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Head and Neck > SM_14b-15b: Paranasal Sinuses and Nose I and II > Flashcards

SM_14b-15b: Paranasal Sinuses and Nose I and II Flashcards

1
Q

Function of nasal and paranasal sinuses are ____, ____, ____, and ____

A

Function of nasal and paranasal sinuses are breathing, warming / humidifying air, filtering particulates, and olfaction

(effects: vocal resonance, immunologic deficiencies, reduce weight of head)

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2
Q

Nasal septum is a ____ structure that receives blood supply and nutrients from the ____

A

Nasal septum is a midline structure that receives blood supply and nutrients from the mucosa

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3
Q

Septal hematoma occurs after ____ and results in ____ and ____ if not drained due to ____

A

Septal hematoma occurs after trauma and results in infection and septal perforation if not drained due to loss of blood supply to the septum

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4
Q

Nasal turbinates are responsible for ____, ____, ____, and ____

A

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
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5
Q

Airflow is brought to the top of the nose during a ____

A

Airflow is brought to the top of the nose during a sniff

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6
Q

Lifespan of olfactory sensory nerve is ___

A

Lifespan of olfactory sensory nerve is 6-8 weeks

(suffer a lot of wear and tear, progenitor cells sprout to replace each neuron)

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7
Q

Chemosensory perception involves a lot of genes for ____

A

Chemosensory perception involves a lot of genes for odorant receptors

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8
Q

Common etiologies of olfactory loss are ____, ____, ____, ____, and ____

A

Common etiologies of olfactory loss are head trauma, viral, sinonasal, aging, and neurodegenerative disease

(head trauma, viral, and sinonasal account for 80%)

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9
Q

Olfactory testing is conducted using the ____

A

Olfactory testing is conducted using the University of Pennsylvania Smell Inventory Test

(normative data by gender and age)

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10
Q

Internal carotid artery turns into the ____ and ____ in the nose

A

Internal carotid artery turns into the anterior and posterior ethmoid arteries in the nose

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11
Q

External carotid artery turns into the ____ in the nose

A

External carotid artery turns into the sphenopalatine artery in the nose

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12
Q

Blood to the supply to the nose includes the ____, ____, and ____ arteries

A

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)

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13
Q

____ feeds the ophthalmic artery

A

Internal carotid artery feeds the ophthalmic artery

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14
Q

____ artery can be embolized to treat epistaxis

A

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)

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15
Q

Describe treatment for epistaxis

A

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)
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16
Q

Common causes of nasal obstruction include ____ and ____

A

Common causes of nasal obstruction include nasal septum deviation (nasal valve obstruction) and enlarged inferior turbinates

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17
Q

Image on the right shows ____

A

Image on the right shows deviated nasal septum

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18
Q

Sinuses develop as ____

A

Sinuses develop as face develops

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19
Q

This is ____ to ____

A

This is lateral to middle turbinate

20
Q

Describe the anatomy of the maxillary sinus

A

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
21
Q

Describe the anatomy of the ethmoid sinuses

A

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
22
Q

Describe the anatomy of the sphenoid sinus

A

Sphenoid sinus anatomy

  • Centrally located within the skull base
  • Lateral to sphenoid sinus: carotid artery, optic nerve, cavernous sinus, 3rd / 4th / 5th / 6th CN
23
Q

Describe the anatomy of the frontal sinus

A

Frontal sinus anatomy

  • Extension of ethmoid sinuses into frontal bone
  • Most complex drainage pattern
  • Valveless veins through posterior table
24
Q

Paranasal sinus cells of the anterior skull base include the ___, ___, ___, and ___

A

Paranasal sinus cells of the anterior skull base include the ethmoid bulla, posterior ethmoids, sphenoid sinus, and frontal sinus

25
Q

Label the sinuses on this coronal view

A
26
Q

Label everything

A
27
Q

Common variants of paranasal anatomy that are not pathologic are ____ and ____

A

Common variants of paranasal anatomy that are not pathologic are concha bullosa and Haller cell (infraorbital ethmoid)

28
Q

Mucociliary flow functions to ___ and ___

A

Mucociliary flow functions to humidify and filter inspired air

(up to 95% humidity of inspired air, water filter)

29
Q

Sinuses generate ___ whose drainage is driven by ___

A

Sinuses generate mucus whose drainage is driven by cilia

30
Q

Sinuses in the front of the nose, including the ____, ____, and ____, drain under the ____

A

Sinuses in the front of the nose, including the frontal, ethmoid, and maxillary sinuses, drain under the middle turbinate

31
Q

____ and ____ sinuses drain into ____ behind the ____

A

Posterior ethmoids and sphenoid sinus drian into sphenoethmoid recess behind the middle turbinate

32
Q

Describe the uncinate process

A

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)

33
Q

Rhinosinusitis is ____

A

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)

34
Q

Describe the cycle of ostial obstruction

A

Cycle of ostial obstruction

35
Q

Viral rhinosinusitis is ____ and involves symptoms that are present for ____ and ____

A

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
36
Q

Symptoms of URI ____

A

Symptoms of URI vary by person

37
Q

Acute bacterial rhinosinusitis is caused by ____ and may be present if ____ or ____

A

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)

38
Q

Describe diagnosis of acute bacterial rhinosinusitis

A

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
39
Q

Describe diagnosis of chronic rhinosinusitis

A

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
40
Q

Chronic rhinosinusitis without nasal polyps presents as ___, ___, ___, and ___

A

Chronic rhinosinusitis without nasal polyps presents as stuffy, pressure / pain, mucus, and frequent exacerbations (may be infections)

41
Q

Chronic rhinosinusitis presents as ____ and ____

A

Chronic rhinosinusitis presents as stuffy -> obstruction and decreased olfaction

42
Q

Allergic fungal sinusitis involves ____, ____, ____, and ____

A

Allergic fungal sinusitis involves fungal growth, polyps, eosinophils, and possibly bone remodeling

43
Q

Pathophysiology of chronic rhinosinusitis involves ____

A

Pathophysiology of chronic rhinosinusitis involves inflammation

(results from many factors)

44
Q

Medial management of chronic rhinosinusitis primarily involves ___ and ___

A

Medial management of chronic rhinosinusitis primarily involves non-pharmacologic treatment such as saline lavage and corticosteroids (sprays, lavage, oral)

(also antibiotics, antihistamines, decongestants)

45
Q

Describe surgery for chronic sinusitis

A

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
46
Q

Goal of surgery for chronic sinusitis is ____

A

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
47
Q

___ is effective for nasal polyps through blocking IL-4 and IL-13

A

Dupilimab is effective for nasal polyps through blocking IL-4 and IL-13

Head and Neck (29 decks)

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