Nose Flashcards
What are the bony projections on the lateral nasal wall called?
Turbinates
What is the tin plate of bone that separates the erythroid sinuses from the orbit called
lamina papyracea
The lamina papyracea is very thin, what are the implications of this regarding disease?
Infections from sinuses can spread to the orbit, brain and meninges
In what three pt groups does epistaxis commonly occur?
Children
Elderly
Middle aged
From what major blood artery are the blood vessels in the nose derived from?
Internal and external carotid
What name is given to the area in the nose where the blood vessels converge and what is the significance of this?
Little’s area
Common site of bleeding
What vascular feature is a common source of bleeding in children?
reterocolumellar vein - prominent vein running between the junction of the skin and mucosa of the nasal septum
3 steps to stopping a nosebleed
Pressure for 10 mins on fleshy part of nose
cautery with local anaesthetic
nasal packing
4 causes other than HTN and trauma that can lead to recurrent epistaxis?
Anticoagulant therapy Thrombocytopaenia Leukaemia Haemophilia Telangiectasia
What chemical is commonly used to cauterise the nose to prevent recurrent nose bleeds?
Silver nitrate
4 broad causes of septal perforation
Trauma Surgery Infections Vasculitic conditions Recreational drug use
What infections can cause a septal perforation?
Syphilis
TB
Why is a septal haematoma bad news for the cartilage?
It’s a bleed under the perichondrium that lines the cartilage. So blood supply will be interrupted and necrosis can occur.
What is the treatment for a septal haematoma and why does this need to be done quickly?
Drain the blood.
Otherwise necrosis of the cartilage can occur
If necrosis occurs following a septal haematoma what is the possible consequence of this?
Septal perforation
If someone comes into A&E with a smashed nose, what do you need to check for?
Septal haematoma
If someone breaks their nose, when should they/you try and reset it?
Immediately following injury
Otherwise wait for 1 week for swelling to go down
After 3 weeks surgery will be required
How long have you got to treat a septal haematoma before necrosis occurs?
48 hours
Other than obvious trauma, how does a septal haematoma present and what would you see in inspection?
Progressive nasal obstruction
Large, soft bluish, red swelling
If there is clear nasal discharge following trauma what should you suspect is going on and what might be damaged ?
CSF leak
Cribriform plate
If you suspect someone has a CSF leak, how can you test it to check?
Glucose test - should be similar to serum
2 transferrin - protein present in CSF and perilymph
What is the management of CSF leak?
Most resolve themselves
Otherwise require surgical intervention
What should pts be advised that there is a risk of until a CSF leak resolves?
Meningitis
What is acute rhinosinusitis?
Acute inflammatory condition of the nose and paranasal sinuses
ARS is defined as a sudden onset of two or more symptoms, one of which should be either…..?
Nasal blockage/congestion/obstruction nasal discharge (anterior or posterior)
In addition to nasal symptoms, what else might the patient complain of?
facial pain/pressure
loss/reduction of smell
To be diagnosed with ARS how long can the symptoms be going on for?
Less than 12 weeks
What is ARS usually caused by?
preceding viral URTI which leads secondarily to a bacterial infection
What are the 5 pathophysiological steps in the development of ARS?
Viral URTI Mucosal Oedema of nose and para nasal sinuses Blockage of sinus drainage Stasis of mucosal secretions Secondary bacterial infection
What are the most common bacterial pathogens in the development of ARS?
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
A pt with preceding history of coryzal illness, clear rhinorrhoea, nasal congestion, fever and malaise will go on to develop what is they have ARS? 5
Prurulent rhinorrhoea Nasal congestion (more marked) Facial pain/pressure Hyposmia or altered taste Dental pain
3 principles of management of ARS/
Analgesia (NSAIDS)
Decongestants (topical or systemic)
Antibiotics (amoxicillin, cephalosporins)
What is the most common complication of ARS, notably in children?
Peri orbital cellulitis
How does periorbital cellulitis develop from ARS?
Infection spreads through lamina papyracea or via venous thrombophlebitis
What are the implication if periorbital cellulitis is not treated promptly?
Orbital cellulitis - blindness
subperosteal/orbital bacess
cavernous sinus thrombosis - death
What is the management of periorbital cellulitis?
hospital admission
IV antibiotics
What is the most common intercranial complication of ARS?
Subdural abcess
If ARS causes osteomylitis of the frontal bone what can this result in?
Subperiosteal abscess known as Potts puffy tumour
Chronic rhinosinusitis is the nasal symtoms of ARS plus either…?
Endoscopic signs of; polyps mucopurulent discharge oedema CT changes of mucosal complex
Which meatus is usually affected in rhinosinusitis and what is this located lateral to?
Middle meatus
Middle turbinate
Which sinuses drain through the middle meatus?
Maxillary
Frontal
anterior erythmoid
Which sinuses drain through the superior meatus?
Posterior erythmoid
Sphenoid
What aetiologial factors would predispose someone to CRS?
Atopy Ciliary dysfunction - cystic fibrosis NSAID sensitivity Immune dysfunction Airway disease
What is the mainstay of CRS management?
Topical and oral steroids
antibiotics]saline nasal irrigation
Allergy investigation and avoidance
