Nose Flashcards
what type of epithelium lines the nasal cavity?
roof = olfactory epithelium (allows receptor cells from the olfactory bulb to send information about smell
rest is lined by respiratory epithelium
what bones form the nasal septum?
perpendicular plate of the ethmoid bone
vomer
what nerve supplies the upper half of the nasal cavity?
CN V1
what nerve supplies the lower half of the nasal cavity?
CN V2
describe arterial supply to the lateral wall of the nasal cavity
superior :
- anterior ethmoidal arteries
- posterior ethmoidal arteries
posterior = sphenopalatine artery (traverses sphenopalatine foramen)
inferior = greater palatine artery
anterior = lateral nasal branches of facial artery
what is kieselbachs area?
area on nasal septum which is rich an anastomosing arteries
common site of bleeding
- anterior and posterior ethmoidal arteries
- septal branch of labial artery
- greater palatine artery
- branch of sphenopalatine artery
where is the sphenoethmoidal recess and what drains here?
above the superior nasal concha
drains the sphenoidal sinus
where is the superior meatus and what drains here?
below the superior nasal concha
drains posterior ethmoidal air cells
where is the middle meatus and what are the 2 parts of it?
below the middle meatus
2 parts
- semilunar hiatus
- ethmoidal bulla
what drains into each part of the middle meatus?
semilunar hiatus - frontal sinus - maxillary sinus - anterior ethmoidal cells ethmoidal bulla - middle ethmoidal air cells
where is the inferior meatus and what drains here?
below the inferior nasal concha
drains nasolacrimal duct
how may a nasal fracture present and how is it managed?
bruising, swelling, tenderness, deviation, epistaxis
review after 2-3 weeks once swelling has reduced and manipulate under anaesthetic
4 risks which accompany nasal fracture?
recurrent epistaxis
CSF leak/meningitis
anosmia
septal haematoma
what are the dangers of a septal haematoma?
can lead to perichondrium separation, de vascularisation of the cartilage, necrosis and infection
where does epistaxis usually occur from?
kiesselbachs area (anastomising arteries on the septal wall)
how is mild epistaxis managed?
lean forward
external compression
ice
how is moderate epistaxis managed?
silver nitrate vessel cautery or electrocautery
how is severe epistaxis managed?
nasal packing post nasal packing topical vasoconstriction rhino packs consider arterial ligation in severe bleeds
viral vs bacterial vs secondary bacterial sinusitis?
viral = lasts less than 10 days
bacterial = lasts over 10 days, but less than 4 weeks
secondary bacterial = viral infection which seems to get better then worsens a few days later
symptoms of sinusitis?
purulent nasal discharge
nasal obstruction
facial pain/pressure over sinuses
how is acute viral sinusitis managed?
analgesia decongestants intranasal corticosteroids ipratropium mucolytics
how is acute bacterial sinusitis managed?
watchful waiting for >10 days and then commence antibiotics
- 1st line = penicillin for 7 days
- 2nd line = doxycycline for 7 days
plus same management as viral
how is sinusitis managed in immunosuppressed?
immediate antibiotic treatment and ENT specialist referral
what is chronic sinusitis?
lasting more than 12 weeks
how is chronic sinusitis investigated?
anterior rhinoscopy flexible nasoendoscopy imaging - sinus CT (for pre surgical staging) sinus MRI (shows intracranial spread, fungal infections etc)
how is chronic sinusitis managed medically?
antibiotics
decongestants
intranasal corticosteroids
oral corticosteroids (if oedema or polyps present)
anti-histamines/anti-leukotrienes if complicated with allergic rhinitis
how is chronic sinusitis managed surgically?
FESS (functional endoscopic sinus surgery)
- increases diameter of sinus opening to allow drainage of sinuses
what are the 2 groups of rhinitis?
allergic
non-allergic
what is allergic rhinitis?
inflammation of the nasal cavity due to a type 1, IgE associated response to indoor and/or outdoor environmental allergens
e.g - pollens, mould spores, animals, feathers, dust mites
how is allergic rhinitis investigated?
skin prick allergy test
RAST testing
how is allergic rhinitis managed?
oral anti-histamines (cetirizine) intranasal antihistamines (azelastine) intranasal corticosteroid (beclomethasone) 2nd line = leukotriene receptor antagonists (e.g montelukast) - helpful in patients with persistent asthma
what are the 2 types of non-allergic rhinitis?
vasomotor
NAR eosinophilic syndrome
how does non-allergic rhinitis occur?
regulated by autonomic innervation of the nasal cavity
reacts to changes in temperature, humidity, stress, hormonal changes
how is non allergic rhinitis diagnosed?
negative findings in skin prick testing and serological IgE testing
how is non allergic rhinitis managed?
iptrtropium for vasomotor
nasal saline irrigation, intranasal antihistamines + intranasal corticosteroids + oral decongestant
surgical = CO2 laser turbinectomy
what are nasal polys and where do they usually come from?
swellings in the nasal cavity formed of oedematous mucosa
usually occurs from the ethmoidal sinuses - presenting bilaterally in the middle meatus causing obstruction
can sometimes occur from maxillary sinuses (antrochoanal polyps)
what causes nasal polyps?
samter’s triad (aspirin intolerance, asthma, nasal polyps)
EGPA
what presentation of nasal polyps required further investigation?
if occurring in children
if unilateral
how are nasal polyps managed?
intranasal corticosteroids (beclomethasone)
oral corticosteroids if severe
surgical polypectomy
what are inverting papillomas?
wart like unilateral projections into the nasal cavity or paranasal sinuses
benign but can become malignant in 5-15% of cases
symptoms of inverting papillomas?
anosmia
bleeding
irritation
occlusion
what causes inverting papillomas?
unknown
can be virus (HPV)
industrial contaminants
pollution
how are inverting papillomas managed?
all papillomas are removed
radiotherapy may be required for malignant inverting papillomas
what is the most common cancer of the nasal cavity?
SCC
2nd = adenocarcinoma
risk factors for nasal cancers?
work exposure hard woods (saw dust) - adenocarcinoma risk glues dyes chemicals HPV infection smoking
how are nasal cancers managed?
complete surgical resection and adjuvant radiotherapy
