Pathology of Nose and Paranasal Sinuses Flashcards
What is the medial wall of the nasal cavity formed by?
The nasal septum
What does the nasal septum consist of?
- The perpendicular plate of the ethmoid bone
- Septal cartilage
- Vomer
What does the septal cartilage rely on for its blood supply?
The overlying perichondrium
Where does the septal cartilages’ blood supply have important clinical implications?
For injuries involving the nasal septum
What is the clinical implication for injuries involving the nasal septum?
Septal haemotoma
What causes a septal haematoma?
Trauma to the nose leading to buckling of the septum, and shearing of the blood vessels
What happens in a septal haemotoma?
Blood collects in the space between the septum and its perichondrium
What is the result of blood developing between the septum and its perichondriuM?
It lifts the perichondrium off the cartilage, stripping away its blood supply
What does the pressure of the accumulating blood do in a septal haemotoma?
It causes ischaemia of the cartilage
What happens if a septal haemotoma is not recognised and drained in a timely fashion?
- Irreversible avascular necrosis of the cartilage can occur
- Infection development in collecting haemotoma
What does avascular necrosis of the cartilage cause in a septal haemotoma?
Cosmetic distortion of the nose - saddle deformity
What does septal abscess formation increase the likelihood of?
Avascular necrosis of the septum
What is sinusitis?
Acute inflammation of the lining of the sinuses
How long does sinusitis last?
Under 4 weeks
When can sinusitis occur?
Following a viral infection of the nasal mucosae, e.g. a cold
What does sinusitis cause?
- Mucosal oedema
- Impedence of ciliary function
- Increase in mucosal secretions
When may drainage from the sinuses become obstructed?
If the oedema involves their opening into the nasal cavity
What does obstruction of the sinuses cause in sinusitis?
This, combined with increased mucosal secretions, leads to a stagnant pool collection within the sinus
What can sometimes happen when a stagnant pool collects in sinusitis?
It can become secondarily infected with bacteria
Which sinus is particularly prone to infection?
The maxillary sinus
Why is the maxillary sinus the most prone to infection?
Most likely becasue of the location opening high on the medial wall of the nasal cavity
What increases the risk of sinusitis?
Conditions which may block the ostia of sinuses
Which conditions may block the ostia of sinuses?
- Nasal polyps
- Deviated septum
When may a dental infection cause sinusitis?
When it involves the upper teeth
How is a diagnosis of sinusitis made?
Based on history and clinical examination alone
What are the symptoms of sinusitis?
- Non-resolving cold or flu-like illness that persists for more than a week
- Pyrexia
- Rhinorrhoea +/- green/yellow discharge
- Headahe/facial pain (in area of affected sinus), worse on leaning forward
- Blocked nose
How is sinusitis managed?
Most cases are self limiting, and can be treated with simple analgesics. They start to improve within 1-2 weeks
When may a course of antibiotics be required in sinusitis?
If secondary bacterial infection is suspected
What complications can arise from sinusitis?
Orbital cellulitis
How may orbital cellulitis occur in sinusitis?
Infections of the air cells of the ethmoidal sinuses may break through the thin medial wall of the orbit, causing orbital cellulitis
What is problem with orbital cellulitis?
Spread of infections into the orbit can be potentially sight threatening
Why may infections of the orbit be sight threatening?
They may involve the optic nerve
How may orbital cellulitus progress?
May track back further to involve intracranial structures
What is an epistaxis?
A nosebleed
Describe the prevalence of epistaxis
Very common
How are epistaxis usually managed?
Often minor, so usually self-treated with simple first-aid measures, by pinching in front of (not on) the bony bridge of the nose, and applying a cold compress
What is the arterial supply of the nasal cavity from?
Mainly from branches of the maxillary artery
What branches of the maxillary artery supply the nasal cavity?
- Sphenopalatine
- Greater petrosal
What % of nosebleeds come from the sphenopalatine artery?
10%
Why can nosebleeds from the sphenopalatine area be particularly problematic?
Blood in this vessel tends to be at higher pressure, and as it is posteriorly located in the nasal cavity, harder to reach to stop the bleed
Other than branches of the maxillary artery, what contributes to the nose’s rich blood supply?
Ethmoidal branches from the opthalmic artery, and a branch of the facial artery
What is the opthlamic artery a branch of?
The internal carotid artery
What forms Little’s area?
Anastomoses of the opthlamic artery (ethmoidal branches), facial artery, greater petrosal, and sphenopalatine artery
What is Little’s area also known as?
Keiselbach’s Area or Plexus
What is Little’s Area?
A cartilaginous part of the septum
What % of nosebleeds originate from Little’s area?
90%
When may nosebleeds occur?
Spontaneously, or with very minor trauma to the nose
What may sometimes be the cause of nosebleeds?
Underlying systemic causes;
- Abnormal coagulation
- Connective tissue disorders
What can happen is serious nosebleeds occur?
Can potentially risk significant blood loss, and rarely even death
How is a serious nosebleed managed?
- Applying simple compression and leaning forwards
- Cauterise a visible bleeding point using silver nitrate
- Anterior packing using nasal tampons
- Posterior packing
- Surgical intervention
What do nasal tampons do?
Expand within the nasal cavity, and tamponade the area of bleeding
What surgical interventions are taken in a serious nosebleed?
- Embolism
- Ligation of blood vessels
What should be monitored in severe epitaxis?
- ABCs
- Blood tests to check Hb levels and clotting
What should happen regarding underlying systemic consequences in severe epitaxis?
They should be sought and treated
What are nasal polyps?
Benign, fleshy swellings arising from nasal mucosa
Do nasal polyps usually affect one or both sides of the nasal cavity?
Both
Describe the appearance of nasal polyps
Pale or yellow in appearance, or flesh coloured and reddened
Who are nasal polyps most common in?
Those over 40 years
What are the symptoms of nasal polyps?
- Blocked nose and watery rhinorrhea
- Post nasal drip
- Decreased smell and reduced taste
What might suggest a tumour instead of a polyp?
Unilateral polyp, with or without blood-tinged secretion
How are nasal polyps treated?
Nasal spray, to reduce size
How do you differentiate between a nasal polyp and a turbinate?
Polyps are mobile if poked, and can’t be felt, whereas turbinates are immobile and painful if poked
What is rhinitis?
Inflammation of the nasal mucosal lining
What are the common causes of rhinitis?
- Simple acute infective rhinitis
- Allergic rhinitis
What causes simple acute infective rhinitis?
Common cold
What causes allergic rhinitis?
Hayfever
What are the symptoms of rhinitis?
- Nasal congestion
- Rhinorrhoea
- Sneezing
- Nasal irritation
- Postnasal drip
