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Head and Neck and CNS > Para-nasal sinuses > Flashcards

Para-nasal sinuses Flashcards

1
Q

what are the 4 types

A

ethmoid, maxillary, sphenoid, frontal

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2
Q

what does the sinuses communicate with

A

the nasal cavity, PNS discharges fluid into the meatus, which lie at the middle conchae

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3
Q

frontal sinus

A

frontal bone
compartmentalised

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4
Q

ethmoid sinus

A

back of the NC, between orbits
small sinuses = ethmoid air cells [ant, middle, post]
least common

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5
Q

sphenoid sinus

A

roof of the NC

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6
Q

maxillary sinus

A

largest group
most common site
either side of the NC, underneath the zygoma
discharge fluid into the meatus, which lie at the middle conchae

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7
Q

what is a build up of fluid called

A

sinusitis

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8
Q

what lines the PNS

A

respiratory mucosa
goblet secreting cells, in which mucus drains into the NC
highly vascularised, ciliated columnar

olfactory mucosa lines the NC not the PNS

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9
Q

what is the blood supply

A

arterial: facial artery, a branch from the internal carotid artery
common carotid -> external + internal carotid which supplies the different regions

venous: lateral nasal vein -> facial vein -> IJ vein -> brachiocephalic -> IVC

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10
Q

what is the lymph supply

A

buccal nodes
parotid nodes
submandibular nodes

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11
Q

what is the nerve supply

A

sensory innervation
- opthalamic division
- maxillary division of the trigeminal nerve

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12
Q

what is the function

A

respiratory: warms and humidifies moistens inspired air
olfactory: nerve endings at the cribiform plate detects smell
speech: resonating chamber

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13
Q

what is the only sinus that uses TNM

A

maxillary

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14
Q

what shape is the maxillary sinus

A

pyramid shape: base of the pyramid forms lateral wall of the NC, apex extends to the zygomatic process

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15
Q

what does the superior aspect of MS comprise of

A

floor of the orbit and the ethmoid sinus

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16
Q

what does the inferior aspect of the MS comprise of

A

alveolar process and typically lies below the NC

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17
Q

describe the infra-orbital nerve

A

transverses the roof of the sinus whereas the second and first molar teeth, typically project the sinus floor. posterior wall extends into the infratemporal and pherygopalatine fossae

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18
Q

what does the MS drain

A

ostum maxillae beneath the middle conchae

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19
Q

describe the frontal sinus

A

full size at puberty
drains into the NC through the middle meatus beneath the middle conchae via the frontal nasal duct

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20
Q

how can tumours in the frontal sinus present

A

bone swelling

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21
Q

describe the location of the ES

A

upper part of the NC and between orbits
ant and middle drain into the NC via the middle meatus and posterior drains via the superior meatus beneath the superior conchae

22
Q

where do the ES lie in respect to the optic nerves

A

optic nerves lie posterior to the sinus and the anterior cranial fossa lies superiorly

23
Q

what pathology is ES commonly

A

adenocarcinoma

24
Q

what separates the sinus from the orbit and NC

A

lamina papyracea

25
how is ES tumours presented
nasal obstruction and loss of smell
26
describe the location of the sphenoid sinus
deep in the base of the skull, beneath the pituitary gland nasopharynx lies inferior and NC anterior optic nerve and cavenous lies laterally
27
where does the sphenoid drain into
the NC via the sphenoethmoidal recess above the superior conchae of the NC
28
what is the presentation for a sphenoid tumour
deep seated pain, cranial nerve palsies
29
what is the lymphatic drainage
retropharyngeal and upper deep cervical
30
what does presentation related with
tumour location
31
what are the tumour presentation relations in terms of the MS
inf = pain in the teeth + ulceration inf + post = trismus sup =. proptosis and diplopia medial = nasal stiffness with discharge ant + lat = mass in cheeks infraorbital nerve involvement can lead to numbness in the cheeks
32
diagnosis and staging
- inspection of the OC - plain x-ray = bone erosion - CT + MRI = locoregional staging - CT = bony detail - MRI = tumour distinction from adjacent structures - orthopantogram = tooth preservation assessment - histology assessment on cells - nasal speculum = upper airway endoscopy
33
are LN mets rare
yes
34
do they have early or late presentation
late
35
what should be inspected
the air filled cavities with an endoscope
36
what is the ohngrens line
theoretical line which divides the MS, from the medial canthus to the angle of the mandible in the lateral plane
37
where can they spread to
to other adjacent sinuses via the mucosal layer
38
what are the sinuses line with
ciliated columnar epithelium
39
what are the pathological types
adenocarcinoma, adenoid cystic carcinoma, melanoma and lymphoma
40
what do the sinuses do
lighten the skull, gives resonance to voice
41
with good clearance with surgery what is the 5 year survival rate
50%
42
what is the survival rate
25-30%
43
what is the surgery types
endoscopic resection craniofacial resection matxillectomy (with or without exenteration) partial or total maxillectomy, ethmoidectomy and/or sphenoidectomy vascularised flap reconstruction all dependent on size, extent, stage and type
44
what is the treatment for M + E
surgery + post op RT [except for rare T1 lesions]
45
describe RT
concurrent with chemo post-op given to operative bed [tumour location and spread] volume irradiation correlates with the investigation findings tongue depressor moves inferiorly out of the volume, volumes need to be delineated with contrast retropharyngeal nodes need to be included IMRT: improved coverage and sparing
46
do PNS have good local control
no, risk of treatment related sequelae
47
describe ethmoid RT
difficult to irradiate lies between the optic nerves surgery + RT = increased local control CTV = medial portion of maxilla, pterygoid fossa, ethmoid sinus + nasal fossa 3 field plan: ant + 2 lat 66-70Gy in 33-35 fractions
48
what is the margin and fields for the NC
CTV = lesion + 1cm margin field = ant wedged pair whole NC = ant + lat field
49
MS antrum RT
supine mouthbite: lower OC + tongue out of the field PTV close to the optic nerves, chiasm, orbit, temporal lobe and brainstem CTV = M + ES, NC, pterygoid fossa + lat pharyngeal node shielding of the brain stem, optic pathway, eyeball, lacrimal gland, and orbit heavy weighted anterior and one/ two lateral field, non divergent field border, avoid exit dose to lens, 5-10 degree gantry angle 65-70Gy in 30-35 fractions superior border of lat fields may be reduced to 50Gy to avoid exceeding optic nerve
50
columella RT
extensive = 2/3 field superficial = direct ant electron field wax block and wax nose plugs, produce homogenous tissue density for dose deposition confined: 55Gy in 20 extending upper NC = 65-70Gy in 30-35
51
olfactory neuroblastoma
rare surgery + adj RT chemo for advanced CTV is pre-operative GTV with a 1cm margin margin includes bilateral NC, ES, cribiform plate, olfactory bulb three field, IMRT optic nerve and chiasm close by 60Gy in 30

Head and Neck and CNS (12 decks)

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