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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
Q

how is ES tumours presented

A

nasal obstruction and loss of smell

26
Q

describe the location of the sphenoid sinus

A

deep in the base of the skull, beneath the pituitary gland
nasopharynx lies inferior and NC anterior
optic nerve and cavenous lies laterally

27
Q

where does the sphenoid drain into

A

the NC via the sphenoethmoidal recess above the superior conchae of the NC

28
Q

what is the presentation for a sphenoid tumour

A

deep seated pain, cranial nerve palsies

29
Q

what is the lymphatic drainage

A

retropharyngeal and upper deep cervical

30
Q

what does presentation related with

A

tumour location

31
Q

what are the tumour presentation relations in terms of the MS

A

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
Q

diagnosis and staging

A
  • 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
Q

are LN mets rare

A

yes

34
Q

do they have early or late presentation

A

late

35
Q

what should be inspected

A

the air filled cavities with an endoscope

36
Q

what is the ohngrens line

A

theoretical line which divides the MS, from the medial canthus to the angle of the mandible in the lateral plane

37
Q

where can they spread to

A

to other adjacent sinuses via the mucosal layer

38
Q

what are the sinuses line with

A

ciliated columnar epithelium

39
Q

what are the pathological types

A

adenocarcinoma, adenoid cystic carcinoma, melanoma and lymphoma

40
Q

what do the sinuses do

A

lighten the skull, gives resonance to voice

41
Q

with good clearance with surgery what is the 5 year survival rate

A

50%

42
Q

what is the survival rate

A

25-30%

43
Q

what is the surgery types

A

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
Q

what is the treatment for M + E

A

surgery + post op RT [except for rare T1 lesions]

45
Q

describe RT

A

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
Q

do PNS have good local control

A

no, risk of treatment related sequelae

47
Q

describe ethmoid RT

A

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
Q

what is the margin and fields for the NC

A

CTV = lesion + 1cm margin
field = ant wedged pair
whole NC = ant + lat field

49
Q

MS antrum RT

A

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
Q

columella RT

A

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
Q

olfactory neuroblastoma

A

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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