SM_14b-15b: Paranasal Sinuses and Nose I and II Flashcards
Function of nasal and paranasal sinuses are ____, ____, ____, and ____
Function of nasal and paranasal sinuses are breathing, warming / humidifying air, filtering particulates, and olfaction
(effects: vocal resonance, immunologic deficiencies, reduce weight of head)
Nasal septum is a ____ structure that receives blood supply and nutrients from the ____
Nasal septum is a midline structure that receives blood supply and nutrients from the mucosa
Septal hematoma occurs after ____ and results in ____ and ____ if not drained due to ____
Septal hematoma occurs after trauma and results in infection and septal perforation if not drained due to loss of blood supply to the septum
Nasal turbinates are responsible for ____, ____, ____, and ____
Nasal turbinates are responsible for increasing mucosal surface area, directing airflow, the nasal cycle, and sensation of nasal airflow
- Dynamic: venous sinusoids - the nasal cycle
- Sensation of nasal airflow: evaporative cooling tells your brain that things are working properly
Airflow is brought to the top of the nose during a ____
Airflow is brought to the top of the nose during a sniff
Lifespan of olfactory sensory nerve is ___
Lifespan of olfactory sensory nerve is 6-8 weeks
(suffer a lot of wear and tear, progenitor cells sprout to replace each neuron)
Chemosensory perception involves a lot of genes for ____
Chemosensory perception involves a lot of genes for odorant receptors
Common etiologies of olfactory loss are ____, ____, ____, ____, and ____
Common etiologies of olfactory loss are head trauma, viral, sinonasal, aging, and neurodegenerative disease
(head trauma, viral, and sinonasal account for 80%)
Olfactory testing is conducted using the ____
Olfactory testing is conducted using the University of Pennsylvania Smell Inventory Test
(normative data by gender and age)
Internal carotid artery turns into the ____ and ____ in the nose
Internal carotid artery turns into the anterior and posterior ethmoid arteries in the nose
External carotid artery turns into the ____ in the nose
External carotid artery turns into the sphenopalatine artery in the nose
Blood to the supply to the nose includes the ____, ____, and ____ arteries
Blood to the supply to the nose includes the anterior and posterior ethmoid and sphenopalatine arteries
(ICA -> anterior and posterior ethmoid arteries, ECA -> sphenopalatine artery)
____ feeds the ophthalmic artery
Internal carotid artery feeds the ophthalmic artery
____ artery can be embolized to treat epistaxis
Sphenopalatine artery artery can be embolized to treat epistaxis
(anterior and posterior ethmoid arteries should not be embolized because come from ICA which feeds the ophthalmic artery -> can blind someone)
Describe treatment for epistaxis
Treatment for epistaxis
- Pressure: packing (gauze, sponge, and balloon)
- Cauterization: silver nitrate, electrical
- Ligation: internal maxillary, sphenopalatine, anterior and posterior ethmoids
- Embolization, internal maxillary, sphenopalatine (only)
Common causes of nasal obstruction include ____ and ____
Common causes of nasal obstruction include nasal septum deviation (nasal valve obstruction) and enlarged inferior turbinates
Image on the right shows ____
Image on the right shows deviated nasal septum
Sinuses develop as ____
Sinuses develop as face develops
This is ____ to ____
This is lateral to middle turbinate
Describe the anatomy of the maxillary sinus
Maxillary sinus anatomy
- Expansion of lateral nasal wall into maxillary bone
- Natural ostium (opening) at the top of the sinus
- Roof of the maxillary sinus is the orbital floor
- Roof of maxillary sinus contains infraorbital nerve (V2)
- Roots of teeth may project into floor of maxillary sinus
Describe the anatomy of the ethmoid sinuses
Ethmoid sinuses anatomy
- Complex arrangement of sinuses developing within the ethmoid bones
- Divded into anterior and posterior ethmoids
- Lateral boundary of ethmoid is the orbit
- Roof of ethmoid is anterior cranial fossa
- Medial boundary of ethmoid is cribriform plate
Describe the anatomy of the sphenoid sinus
Sphenoid sinus anatomy
- Centrally located within the skull base
- Lateral to sphenoid sinus: carotid artery, optic nerve, cavernous sinus, 3rd / 4th / 5th / 6th CN
Describe the anatomy of the frontal sinus
Frontal sinus anatomy
- Extension of ethmoid sinuses into frontal bone
- Most complex drainage pattern
- Valveless veins through posterior table
Paranasal sinus cells of the anterior skull base include the ___, ___, ___, and ___
Paranasal sinus cells of the anterior skull base include the ethmoid bulla, posterior ethmoids, sphenoid sinus, and frontal sinus
Label the sinuses on this coronal view
Label everything
Common variants of paranasal anatomy that are not pathologic are ____ and ____
Common variants of paranasal anatomy that are not pathologic are concha bullosa and Haller cell (infraorbital ethmoid)
Mucociliary flow functions to ___ and ___
Mucociliary flow functions to humidify and filter inspired air
(up to 95% humidity of inspired air, water filter)
Sinuses generate ___ whose drainage is driven by ___
Sinuses generate mucus whose drainage is driven by cilia
Sinuses in the front of the nose, including the ____, ____, and ____, drain under the ____
Sinuses in the front of the nose, including the frontal, ethmoid, and maxillary sinuses, drain under the middle turbinate
____ and ____ sinuses drain into ____ behind the ____
Posterior ethmoids and sphenoid sinus drian into sphenoethmoid recess behind the middle turbinate
Describe the uncinate process
Uncinate process
- Cuts off anterior pathway drainage system
- All secretions drain to middle meatus lateral to middle turbinate - uncinate process sticks out here
(frontal drainage has some recirculation but mainly small pathway anterior to the face)
Rhinosinusitis is ____
Rhinosinusitis is inflammation of the nasal cavity and paranasal sinuses due to acute infections or chronic inflammation
(lots of individual variability but symptoms include nasal blockage, nasal discharge, facial pain / headache, reduction / loss of smell)
Describe the cycle of ostial obstruction
Cycle of ostial obstruction
Viral rhinosinusitis is ____ and involves symptoms that are present for ____ and ____
Viral rhinosinusitis is acute rhinosinusitis caused by viral infection and involves symptoms that are present for < 10 days and are not worsening
- Caused by rhinovirus, coronavirus, RSV, adenovirus, influenza, parainfluenza
- Majority of URIs are viral
Symptoms of URI ____
Symptoms of URI vary by person
Acute bacterial rhinosinusitis is caused by ____ and may be present if ____ or ____
Acute bacterial rhinosinusitis is caused by bacterial infection and may be present if symptoms / signs fail to improve within 10 days or so after the onset of upper respiratory symptoms or symptoms / signs of acute rhinosinusitis worsen at 5-10 days (double worsening)
(most often caused by S. pneumonia, H. influenzae, and M. catarrhalis)
Describe diagnosis of acute bacterial rhinosinusitis
Diagnosis of acute bacterial rhinosinusitis
- Up to 4 weeks of purulent nasal drainage
- Purulent nasal discharge is cloudy or colored
- Nasal obstruction
- Facial pain / pressure / fullness
Describe diagnosis of chronic rhinosinusitis
Diagnosis of chronic rhinosinusitis
≥ 12 weeks with ≥ 2 of the following
- Mucopurulent drainage: anterior, posterior, or both
- Nasal obstruction: congestion, stuffy, blocked
- Facial pain / pressure / fullness
- Decreased sense of smell
AND inflammation documented by
- Purulent mucus or edema in middle meatus or anterior ethmoid
- Polyps in nasal cavity or middle meatus and/or
- Radiographic imaging showing inflammation of paranasal sinuses
Chronic rhinosinusitis without nasal polyps presents as ___, ___, ___, and ___
Chronic rhinosinusitis without nasal polyps presents as stuffy, pressure / pain, mucus, and frequent exacerbations (may be infections)
Chronic rhinosinusitis presents as ____ and ____
Chronic rhinosinusitis presents as stuffy -> obstruction and decreased olfaction
Allergic fungal sinusitis involves ____, ____, ____, and ____
Allergic fungal sinusitis involves fungal growth, polyps, eosinophils, and possibly bone remodeling
Pathophysiology of chronic rhinosinusitis involves ____
Pathophysiology of chronic rhinosinusitis involves inflammation
(results from many factors)
Medial management of chronic rhinosinusitis primarily involves ___ and ___
Medial management of chronic rhinosinusitis primarily involves non-pharmacologic treatment such as saline lavage and corticosteroids (sprays, lavage, oral)
(also antibiotics, antihistamines, decongestants)
Describe surgery for chronic sinusitis
Surgery for chronic sinusitis
- Surgery alters anatomy: enlarges sinus ostia
- Opens areas of anatomic restriction in the nose: septal deviation, concha bullosa
- Improves sinus ventilation
- No direct change in mucosal physiology
- Improves access of intranasal meds to sinus mucosa: sprays, irrigated medications
Goal of surgery for chronic sinusitis is ____
Goal of surgery for chronic sinusitis is improved quality of life
- Improve mucociliary clearance
- Relieve obstruction
- Improve olfaction
- Improve access for topical medications
- Decrease severity / frequency of acute exacerbations
___ is effective for nasal polyps through blocking IL-4 and IL-13
Dupilimab is effective for nasal polyps through blocking IL-4 and IL-13
