Sinus Flashcards
sinus blood supply
Facial Artery: anterior and posterior ethmoid arteries. Posterior supply via Sphenopaletine artery, Venous Drainage: Through anterior and posterior facial veins into the internal jugular system. Drainage also goes into the Cavernous Sinuses.
concha bullosa
middle turbinate w/an air pocket
haller cell
ethmoid cell that sits in maxillary sinus and can block it
primary defense against sinusitis
Mucociliary Clearance
how many people will show sinusitis on a CT?
30% of people will have sinusitis on CT, only sx required if pts are unresponsive to medical treatment
best diagnostic test for sinusitis
CT
PE findings for acute sinusitis
Tenderness over the sinuses and/or upper teeth
Nasal discharge that is purulent is key
Intranasal erythema and congestion
Nasal Endoscopy reveals puss from ostiomeatal unit
Associated with allergies
Patient may have a triad of asthma, nasal polyps and Aspirin sensitivity
Children with polyps need to rule out Cystic Fibrosis
nasal polyps
top of the head HA, which sinus?
sphenoid
b/w the eyes HA, which sinus?
ethmoid
medical tx for acute sinusitis
- Antibiotics (2 weeks minimum)
- Decongestion
- Nasal irrigation
medical tx for chronic sinusitis
- Allergy care
- Decongestion-nasal steroid sprays/antihistamines
- Nasal irrigation
- maybe oral steroids
how to sx tx sinusitis
Fix anatomical deformities
(deviated septum, Concha bullosa)
Remove nasal polyps
Open natural drainage pathways
Preseptal Cellulitis (nrl EOM) Orbital Cellulitis Subperiosteal Abscess (eye pushed laterally) Orbital Abscess Cavernous Sinus Thrombosis eye problems
complications of sinusitis
how to tx allergic rhinitis
Antihistamines, Saline solutions, Decongestants, Steroid Sprays.
MCC epistaxis
broken blood vessel
how to tx epistaxis
Don’t shove stuff up the nose right away, may cause more trauma
Always put on antibiotics when you pack the nose
Occurs in boys from 13-25 yrs old Presents with nose bleeds Vascular tumor Highly aggressive, pressure necrosis Unilateral bleed
juvenile angiofibroma
how to tx nasal fx
- Displaced: Closed reduction can be done if done within 1 week for adults and 5 days for kids
- Needs to be done in the operating room if bones have set. Ideal to wait at least 3 months
- Non-displaced fracture can be observed
MCC nasal infection
staph, tx w/bactroban
- Not Associated With pain, uncommon
- Squamous Cell Carcinoma Most Common
- Elderly pt with unilateral sinus pain, must r/o cancer
- Younger pt w/unilateral lesion get a bx, may be lymphoma
paranasal sinus neoplasms
Enlarged sebaceous glands
Treatment is surgical (laser resurfacing)
rhynophyma
