7. Anatomy and physiology of the nose. Clinical Examination of the Nose. Nasal pyramid fracture. Epistaxis.

Question 1

What does the ANATOMY of the NOSE consist of?

Answer 1

1) EXTERNAL NOSE

2) INTERNAL NOSE

Question 2

What is the ANATOMY of the EXTERNAL Nose?

Answer 2

• Pyramidal Shaped
• Apex = Tip of Nose
• Base is attached to the Forehead
• Perforated via 2 Apertures (Nostrils), separated by Columella
• Bony Part = 2 Nasal Bones - Nasal Processes of Frontal / Maxillary Bones
• Cartilaginous Part = 2 Pairs of Lateral Cartilages (Upper / Lower), which are connected via Fibrous Tissue

Question 3

What is the ANATOMY of the INTERNAL Nose?

Answer 3

• AKA Nasal Cavity, which is divided by MIDLINE (Nasal Septum) into Right / Left Chambers
• Medial Wall (Nasal Septum) is Osteocartilaginous, covered by Mucoperichondrium / Mucoperiosteum
• Lateral Wall has 3 shelf-like projections called Turbinates
• Inferior Meatus = Opening of Nasolacrimal Duct
• Middle Meatus = Opening of Frontal / Maxillary / Anterior Ethmoid Sinus
• Superior Meatus = Opening of Posterior Ethmoid Sinus
• Sphenoethmoidal Recess = Opening of Sphenoid Sinus

Question 4

What is the BLOOD SUPPLY & LYMPH DRAINAGE of the Nasal Cavity?

Answer 4

0 BLOOD SUPPLY
- Internal / External Carotid Arteries

• Submucosal Plexus FROM Venous Sinusoids

0 LYMPH DRAINAGE
- Submandibular LN
- Deep Cervical LN

Question 5

What is the INNERVATION of the Nose?

Answer 5

1) Olfactory Nerve, FROM Olfactory Epithelium in Olfatorymucosa

2) Ophthalmic / Maxillary divisions of Trigeminal Nerve (CN 3)

3) Vasomotor Nerve Supply

4) Parasympathetic Nerves = Causes Vasodilation + Stimulate Glandular Secretion

5) Sympathetic Nerves = Causes Vasoconstriction + Inhibit Glandular Secretion

Question 6

What is the PHYSIOLOGY of the Nose?

Answer 6

1) RESPIRATORY FUNCTION
- Provides airway for Respiration
- Filtration of the Inspired Air
- Humidification of Inspired Air
- Adjusts temp of Inspired Air

2) OLFACTORY FUNCTION

3) PHONATORY Function
- Provides the VOICE with RESONANT quality

Question 7

What is the CLINICAL EXAMINATION of the Nose?

Answer 7

1) History Taking

2) Nose Examination
- Anterior Rhinoscopy = Using Nasal Speculum
- Posterior Rhinoscopy = Post Nasal Mirror
- Endoscopic = Under Local Anaesthesia

3) Imaging Tests
- Plain Radiography
- CT = Shows fine Bony outline / Soft Tissue
- MRI

Question 8

What is NASAL PYRAMID FRACTURE?

Answer 8

• Fractures of 1 of the bones in the Nose

0 SYMPTOMS
- Bleeding, Swelling, Bruising
- Inability to Breathe thru Nose
- Complicated via other Facial Structures / Septal Hematoma

0 DUE to
- Assault
- Trauma during Sports
- Motor Vehicle Collisions

0 DIAGNOSIS
- Confirmed via X-Ray
- Palpation = Crepitus

0 TREATMENT
- Pain medication
- Cold Compres

Question 9

What is EPISTAXIS?

Answer 9

• AKA Nosebleeds

0 2 TYPES
1) EXTERNAL CAROTID
a. Maxillary = Sphenopalatine / Greater Palatine
b. Facial = Superior Labial

2) INTERNAL CAROTID
- Via Ophthalmic = Anterior / Posterior Ethmoid

0 DUE to
- Infectious
- Nose Picking
- Trauma
- Neoplasms
- FBs

0 MANAGEMENT
- Anterior Rhinoscopy
- Trotter’s Method (Pinching)
- Ice Nasal Dorsum
- Pressure to Superior Labial
- Surgical Ligation = External Carotid / Maxillary