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ENT Specialties > Paranasal Sinuses > Flashcards

Paranasal Sinuses Flashcards

1
Q

When performing an external ethmoidectomy, where is the anterior ethmoid artery found?

A

2.5 em posterior to the lacrimal crest in the frontoethmoid suture line.

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2
Q

What is the reduction in proptosis after endoscopic medial orbital decompression?

A

3.5 mm.

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3
Q

What is the reduction in proptosis after endoscopic medial decompression and external lateral decompression?

A

3-4 mm.

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4
Q

Where is the posterior ethmoid artery in relation to the optic nerve?

A

5 mm anterior.

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5
Q

What percent of patients with rhinogenic headaches secondary to septal impaction experience relief after surgery?

A

50%.

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6
Q

How long can the retina tolerate high intraocular pressures?

A

6o-go minutes; 15-30 minutes in the presence of an arterial bleed.

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7
Q

What is the optimal graft material for sealing the sphenoid cavity?

A

Abdominal fat.

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8
Q

What are the relative contraindications to the transsphenoidal approach to the pituitary gland (TSAP)?

A

Active sinus infection, limited air cell development, septal perforation, and giant pituitary tumor or vascular tumor that would require wide exposure.

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9
Q

What procedure maximizes visualization of the frontal recess?

A

Agger nasi punch out procedure (POP).

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10
Q

When attempting to remove a suprabullar cell, care should be taken to look for what structure?

A

Anterior ethmoid artery.

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11
Q

Where does one enter the posterior ethmoids endoscopically?

A

At the junction of the oblique and horizontal portions of the basal lamella.

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12
Q

If eye changes occur during surgery, what should be done?

A

Awaken patient, massage eye, and administer IV mannitol, +/- steroids; if pressure is not reduced, perform lateral canthotomy and cantholysis. Next, perform medial orbital decompression by Lynch external ethmoidectomy. Lastly, periorbital incisions can be made.

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13
Q

Where does this most commonly occur?

A

Between the middle turbinate and lateral nasal wall.

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14
Q

What is the most common intraoperative complication ofFESS?

A

Bleeding.

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15
Q

What are the indications for osteoplastic flap and frontal sinus obliteration?

A

Chronic frontal sinusitis refractory to endoscopic surgery; mucopyocele; severe trauma with fractures involving the drainage pathways; after resection of large frontal tumors near the frontal recess.

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16
Q

What should be done for a severe arterial hemorrhage during FESS that cannot be controlled with packing?

A

Compress carotid artery, induce hypotension under general anesthesia, have blood ready for transfusion, call neurosurgery, perform arteriogram with balloon occlusion test; if balloon occlusion is normal, ligate carotid artery. If changes occur, insert Swan-Ganz catheter, administer Hespan, and repeat occlusion test. If still abnormal, carotid bypass or barbiturate coma is indicated.

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17
Q

What is the treatment for a CSF fistula detected postoperatively?

A

Conservative management initially-if still present after 2-3 weeks, surgical closure.

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18
Q

What disease should be considered in an adult patient who underwent sinus surgery prior to 18 years of age?

A

Cystic fibrosis.

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19
Q

How can a cerebrospinal fluid (CSF) fistula be detected intraoperatively?

A

Diluted fluorescein injected intrathecally can be detected intranasally after 20-30 minutes.

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20
Q

What is the name of the procedure where the floor of the frontal sinus is removed but the superior nasal septum is left intact?

A

Draf II.

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21
Q

What problem does an accessory maxillary sinus ostium create?

A

Enables mucous to recirculate back into the sinus.

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22
Q

What are the most common complications of middle meatal antrostomy?

A

Epiphora secondary to nasolacrimal duct injury, synechiae.

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23
Q

What is the safest direction to follow when resecting cells from the frontal recess?

A

From posterior to anterior, avoiding the skull base.

24
Q

Where do most osteoplastic flaps for frontal sinus obliteration fail?

A

Frontal recess and upper anterior ethmoids.

25
Q

What factors predispose to complications from ethmoidectomy?

A

General anesthesia, multiple previous surgeries, advanced disease, long-term chronic or fungal disease, intraoperative hemorrhage, right-handed right-sided surgery, endoscopic right-handed left-sided surgery, surgeon inexperience.

26
Q

What are the most common complications of osteoplastic frontal sinus surgery?

A

Hypoesthesia in the region of the supraorbital nerve, wound infection.

27
Q

What is the basic principle of the Messerklinger approach for functional endoscopic sinus surgery (FESS)?

A

Identify the skull base first then follow it in a posterior to anterior direction.

28
Q

Why is this preferred over muscle?

A

Improved take rate, less atrophy, increased resistance to infection, better sealing, and less donor site morbidity.

29
Q

What are the complications from excessive orbital decompression?

A

Intractable strabismus and hypoglobus.

30
Q

What are the three most important surgical landmarks during endoscopic ethmoidectomy?

A

Lamina papyracea, fovea ethmoidalis, and anterior ethmoid artery.

31
Q

What is the primary advantage of the inferior orbital decompression technique?

A

Large volume for decompression.

32
Q

What external structure serves as a landmark for the fovea ethmoidalis?

A

Medial canthus.

33
Q

What are the three transpalatal approaches to the sphenoid sinus?

A

Midline palatal split, U-shaped incision, S-shaped incision.

34
Q

What are the complications of transsphenoidal approach to the pituitary gland (TSAP)?

A

Numbness of teeth and gums, nasal septal perforation, short-term crusting/dryness of nasal mucosa, and CSF leak.

35
Q

What is the treatment for subcutaneous emphysema after FESS?

A

Observation and reassurance-usually resolves in 7-10 days.

36
Q

What are the indications for orbital decompression?

A

Optic neuropathy, severe proptosis (in excess of 24 mm), exposure keratopathy, acute deterioration in orbital status not responsive to short-term corticosteroids.

37
Q

Orbital hemorrhage occurs most frequently from trauma to which vessels?

A

Orbital veins lining the lamina papyracea and anterior ethmoid artery.

38
Q

If orbital fat is exposed during the operation, why should the nose not be overly packed?

A

Packing may press into the periorbita and posterior chamber, increasing pressure and causing proptosis.

39
Q

For which patients are gravity-dependent inferior antrostomies required?

A

Patients with dysfunctional cilia (immotile cilia, cystic fibrosis).

40
Q

What are the indications for endoscopic frontal sinus drillout?

A

Patients with mucoceles or severe frontal sinusitis in whom previous surgery has failed.

41
Q

Which area of the orbital floor should be preserved during endoscopic orbital decompression?

A

Portion lateral to the infraorbital nerve canal to prevent vertical subluxation.

42
Q

What is the landmark for the posterior extent of bone resection during medial orbital decompression?

A

Posterior ethmoid artery.

43
Q

Is an orbital hematoma a pre- or postseptal injury?

A

Postseptal.

44
Q

How can one differentiate between pre- and postseptal orbital bleeding?

A

Preseptal hematoma is darker, more diffuse with more lid edema; proptosis, chemosis, and mydriasis are characteristic of postseptal hematomas.

45
Q

Why is suprasellar tumor extension not a contraindication to transsphenoidal approach to the pituitary gland (TSAP)?

A

Resection is facilitated by auto decompression of the tumor into the sphenoid cavity.

46
Q

What complication after orbital decompression is most threatening to the vision?

A

Retinal artery occlusion.

47
Q

What adjuvant to endoscopic sinus surgery has been shown to decrease the need for subsequent surgery in patients with cystic fibrosis?

A

Serial antibiotic lavage.

48
Q

What factors increase the likelihood of requiring revision sinus surgery?

A

Smoking, severe diffuse disease preoperatively.

49
Q

Which two eye muscles are most prone to damage during FESS?

A

Superior oblique and medial rectus muscles.

50
Q

What is the most common postoperative complication of FESS?

A

Synechiae.

51
Q

What is bulgarization?

A

Technique to incite synechiae formation between the middle turbinate and septum to prevent the middle turbinate from collapsing and obstructing the osteomeatal complex postoperatively.

52
Q

Why must all mucosae be removed during frontal sinus obliteration?

A

To prevent mucocele formation.

53
Q

Which type of frontoethmoid cells are more likely to necessitate both an above (via trephination) and below (endoscopic) approach for adequate resection?

A

Type III and IV.

54
Q

What are the indications for surgical intervention in patients with sinusitis?

A

Well-documented history, failure of medical management, significant quality-of-life issues; history confirmed with CT scan and nasal endoscopy.

55
Q

If there is no evidence of a CSF leak intraoperatively, is a fat graft still used?

A

Yes, if a thin, bulging diaphragma sella is left, the fat will help prevent secondary empty sella syndrome and the potential for delayed CSF leak.

ENT Specialties (17 decks)

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