxillary> frontal> ethmoid> sphenoid
Office headache and periodicity seen in….
…….sinusitis is common in children. …….is the complication.
Frontal sinusitis
Ethmoidal sinusitis
Orbital cellulitis
Post nasal drip is seen in ….sinusitis (2)
- Maxillary
- Sphenoid sinusitis
Trans illumination test used for ….
Complication of acute sinusitis. Sms
Acute sinusitis
Potts puffy Tumor:
Complication of acute frontal sinusitis
Mucosa of frontal sinus—> frontal bone—> osteomyelitis—> subperiosteal frontal abscess.
Sms: painful red forehead and swelling
Acute rhinosinusitis is ……duration.
Chronic rhinosinusitis is ……duration
<4weeks
> 12 weeks
- Mc xray for sinuses:
- Best X-ray for sinus :
- Waters view is ……view
- Waters view
- Waters view
- Occipitomental view
- Pierre’s view is …..
- Waters view shows …..sinus
- Waters view shows all sinus except …
- Waters view can be done with open mouth
- Maxillary sinus
- Posterior ethmoidal
What is caldwell view?
Xray for sphenoid sinus is ….
Occipitofrontal view.
Best for frontal and ethmoidal sinus.
Xray skull lateral view
What are the ethmoidal air cells?
Single bone in the body between 2 orbits.
Contains many air cells.
Allergic fungal rhinosinusitis is ….hypersensitivity
2 findings of allergic fungal rhinosinusitis
Type 1
- Allergic nasal mucin
Thick peanut butter fungal hyphae. Charcot Leyden crystals. - Nasal polyps
Fungal debris present.
Ct scan for allergic fungal rhinosinusitis
Investigation for mucormycosis (4)
Double density nasal polyp
- Nasal endoscopy
- KOH smear
- Fungal culture
- Radiology
What are the major and minor criteria for allergic rhinosinusitis ?
Bent and Kuhn criteria
Major :
1. Type 1 HS ( by skin test/IgE)
2. Nasal prognosis
3. Ct: double density nasal polyp
4. Eosinophilic mucus that doesn’t invade sinus tissue
- Positive fungal stain
Minor criteria:
1. Bone erosion
2. Charcot Leyden crystals
3. U/L disease
4. Peripheral eosinophilia
5. + fungal culture
Young patient with roomy nasal cavities and nasal crusting has …..
Young patient with roomy nasal cavities and nasal crusting + hard woody nose is…
Atrophic rhinitis
Rhinoscleroma
Atrophic rhinitis is caused by ……organism
Rhinoscleroma caused by ……..
K.ozonae
K. rhinoscleromatosis
Nutrition deficiencies that can cause Atrophic rhinitis
Which race is more affected ?
Endocrine feature of Atrophic rhinitis
Vit A,D,E, iron
Yellow and white race
Starts at puberty and stops at menopause
Most characteristic symptom of Atrophic rhinitis is ….
Extensive crusting and fetor is known as…
Mc seen in …..
Foul odor- detected by others but not patient- merciful anosmia
Ozaena
Females,puberty,B/L condition
Medical rx for Atrophic rhinitis (6)
1 . alkaline nasal douches
2. 25% glucose in glycerine
3. Estradiol nasal spray
4. Human placental extract
5. Potassium iodide
6. Oral streptomycin-for klebsiella
Surgical Rx for Atrophic rhinitis :
Young’s operation: closure of anterior nares
Modified young’s: partial closure of ant nares
What is Lautenschlager’s operation?
What is Wilson’s operation?
Medialization of lateral nares, by submucus injection of paraffin.
Submucus injection of 50% teflon in glycerin paste.
Nasal perforation:
Bony part seen with ….
Cartilaginous part seen with …..(2)
Apple jelly nodules seen on diascopy s/o…
- Nasal syphillis
- Leprosy, SLE
Lupus vulgaris-TB
Etiology of rhinosporidiosis
Caused by …..organism
Lesion is …..like
Trauma, dust from dung/infected cattle
Contaminated water/pools
Rhinosporidium see beri
Strawberry like
Rx for rhinosporidiosis
Rhinoscleroma seen in ….region
Surgery - complete excision of mass
Dapsone
North India
Pathological feature of rhinoscleroma (2)
Tapir nose seen with ….d/s
Mikulicz cells- large foam cells
Russell bodies- blue cells
Rhinoscleroma
Antrochoanal polyps are due to ….
But ethmoidal polyps due to …
Infections
Allergies,vasomotor symptoms associated with asthma
Antrochoanal polyps are ….. while ethmoidal are …..macroscopically
Antrochoanal polyps arise from ….while ethmoidal arise from …..
Solitary tumors
Multiple grape like
Maxillary sinus
Ethmoidal sinus
Antrochoanal polps are ….(U/L or B/L)
Ethmoidal polyps are ….
Recurrence is …..in Antrochoanal while ….in ethmoidal
U/L
B/L
Uncommon
Common
Rx of choice for Antrochoanal polyp
Rx of choice for ethmoidal polyp
- FESS-rx of choice
Sometimes Caldwell-Luc - Medical: intranasal CS spray
Mc cause of CSF rhinorrhoea, mc site of leak….
2md mc cause of CSF rhinoorhoea
Spontaneous CSF rhinorrhoea seen in …
Accidental head injury
Cribriform plate
Iatrogenic
Idiopathic intracranial HTN.
Mc site of CSF leak in trauma is …
C/f of CSF rhinorrhoea
Fovea ethmoidalis - roof of ethmoid bone
Clear watery fluid sweet in taste that can’t be sniffed back.
Signs seen with CSF rhinorrhoea
- Handkerchief test:
No stiffening of hanky with CSF.( nasal discharge stiffens). - Reservoir test:
Immediately rising from bed,ask patient to keep his chin over chest for a min-> CSF rhinorrhoea - Double ring/target sign/ halo sign:
Traumatic leaks- CSF blood in centre, CSF gravitates to periphery - Paradoxical rhinorrhoea: midline structures that act as separating barriers are dislocated- crista galli, vomer
Confirmatory test for CSF rhinorrhoea
Gold standard for localizing site of leak.
Imaging modality of choice
Beta 2 transferrin
CT cisternography
High resolution CT
Rx for CSF rhinorrhoea
- Bed rest with semi sitting position- avoid coughing, sneezing, nose blowing
- Persistent cases: nasal endoscopic approach
Mc cause of epistaxis in children
In adults
Nose picking
HTN
Blood supply of nose
Internal C A : Ant ethmoid Post ethmoid
———middle turbinate ——-
ECA: Sphenopalatine
Greater palatine
Superior labial
Mc artery of epistaxis
Mc area of epistaxis
Sphenopalatine artery
Little’s area-keisselbach’s plexus
Has 4 arteries: LEGS
Superior labial
Ant Ethmoidal
Greater palatine
Sphenopalatine
Only branch of opthalmic artery in keisellback’s plexus is …
Mc site of bleeding
For children
For young people
Anterior ethmoidal artery
Children: Little’s area
Young people: retrocolumellar vein
Difference between anterior and posterior epistaxis
Anterior:
1. Blood comes out of the nose
2. Mc
3. Mc cause: trauma
4. Bleeding site : Little’s area
5. Easy to identify
6. Mild bleeding
7. Rx: anterior nasal pack in OPD
Posterior epistaxis:
1. Blood flows back into pharynx and swallowed
2. Less common
3. Mc due to HTN/arteriosclerosis
4. Site of bleed: posteriosuperior
5. Difficult to identify bleeding point
6. Profuse bleeding
7. Rx: posterior nasal pack under GA
Trotters method is ….
Posterior nasal packing in OT is done using …(3)
Ask patient to sit calmly placing head over the sink and spit any blood and breathe quietly from mouth.
Gauze
Foley’s Catheter
Nasal balloon
Arterial ligation is in order: descending (4)
Sphenopalatine
Internal maxillary
External carotid
Anterior / posterior ethmoid artery
Rx for refractory epistaxis
ESPAL: endoscopic Sphenopalatine artery ligation
Septal Hematoma is due to …..
Sms
Rx
Complications
Trauma
Smooth round swelling
Immediate drainage and closure with septal buttons.
Else complications like : septal abscess- fever, pain, tenderness on bridge of nose
Wegners granulomatosis causes perforation of ……
Sms (3)
Both cartilage and bony part
Epistaxis, sms of sinusitis, hemoptysis
2 conditions caused by trauma to nose
- Deformity- nasal bone fracture
- B/L nasal block- septal Hematoma
What is sluders neuralgia?
High deviated nasal septum pressing middle turbinate
Also known as anterior ethmoidal nerve syndrome
Cottle’s test is done for …..
Procedure
Deviated nasal septum
Confirm narrowing in neck valve area, ask the patient to pull the cheek outwards, and this should decrease the block.
Rx for DNS
What is crooked nose?
Septoplasty- conservative septal surgery
Deviation of cartilaginous dorsum, bony dorsum and tip on either side —> C or S shaped deformity.
Classes of fracture nose (3)
1: Nasal fracture but septum not involved
2: Involves nasal septum
3: Nasooribitoethmoidal fracture with CSF leaks
Blow from below nose causes …..fracture
Blow from front of nose causes ….#
- Chevallet
- Jarjavay
Rx for nasal trauma
- No swelling- immediate closed reduction - walsham forceps
- Swelling- wait 7 days let edema subside then closed reduction.
Walsham forceps used for ….
Asch’s septum forceps used for ….
Reducing nasal bone fracture
Reducing nasal septal fracture
Fractures of maxilla/face
Le fort 1: transverse maxilla
Lefort2: pyramidal, over the nose
Damages infraorbital n
Lefort 3: through the orbit-> cranial facial dysfunction
Mc fracture of body is …..
Second mx is ….
Third mx is …..
- Clavicle
- Wrist
- Nose
Mc site of mandibular fracture is ….
When bone breaks at 3 places it’s called …
Tear drop sign on Ct is ….
Subcondylar region - dingman classification is used
Zygomatic fracture-tripod fracture
Blow out orbital fracture
Mc cause of oroantral fistula
Inverted papilloma is also known as ….(3)
Extraction of upper first molar
Transitional cell papilloma/ schmeiderian papilloma/ ringertz Tumor
Mc benign tumor of nasal cavity is …..
Premalignant condition ; leads to ….
Arises from …..
Inverted papilloma
SCC
Lateral wall of nose
Sms of inverted papilloma (3)
Rx for inverted papilloma is …
Nasal obstruction
Rhinorrhoea
U/L epistaxis
Adequate local excision
Ca paranasal sinus due to leather and nickel is …..
Ca paranasal sinus due to wood dust is …..
Squamous cell carcinoma
Adenocarcinoma
Mc cancer of PNS is …at ……
What is ohngren’s line? Importance
Squamous cell cancer
Maxillary sinus
Theoretical line that connects medial canthus of eye to angle of mandible
Any tumor above line is poor prognosis- due to closeness to orbit.
- Rx for maxillary sinus is …
- ………incision is used
- Ethmoidal sinus cancer is due to ….
- ……..invasion seen in adenoid cystic cancer
- Radical maxillectomy
- Weber Ferguson incision
- Extension of maxillary sinus cancer
- Perineural invasion
Mc site for NPC cancer is ….in ……
Mc type of NPC cancer is….
Fossa of rosenmuller in lateral wall of NP
It’s a hidden area, can’t find cancer till it enlarges and causes glue ear
Squamous cell cancer
Nasopharyngeal cancer is Common in …..regions
Risk factors for NPC
Southern China
Southeast Asia
Northeast India
- Consumption of salt cured fish— High in nitrosamines
- Smoking
- Vit C deficient diet
- Insence- polycyclic hydrocarbons
EBV is ……..SCC
Earliest LN affected in NPC is ….
Non Keratinizing undifferentiated
Sentinel LN
What is trotters triad?
Neuralgia in temporoparietal area- CN5
Palatal palsy - CN10
CHL - U/L- glue ear.
Dx and rx for NPC
Ho’s triangle seen with …
Dx: nasopharyngeoscopy + Bx—-> chemoradiation.
Supraclavicular fossa- triangle between medial and lateral ends of clavicle and point where neck meets shoulder.
Mc site of juvenile nasopharyngeal angiofibroma
Site of bleeding during surgery is from …
Superior margin of Sphenopalatine foramen.
Internal maxillary artery
Signs seen with juvenile angiofibroma
What is the Holman miller sign?
Proptosis- frog like deformity
Cheek swelling
Bowing of posterior wall where tumor pushes maxilla forward- seen on CECT.
MRI findings of angiofibroma
What is Hondusa sign? Suggestive of ….
Salt and pepper appearance- similar to glomus tumor!
Widening of gap between ramus of mandible and maxillary body. Right>left.
Suggestive of infratemporal fossa involvement.
Rx of choice is …..
Recurrence via common.
Rx for angiofibroma is ….
Open excision
Preoperative estrogen/flutamide -shrink the tumor.
Angiofibroma is hormone sensitive tumor.
Main source of blood supply for angiofibroma is ….
What is stage 1 of angiofibroma?
Maxillary artery - embolise this artery to prevent blood loss during surgery.
Limited to Np
Endoscopic approach
Test for olfaction is …..
Define saccharine test
UPSIT- university of Pennsylvania smell identification test
Test for motility of cilia of nose.
A patient of anosmia can smell ……agent?
What is cacosmia?
What is parosmia?
Ammonia-as it’s an irritant -irritates cn5
Perception of bad smell-Eg: foreign body in nose.
Distorted smell- fruit smelling like rotting flesh
Phantomsmia seen in ….(2)
Perception of unpleasant smell in absence of any disease process.
Temporal lobe epilepsy
Streptomycin toxicity.
What is stankiewick’s sign?
Injury to orbital nerve during FESS.
Fat protrudes into nasal cavity on compression of eyeball from outside
Tea pot sign seen in ….
Dodd’s sign postive in ….negative in ….
CSF rhinorrhoea
Positive: Antrochoanal polyp
Negative: Angiofibroma
Uvula pointing sign seen in …
Wood’s sign seen with …..
Rhinoscleroma
Jugulodigastric LN
Rhinitis medicamentosa seen with …..
Reflex vasodilation secondary to prolonged use of decongestant drops like xylomethazoline/oxymethazoline.
What is rhinophyma?
Complication of acne rosacea
Hyperplasia of sebaccous tissue on skin of external nose.
Rhinitis sicca
Rhinitis caseosa
Crusting of nasal cavities in people who work in hot, dry,dusty environment.
Cheesy material drains into nose from maxillary sinus.
Cortical olfactory area is …&….
Max perforation in disc battery seen in ….pole of battery
Prepyriform cortex
Amygdaloid nucleus
Negative
Test for :
Lacrimation
Mucociliary flow
Ammonia test -greater petrosal n
Saccharin test
Narrowest area of airway is …..
Mc carcinoma of nose skin is ….
Mulberry appearance of nasal mucus membrane seen with ….
Internal nasal valve.
BCC- rodent ulcer
Chronic hypertropic rhinitis
Mc pediatric malignancy of upper respiratory tract
Mc fibrous dysplasia is ….
Rhabdomyosarcoma
Maxilla
Mc site of osteoma in PNS is ….
Parasympathetic fibers carried by ….ganglion
Frontal sinus
Otic ganglion
Kallaman’s syndrome
Anosmia+ congenital hypogoonadism
What is Samters triad?
Aspirin sensitivity + asthma+ nasal ethmoidal polyposis.
Mostly PG induced.
Define kartegeners syndrome ?
Recurrent sinusistis
Bronchiectasis
Situs inversus
Sterility- due to dynein defect
Sluders sphneopalatine neuralgia define.
Vidian neurectomy. Define
What is NARES?
Rhinorrhoea
Increased lacrimation
Nasal stuffiness
Vasomotor rhinitis
Non allergic rhinitis with eosinophilia syndrome
