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HNN > Session 9 B > Flashcards

Session 9 B Flashcards

1
Q

Functions of nose and nasal cavity

A

Olfaction
Filtering
Humidifying and warming inspired air
Drainage of secretions from paranasal sinuses and nasolacrimal ducts

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2
Q

External nose is predominantly

A

Cartilaginous, however frontal processes of maxillae and 2 nasal bones form root

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3
Q

Complications of nose injuries

A

Septal haematoma, septal deviations and nasal bone fractures

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4
Q

Describe Nasal cavity

A

Extends from nostrils anteriorly (anterior nasal apertures)

To posterior nasal apertures (choanae)

Has a roof, floor and 2 walls

Opens into most superior part of pharynx, Nasopharynx

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5
Q

Medial wall of nasal cavity is formed by

A

Nasal septum - perpendicular plate of ethmoid bone, septal cartilage and vomer

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6
Q

Cartilaginous portion of septum relies on

A

Overlying perichondrium for blood supply

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7
Q

Clinical implications of injuries involving nasal septum

A

-Septal haematoma
-blood collects in space between cartilagenous septum and perichondrium
-Lifts perichondrium off cartilage, stripping away blood supply
- Pressure of accumulating blood causes ischeamia of cartilage

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8
Q

Outcomes of septal haematoma

A

Must be recognised and drained in timely fashion, irreversible necrosis occurs if not

Saddle deformity- cosmetic distortion of the nose

hence important to inspect nasal septum after any sort of nasal trauma

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9
Q

What are these

A
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10
Q

Describe the paranasal cavities or sinuses

A

4 major ones

Maxillary, frontal, ethmoidal and sphenoid

All paired except sphenoid, maxillary is largest

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11
Q

Ethmoidal sinuses collectively consist of the

A

Anterior, middle and posterior air cells

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12
Q

Describe paranasal sinuses anatomy

A

Air-filled spaces

Lined with respiratory mucosa (ciliated Pseudostratified columnar with goblet cells)

Communicate with nasal cavity via openings e.g. middle meatus

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13
Q

Obstruction to drainage from a paranasal sinus can lead to

A

An accumulation of mucosal secretions, development of acute sinusitis

Pain and tenderness over sinus involved, nasal discharge, general systemic upset (fever, feeling unwell)

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14
Q

Causes of sinusitis

A

Infections of nose (infective rhinitis)

Dental infections (roots of some of the upper teeth lie on floor of maxillary sinus)

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15
Q

4 paranasal air sinuses

A
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16
Q

What is sinusitis

A

Inflammation of the lining of the sinuses and can occur following a viral infection of the nasal mucosae

Spreads to involve sinuses

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17
Q

Paranasal sinus infection causes

A

Mucosal oedema, impedance of ciliary function and increasing mucosal secretions

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18
Q

What can happen if drainage from sinuses become obstructed

A

Oedema involves openings into nasal cavity

Obstruction combined with increased mucosal secretions leads to a stagnant pool collecting within sinus

Secondarily infected by bacteria

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19
Q

Which sinus is prone to infection

A

Maxillary sinus- antrum

Location of its opening high on the wall of the nasal cavity

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20
Q

Diagnosis and treatment of sinusitis

A

History and clinical examination

Self-limiting, treated with simple analgesics, improve within 1-2 weeks

Antibiotics needed if secondary bacterial infection suspected (prolonged, severe symptoms)

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21
Q

Complications from sinusitis

A

Rare

Ethmoidal sinuses= break through thin medial wall of orbit

Infection spreads to orbit = orbital cellulitis

Potentially sight threatening as may involve optic nerve, track back further to involve intracranial structures

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22
Q
A
23
Q
A
24
Q
A
25
Q

Role of concha and meatuses

A
26
Q

Lateral wall of nasal cavity

A
27
Q

Medial wall of nasal cavity

A
28
Q

What is this

A

Septal haematoma

29
Q
A
30
Q

Features of nasal bone fracture

A
31
Q

Features of blood supply to nasal cavity

A

rich

Allows humidification and warming

Anastomoses on medial wall is a site of bleeding (Epistaxis)

32
Q
A
33
Q

What are nasal polyps

A
34
Q

Features of rhinitis

A
35
Q

What are Ostia

A

Small channels that drain from paranasal cavity into nasal cavity into meatus

36
Q

Anterior and posterior ethmoid arteries arise from the

A

Opthalmic artery

37
Q

Opthalmic artery is a branch of the

A

Internal carotid artery

38
Q

Sphenopalatine artery and greater palatine arteries are branches of the

A

Maxillary artery

39
Q

Maxillary artery is a branch of the

A

External carotid

40
Q

Branches of external carotid artery

A

Some anatomists like freaking out poor medical students

41
Q

Nervous supply to nasal cavity

A

Trigeminal nerve- Opthalmic branch and maxillary branch

42
Q

Paranasal air sinus innervation

A
43
Q

Clinical diagnosis of acute sinusitis

A

recent URTI
Blocked nose and rhinorrhoea +/- green yellow discharge
Pyrexia
Headache/facial pain worse on leaning forwards

44
Q

Acute bacterial sinusitis more likely if

A

Symptoms particularly severe at onset

Symptoms more than 10 days without improvement but less than 4 weeks

Worsen after initial improvement

45
Q

Most common bacteria for acute bacterial sinusitis

A

Streptococcus pneumonia, haemophilia influenzae, moraxella catarrhalis

46
Q
A
47
Q

Arteries that are important to know for nose bleeds

A
48
Q

Minor treatment of nose bleeds

A

Pinch in front of the bony bridge of nose and hold for 15-20 mins

49
Q

Arterial supply to the nasal cavity is mainly from

A

Branches of the maxillary artery

50
Q

Origin for most nosebleeds

A

Little’s area (90%)

10% arise from sphenopalatine artery (can be very problematic as at higher pressure, and posteriorly located, harder to reach)

51
Q

Causes of nose bleeds

A

Spontaneously, very minor trauma, underlying systemic causes (abnormal coagulation and connective tissue disorders)

52
Q

Management of epistaxis includes

A

Applying simple compression, cauterisation or anterior packing using nasal tampons

Posterior packing or surgical intervention e.g. embolisation, ligation of blood vessels

ABCs closely monitored in severe epistaxis

53
Q

Steps to confirm correct placement of nasogastric tube

A

Aspirate to confirm pH is acidic, CXR

54
Q

NG tube use (not feeding)

A

Bowel obstruction

Act to drain or empty stomach of excess gas and fluid that is accumulating whilst bowel is obstructed

HNN (19 decks)

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