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Head and Neck > Nasal cavity and paranasal air sinuses > Flashcards

Nasal cavity and paranasal air sinuses Flashcards

1
Q

5 functions of nasal cavity

A

Smell
Warms and humidifies air
Route for air into lungs
Filters air - traps particles with hairs
Resonating chamber for speech

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2
Q

Structure of nasal cavity

A

Medial wall = septum
2 lateral walls
Roof and floor

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3
Q

Entrance to nasal cavity nostrils is called

A

Nares

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4
Q

Exit into nasopharynx at back of nasal cavity is called…

A

Choanae

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5
Q

3 Regions within the nasal cavity and epithelia

A

Vestibule - stratified squamous (skin) epithelia, near entrance

Respiratory - pseudostratified ciliated columnar epithelia

Olefactory region - smell, roof of nasal cavity

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6
Q

Bones contributing to roof of nasal cavity

A

Nasal
Frontal
Ethmoid
Sphenoid

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7
Q

Bones contributing to floor of nasal cavity

A

Maxilla
Palatine

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8
Q

What do the lateral walls of the nasal cavity have?

A

Concha/turbinates - projections of bone

Meatuses - under concha

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9
Q

Concha and meatus number

A

3 concha and 3 meatus - superior, middle and inferior

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10
Q

What bone makes the superior and middle concha?

A

Ethmoid bone

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11
Q

Function of concha

A

Slow down air flow
Increase surface area
= rapid warming and humidification of air for lungs

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12
Q

Functions of meatuses

A

Drainage - connect to the paranasal air sinuses and nasolacrimal duct

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13
Q

How do concha change in size as you go deeper within the nasal cavity?

A

Increasing size of concha as you travel further from the orbit

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14
Q

What makes the medial wall of the nasal cavity?

A

Perpendicular plate of ethmoid bone
Vomer bone
(boney parts)

Septal cartilage

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15
Q

What is the route used to surgically access pituitary gland?

A

Transphenoidal surgery - up nose and through sphenoid sinus

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16
Q

What is a septal haematoma?

A

Trauma to cartilage in nose causes perichondrium lining cartilage to be stripped off

Blood accumulates between cartilage and perichondrium

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17
Q

Problem with septal haematoma

A

Cartilage is avascular - no blood supply from perichondrium can lead to avascular necrosis

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18
Q

Permanent damage from septal haematoma

A

Saddle deformity - loss of height of dorsum of nose

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19
Q

Appearance of septal haematoma

A

Bulging within nose- needs draining and packing to stick perichondrium back onto cartilage

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20
Q

Bones contributing to lateral nose edge

A

Maxilla
Nasal bone

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21
Q

Cartilage on nose

A

Septal cartilage
Lateral
Major and minor alar (major near tip and bigger)
Fibro fatty tissue near nostrils

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22
Q

3 parts of nose

A

Bridge
Dorsum
Tip

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23
Q

How common are nasal bone fractures?

A

50% of all facial fractures - easily damaged as structure sticks out

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24
Q

Appearance of nasal bone fractures

A

Lots of swelling - can sometimes hide deformity of deviated septum
Epistaxis

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25
Q

What to do with nasal bone fracture presentation

A

X-ray not needed
Follow up in several days in OP clinic once swelling reduced
Assess to see if reset is needed - breathing problems, cosmetic etc

26
Q

Rare complications of nasal bone fracture

A

CSF leak
Anosmia

27
Q

Blood supply to nasal cavity - why?

A

Rich supply - allows it to perform humidification and warming of incoming air

28
Q

Where is the most common site of nosebleeds? NAME IT

A

Anastomoses in medial wall - Kiesselbachs/Littles area

Where all 5 blood vessels join

29
Q

5 blood vessels supplying nasal cavity

A

Anterior and posterior ethmoidal arteries - from ophthalmic artery

Sphenopalatine artery
Greater palatine artery
(both from maxillary artery)

Superior labial artery (septal branch)

30
Q

What vessel bleeds in posterior epistaxis? Character of bleed

A

Sphenopalatine artery - difficult to stop, have to try and pack nose.
Sometimes comes out of both nostrils, down back of throat or is coughed/vomitted up

31
Q

Medial wall - Kiesselbachs area bleed character

A

Easier to stop - closer to entrance to nose, can pinch squishy part of nose to stop and ask them to lean forward

32
Q

Blood vessel that ophthalmic artery arises from

A

Internal carotid artery

33
Q

Blood vessel that maxillary artery is from

A

External carotid artery

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior aurciular
Maxillary
Superficial temporal

34
Q

Nerve supply to inside nasal cavity

A

Trigeminal - ophthalmic branch does most of anterior portion of nose, tip and inner cavity if you sliced off nose

Trigeminal - Maxillary branch does posterior nasal cavity

35
Q

What are nasal polyps?

A

Benign swellings of nasal mucosa

36
Q

Who do nasal polyps affect?

A

M:F = 2:1
40+ year olds
If in children - suggests cystic fibrosis

37
Q

Which side do nasal polyps affect?

A

Bilateral - both sides

38
Q

Symptoms of nasal polyps

A

Nasal congestion - blocked nose
Rhinorrhoea - runny nose
Hypo/anosmia
Snoring
Post-nasal drip - can cause cough

39
Q

Red flags for nasal polyp

A

Unilateral
Bleeding

could suggest nasal cancer

40
Q

Treatment for nasal polyp

A

Intranasal steroids

41
Q

What is rhinitis?

A

Inflammation of nasal mucosa

42
Q

Two types of rhinitis

A

Infective - viral usually, typical cold –> painkillers, nasal decongestion spray etc

Allergic - eg hayfever, pet hair, dust –> antihistamines

43
Q

Symptoms of rhinitis

A

Nasal congestion
Rhinorrhoea
Sneezing
Post-nasal drip
Nasal irritation

44
Q

Common cause for unilateral discharge and bleeding from nose in young child

A

Foreign body

45
Q

What are paranasal air sinuses?

A

Extensions of nasal cavity - drain into meatus via small channels called ostia

46
Q

Paranasal air sinuses lining

A

Respiratory mucosa - ciliated and mucous secreting

47
Q

What can occur due to paranasal air sinuses communicating with nasal cavity?

A

Infections of nasal cavity can involve the sinuses causing sinusitis

48
Q

Most common location for sinusitis

A

Maxillary - opening to drain is high up, fluid cannot escape very easily

49
Q

Functions of paranasal air sinuses

A

Humidify and warm inspired air
Reduce weight of skull

50
Q

Paranasal air sinuses names

A

Sphenoid
Ethmoid
Maxillary
Frontal

51
Q

What drains into the middle meatus?

A

Frontal
Maxillary
Anterior ethmoid sinus

52
Q

What drains into the inferior meatus?

A

Nasolacrimal duct - tears

53
Q

What drains into the roof?

A

Sphenoid sinus

54
Q

Which sinuses get general sensory from Va - ophthalmic branch of trigeminal

A

Frontal
Ethmoid
Sphenoid

55
Q

Which sinuses get general sensory from Vb maxillary branch of trigeminal

A

Maxillary

56
Q

What is acute sinusitis?

A

Inflammation of paranasal sinus usually caused by upper respiratory tract infection spreading here

57
Q

Pathophysiology of acute sinusitis

A

Inflammation of respiratory mucosa = swelling, reduced cilia movement and increased secretions
Ostia become blocked = sinus cannot drain
Fluid builds in sinus = increased pressure and pain
Can develop secondary bacterial infection

58
Q

How long does sinusitis have to be to be acute?

A

Less than 4 weeks long but usually resolves within 10 days

59
Q

Clinical diagnosis of acute sinusitis - signs/symptoms

A

Recent URTI
Blocked nose
Rhinorrhoea +/- yellow or green discharge
Pyrexia
Headache/facial pain - worsened on leaning forward

60
Q

Management for acute sinusitis

A

Conservative - most are viral only 0.5-2% then become bacterial from stasis of fluid within sinus

61
Q

When is acute bacterial sinusitis more likely diagnosis?

A

Symptoms severe at onset and lasting more than 10 days (but less than 4 weeks)
Symptoms improve initially then worsen (suggests was viral and now secondary bacterial)

62
Q

Bacteria causing bacterial sinusitis

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

Head and Neck (26 decks)

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