Nose/Sinus

Question 1

Functions of the Nose? [9]

Answer 1

• Airway for respiration
• Warming & Humidifying air
• Filtering out large particles
• Immune function
• Olfaction
• Drains paranasal sinuses & nasolacrimal duct
• Drains/aerates middle ear via eustachian tube
• Voice Modification
• Pheromone Detection via Vomeronasal organ (of Jacobson) (in animals)

Question 2

Who is most in need of the nose for respiration? [1]

Answer 2

Neonates, they are obligate nasal breathers.

Question 3

Describe the epithelium of the nasal cavity? [3]

Answer 3

The sinonasal mucosa is the same as most of the resp. tract. [1]
Ciliated Pseudostratified Columnar Epithelium [1] with Goblet Cells [1]

Question 4

How does the nose filter out particles? [2]

Answer 4

Coarse hairs (Vibrisae) in the nasal vestibule [1] catch large particles.
Smaller ones are caught in mucous and cleared by the cilia [1]

Question 5

What is the eustachian tube? [3]

Answer 5

Connects nasopharynx and middle ear [1], to aerate/equalise pressure in the middle ear. [1]
Normally its closed but opens on positive pressure or swallowing [1]

Question 6

What is the nasolacrimal duct? [2]

Answer 6

Carries excess tears from the lacrimal sac to the nasal cavity. [1]
The reason your nose runs when you cry or you can taste eyedrops.
Also known as tear duct [1]

Question 7

What is the function of sinuses? [3]

Answer 7

Debated but we think:

• Help with vocal resonance
• Decrease weight of skull bones
• Buffer for Trauma

Question 8

What are the sections of the external nose? (Locate on self) [6]

Answer 8

Glabella
Nasion
Dorsum
Supratip
Tip
Collumnella

Question 9

What are the bony sections of the external nose? [2]

Answer 9

The frontal process of the maxilla and the nasal bones.

Question 10

What are the borders of the internal nose? [4]

Midline, lateral, roof, floor

Answer 10

Midline - Nasal Septum
Laterally - Turbinates
Roof - Cribriform plate of ethmoid bone
Floor - Hard palate (maxilla and palatine bones)

Question 11

What structures are associated with the internal nose? [2]

Answer 11

The paranasal sinuses

Nasopharynx

Question 12

What is a turbinate? [1]

What is meatus [1]

Answer 12

A bony scroll like projection from the internal lateral wall of the nose. [1]
There are 3:
- Sup
- Middle
- Inf
Each is associated with its respective meatus which drains the sinuses

Question 13

Clinical relevance of inner nose [4]

Answer 13

• Septal deviation
• Septal perforation
• Septal haematoma
• Nasal blockage due to inflamed turbinates

Question 14

How does a septal perforation occur? [2]

Answer 14

Pressure on the blood supply to the septum due to infection, trauma etc. [1]
This leads to necrosis and break down of cartilage leading to perforation. [1]

Question 15

How would we treat inflamed turbinates? [2]

Answer 15

Topical steroid treatment

Or Turbinate reduction surgery

Question 16

List the sinuses in the face? [4]

Answer 16

Frontal
2x Maxillary
Ant/Post Ethmoid
Sphenoid

Question 17

What is drained through the inferior meatus? [1]

Answer 17

Excess tears from the eye (lacrimal sac) along the nasolacrimal.

Question 18

What is drained by the middle meatus? [4]

Answer 18

• Frontal Sinuses
• Maxillarly Sinuses
• Anterior Ethmoid Sinus
• Middle Ethmoid Sinus

Question 19

What is drained by the superior meatus? [1]

Answer 19

• Posterior Ethmoid sinus

Question 20

Rhinosinusitis

- Definition [2]

Answer 20

Rhinosinusitis
- Concurrent inflammation and infection [1] of the nasal passage and paranasal sinuses. [1]

• Acutely its probably bacterial
• Chronic it may be allergic or non-allergic
• Non-allergic comes with or without polyps

Question 21

What are the anatomical relations of the frontal/ethmoid sinuses? [1]

Answer 21

Anterior Cranial Fossa

Question 22

What are the anatomical relations of the maxillary sinus? [1]

Answer 22

The orbits

Question 23

What are the anatomical relations of the sphenoid sinus? [1]

Answer 23

• Optic Nerve
• ICA
• Cavernous Sinus

Question 24

What are the clinical relevance of the anatomical relations of the sinuses? [4]

Answer 24

Spread of infection E.g.:

• Meningitis
• Intracranial Abscess
• Orbital Sepsis

Risks from surgery E.g.:
- Orbital complications from sinus surgery

Question 25

Explain the nasal blood supply? Anterior [3] Posterior [3]

Answer 25

Anterior of the nose:
ICA -> Opthalmic Art -> Ant/Post Ethmoid Art.

Posterior of the nose:
ECA -> Maxillary -> sphenopalatine

Question 26

Define epistaxis [1]
Where does it occur most commonly [1]
Causes [5]

Answer 26

Epistaxis:
(acute haemorrhage from the nose)
Usually occurs in little’s area (anterior of nasal cavity)

Caused by:

• Trauma
• Anticoagulants
• Iatrogenic (surgery)
• Idiopathic
• Hypertension

Question 27

Explain the nervous innervation of the nose? [3]

Answer 27

Most of the nasal cavity is supplied by the pterygopalatine ganglion at the back of the cavity. [1]
It in turn is mainly facial nerve with some maxillary (Trigeminal V2) involvement… [1]

The olfactory bulb inserts fibres through the roof of the nasal cavity and inserts directly into the forebrain. [1]

Question 28

Clinical relevance of the nose nerves? [3]

Answer 28

Olfactory dysfunction can occur due to rhinosinusitis, post-viral anosmia (loss of smell) or trauma.

Question 29

What drains the sphenoid sinus? [1]

Answer 29

The spheno-ethmoid recess