Trans 54 and 55 Paranasal and Nose Flashcards
in the nose, Upper 1/3 consists of bones which are (3)
while lower 1/3 is composed of?
2 nasal bones
Frontal process of maxilla
Nasal notch of frontal bone
Cartilage
lower lateral cartilage + nasal septal cartilage =
ALA
superior and middle turbinates are part of _________ bone
inferior turbinate is __________ bone
Ethmoid bone;
separate bone
lining epithelium of Upper 1/3 of the nasal cavity?
• Upper 1/3 – olfactory epithelium
Specialized sensory epithelium. Same epithelium with respiratory but without goblet cells. It starts from the superior turbinate.
lining epithelium of lower 2/3 of nasal cavity
Lower 2/3 pseudostratified columnar ciliated epithelium
With goblet cells also with respiratory epithelium
lining epithelium of the vestibule
Vestibule – stratified squamous keratinizing epithelium
lining epithelium of the sinuses?
cuboidal ciliated
located at the antero-inferior part of the septum which is a confluence of arteries.
Kiesselbach’s plexus or Little’s area
No opening • Usually located at the bony-cartilaginous junction of the nasal dorsum • Contain all elements of skin: hair, sweat glands, sebaceous glands, connective tissue • Non-compressible, non-pulsatile • Diagnosis: o CT Scan • Treatment: o Surgical excision
NASAL DERMOID CYST
• Connected to the CNS
• Frequently associated with other midline fusion defects (cleft lip, cleft palate)
• Extracranial herniation of meninges and brain
• Bluish, compressible, pulsatile
(+) Furstenberg’s sign
Diagnosis:
o CT Scan “for confirmation – connection with the brain
• Treatment:
o Surgery
Nasal encephalocele
enlargement on compression of the jugular
(+) Furstenberg’s sign
• Solid • Non-compressible, non-pulsatile gray or purple mass • (-) Furstenberg’s sign • Diagnosis: o CT Scan
Nasal Glioma
acute vs chronic rhinosinusitis?
acute vs chronic rhinosinusitis?
• Acute rhinosinusitis:
o >10 days, <12 weeks with complete resolution of symptoms
• Chronic rhinosinusitis:
o >12 weeks without complete resolution of symptoms
Etiology: most of the time, bacterial sinusitis follows after a course of viral sinusitis. Typical pathogens include
o Streptococcus pneumonia
o Haemophilus influenza
o Moraxella catarrhalis
o Staphylococcus aureus
o PE ▪ Anterior Rhinoscopy/Nasal endoscopy: • pale, bluish-grey, • boggy turbinates • minimal to profuse, watery to mucoid nasal discharge
what disease entity?
ALLERGIC RHINITIS
Pharmacotherapy for Allergic Rhinitis
▪ Antihistamines: for early phase reaction
E.g. loratadine, cetirizine
Blocks histamine receptors
▪ Pseudoephedrine: for decongestion
▪ Intranasal corticosteroids: for early and late phase reaction.
What type of non allergic rhinitis?
- Patient usually have no history of allergens, and there are no signs of infection
- Symptoms may be exacerbated by temperature changes, strong odors, stress, and exposure to variety of irritants.
Vasomotor rhinitis
- Usually caused by Upper Respiratory viral infection
- Tends to resolve after infection run its course
- Nasal discharge is clear or mucopurulent, rather than watery
what form of non allergic rhinitis?
Infectious rhinitis
- Experienced only in workplace
- Thought to result from exposure irritants
- May present with concomitant occupational asthma
What form of non allergic rhinitis?
Occupational rhinitis
- Associated with hormonal imbalance and hypothyroidism
- Most common during puberty, menstruation, pregnancy and with use of hormonal therapies
what type of non allergic rhinitis?
Hormonal rhinitis
- Many drug types have been implicated
- A subtype, rhinitis medicamentosa, is caused by prolonged use of topical decongestants
what type of non allergic rhinitis?
Drug-induced rhinitis
Usually occurs after ingesting hot or spicy foods or alcohol
• Characterized by profuse watery rhinorrhea
what type of non allergic rhinitis?
Gustatory rhinitis
NARES vs BENARES? (non allergic rhinitis with esonophilia syndrome; blood eosinophilia nares)
- NARES: nasal smears show >5% to >20% eosinophils;
- BENARES: No nasal eosinophilia but elevated serum eosinophil levels
- NARES: estimated to account for 20% of rhinitis diagnoses
- NARES/BENARES: Patients at high risk of developing aspirin sensitivity, nasal polyps, sinusitis, and asthma
▪ Presence of two or more of the following symptoms:
• Nasal blockage/ Obstriction/ Congestion
• Nasal discharge (anterior/posterior nasal drip)
• Facial pain/ pressure
• Reduction or loss of smell
▪ Duration of greater than or equal 12 weeks
▪ Presence of any of the following objective findings:
• Mucopurulent discharge from the middle meatus
• Nasal polyps
• Edema/ mucosal obstruction in the middle meatus
• Radiographic imaging showing mucosal changes
within the ostiomeatal complex and/or sinuses.
these are criteria of?
CHRONIC RHINOSINUSITIS
postulates that when gases or fluids pass through a constricted area, a negative pressure may develop in the vicinity of constriction. The lowered pressure leads to an increased formation of tissue fluid and subsequent Polyp formation.
Bernoulli phenomenon
Nasal polyp score
0 - no polyps
1 - small polyps in the middle meatus
2 - reaching below the lower border of middle turbinate
3 - large polyp reaching the lower border of inf turbinate
4 - large polyp causing complete obstruction of the inferior nasal cavity
Grade 1 and grade 2 nasal polyp treatment?
corticosteroids (mometasone and Avamys)
grade 3 and grade 4 nasal polyp treatment?
advise functional endoscopic sinus surgery
