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Clinical Anatomy > Nose And Paranasal Sinuses > Flashcards

Nose And Paranasal Sinuses Flashcards

1
Q

What is littles area?

A

Also called kiesselbachs plexus, a highly vascularised area on the nasal septum

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2
Q

Causes of epistaxis (local/systemic)

A

Local: Idiopathic (85%), traumatic, iatrogenic, foreign body, inflammatory (rhinitis, polyps), neoplastic

Systemic: hypertension, coagulopathies, vasculopathies, Hereditary Haemorrhagic Telangiectasia

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3
Q

Management of epistaxis

A

First Aid - pinch soft part of nose, head forward, spit out blood in mouth
Examination - locate source of bleed, anterior or posterior?
Cautery - silver nitrate or bipolar diathermy
Nasal packing - initially anterior pack, then posterior
Surgical - ligation of sphenopalatine, anterior ethmoid, external carotid (last resort)

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4
Q

Common causes of Nasal trauma

A

Assault
Sports
Falls
RTAs

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5
Q

Complications of nasal bone fracture

A

Septal haematoma leading to avascular necrosis and deformity

CSF leak with associated skull base fracture

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6
Q

Management of nasal bone fracture

A

ABCs
Examine for septal haematoma
If deviated nose consider manipulation under anaesthetic within 2 weeks of injury

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7
Q

Structures at risk during paranasal sinus surgery

A

Lamina papyracea (medial wall of orbit) - lateral to the ethmoid sinus. Loss of colour vision or loss of sight

Anterior cranial fossa - lies just above sphenoid and ethmoid sinus, can be breached and cause CSF leak or brain damage

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8
Q

Site of drainage of sphenoid sinus

A

Sphenoethmoidal recess

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9
Q

Site of drainage of posterior ethmoid sinus

A

Superior meatus

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10
Q

Site of drainage of frontal sinus

A

Middle meatus

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11
Q

Site of drainage of maxillary sinus

A

Middle meatus

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12
Q

Site of drainage of anterior ethmoid cells

A

Middle meatus

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13
Q

Site of drainage of nasolacrimal duct

A

Inferior meatus

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14
Q

Define rhinosinusitis

A

Inflammation of the nose and paranasal sinuses characterised by two or more symptoms, 1of:
Nasal blockage/congestion or discharge
Facial pain/pressure
Reduction or loss of smell

AND 1 of:
Endoscopic signs of polyps, mucopurulent discharge/oedema in Middle meatus
CT Changes

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15
Q

Define Acute and Chronic Rhinosinusitis

A

Acute = 12 weeks, without complete resolution. Divided into CRS with polyps and CRS without polyps

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16
Q

Viral ARS causes

A

Rhinovirus
Influenza virus
Resolution of symptoms within 5 days

17
Q

Non viral ARS causes

A

Persistence of symptoms after 5 days, caused by super added bacterial infections:
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

18
Q

Predisposing factors to ARS

A

Allergy

Ciliary impairment

19
Q

Management of ARS

A

Analgesia if required
Nasal decongestants
If persists for five days consider topical nasal steroids and oral antibiotics

20
Q

Predisposing factors to CRS

A 
Allergy
Infections
Ciliary impairment eg. Cystic fibrosis 
Anatomical abnormalities eg. Septal deviation
Immunocompromised host 
Aspirin hypersensitivity 
Hormonal eg. Pregnancy, hypothyroidism
Trauma
Foreign body
21
Q

Investigations of CRS

A

Skin prick test if allergy suspected

CT sinuses

22
Q

Management of CRS

A

Conservative - avoidance of allergens
Medical - antihistamines, topical nasal steroids, oral steroids (severe), oral antibiotics
Surgical - nasal polypectomy, functional endoscopic sinus surgery to improve ventilation/drainage

23
Q

What is allergic rhinitis?

A

IgE mediated type 1 hypersensitivity reaction in the mucous membranes of the nasal airways.
Allergic reaction leads to mast cell degranulation to release histamine. Increases capillary permeability leading to congestion, oedema, rhinorrhoea, sneezing and irritation

Allergens include pollens, moulds, house dust mites

24
Q

How is allergic rhinitis classified?

A

By duration:
Intermittent = symptoms 4 days a week, more than 4 weeks

By severity:
Mild = normal daily activities, normal sleep, no troublesome symptoms
Moderate - severe = impairment of daily activities and sleep

25
Q

Investigation of allergic rhinitis

A

Skin prick test for specific allergens

26
Q

Treatment of allergic rhinitis

A

Conservative - allergen avoidance
Medical - antihistamines, topical nasal steroids
Immunotherapy

27
Q

Cause of peri orbital cellulitis

A

Direct spread of pus from the ethmoid sinus through Lamina papyracea, or from thrombophlebitis of mucosal vessels in any of the sinuses

28
Q

Symptoms of peri orbital cellulitis

A 
Pain
Oedema of eyelids
Proptosis 
Reduced eye movements 
Reduced colour vision
29
Q

Investigation and treatment of periorbital cellulitis

A

Investigation - test colour vision (red/brown), CT Scan

Management - IV antibiotics, nasal decongestants, urgent surgical drainage of any abscess

30
Q

Describe the blood supply to the nose

A

ECA - superior labial artery, sphenopalatine artery, greater palatine artery

ICA - anterior ethmoidal , posterior ethmoidal

Clinical Anatomy (6 decks)

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