Sinus

Question 1

sinus blood supply

Answer 1

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.

Question 2

concha bullosa

Answer 2

middle turbinate w/an air pocket

Question 3

haller cell

Answer 3

ethmoid cell that sits in maxillary sinus and can block it

Question 4

primary defense against sinusitis

Answer 4

Mucociliary Clearance

Question 5

how many people will show sinusitis on a CT?

Answer 5

30% of people will have sinusitis on CT, only sx required if pts are unresponsive to medical treatment

Question 6

best diagnostic test for sinusitis

Answer 6

CT

Question 7

PE findings for acute sinusitis

Answer 7

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

Question 8

Associated with allergies
Patient may have a triad of asthma, nasal polyps and Aspirin sensitivity
Children with polyps need to rule out Cystic Fibrosis

Answer 8

nasal polyps

Question 9

top of the head HA, which sinus?

Answer 9

sphenoid

Question 10

b/w the eyes HA, which sinus?

Answer 10

ethmoid

Question 11

medical tx for acute sinusitis

Answer 11

• Antibiotics (2 weeks minimum)
• Decongestion
• Nasal irrigation

Question 12

medical tx for chronic sinusitis

Answer 12

• Allergy care
• Decongestion-nasal steroid sprays/antihistamines
• Nasal irrigation
• maybe oral steroids

Question 13

how to sx tx sinusitis

Answer 13

Fix anatomical deformities
(deviated septum, Concha bullosa)

Remove nasal polyps

Open natural drainage pathways

Question 14

Preseptal Cellulitis (nrl EOM)
Orbital Cellulitis
Subperiosteal Abscess (eye pushed laterally)
Orbital Abscess
Cavernous Sinus Thrombosis
eye problems

Answer 14

complications of sinusitis

Question 15

how to tx allergic rhinitis

Answer 15

Antihistamines, Saline solutions, Decongestants, Steroid Sprays.

Question 16

MCC epistaxis

Answer 16

broken blood vessel

Question 17

how to tx epistaxis

Answer 17

Don’t shove stuff up the nose right away, may cause more trauma
Always put on antibiotics when you pack the nose

Question 18

Occurs in boys from 13-25 yrs old
Presents with nose bleeds
Vascular tumor
Highly aggressive, pressure necrosis
Unilateral bleed

Answer 18

juvenile angiofibroma

Question 19

how to tx nasal fx

Answer 19

• 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

Question 20

MCC nasal infection

Answer 20

staph, tx w/bactroban

Question 21

• 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

Answer 21

paranasal sinus neoplasms

Question 22

Enlarged sebaceous glands

Treatment is surgical (laser resurfacing)

Answer 22

rhynophyma