Week 1.8 - Anatomy and Physiology of the Nose

Question 1

What is the innervation of the muscles of the nose?

Answer 1

• nasalis - buccal branch of facial nerve
• procerus - temporal, lower zygomatic and buccal braches

Question 2

What are the parts of the nose muscles and their functions?

Answer 2

• nasalis has alar part which dilates nostrils and transverse part which wrinkles dorsum skin
• procerus depresses medial eyebrows

Question 3

What is the lining of the nose?

Answer 3

• vestibule has hair baring skin
• second respiratory region has ciliated pseudostratified epithelium with mucus secreting goblet cells
• third olfactory region is lined with olfactory receptors

Question 4

What makes up the nasal septum?

Answer 4

vertical wall dividing left and right nasal passages. also forms medial wall of each passage. has bony and cartilaginous parts.

Question 5

What are the nasal turbinates?

Answer 5

3 pairs of paired bones in the lateral nasal wall - superior, middle and inferior. form 3 meatuses - superior, middle and inferior meatus

Question 6

What is the vasculature of the internal nose?

Answer 6

rich vascular supply
- internal carotid provides anterior and posterior ethmoidal arteries
- external carotid supplies sphenopalatine, greater palatine, superior labial and lateral nasal arteries

Question 7

What is kiesselbachs plexus and its significance?

Answer 7

branches from anterior ethmois, sphenopalatine, greater palatine and superior labial. prone to epistaxis

Question 8

What is epistaxis?

Answer 8

nose bleed commonly from kieselbachs plexus but also from woodruff plexus posteriorly

Question 9

How do you manage epistaxis?

Answer 9

nasal packing
- anterior with rapid rhino or tampon
- posterior with foley catheter and clamp
- if all fails, surgical ligation of artery

Question 10

What are the 4 paranasal sinuses?

Answer 10

• frontal
• sphenoid
• maxillary
• ethmoid

Question 11

What is the supply and drainage of the sphenoid sinus?

Answer 11

• most posterior
• drain in spheno-ethmoidal recess
• nervous supply ethmoidal nerve of V1
• arterial supply is sphenopalatine artery of maxillary and posterior ethmoidal artery of ICA

Question 12

What is the supply and drainage of the posterior ethmoid sinus?

Answer 12

lateral wall of superior meatus

Question 13

What is the sinus drainage of the frontal, maxillary and anterior ethmoid sinuses?

Answer 13

middle meatus - narrow

Question 14

What is trans-sphenoidal surgery?

Answer 14

• allows us to resect pituitary adenomas and other cancers without transcranial approach.
• aware of ICA proximity and CSF leak

Question 15

What is orbital cellulitis?

Answer 15

proximity of ethmoid and frontal sinus to orbit cause risk of infection spread. may cause severe infection and subperiosteal abscess formation

Question 16

What is sinusitis?

Answer 16

inflammation of lining of sinuses. may be allergic or infective. may be acute or chronic.

Question 17

Acute vs chronic sinusitis?

Answer 17

• acute usually viral and self limiting
  chronic 3+ months of obstruction, discharge, reduced smell. may be due to polyps. trapped mucus may become infected - antibiotic

Question 18

what is the nasopharynx?

Answer 18

the post-nasal space. contains adenoids and eustachian tube.
engalged adenoids may block eustachian tube and cause glue ear. also cancer may do the same thing - red flag