Nose

Question 1

What are the functions of the nose?

Answer 1

Olfaction
Route for inspired air
Filters air
Moistens and warms air
Resonating chamber for speech

Question 2

What is the nose vestibule?

Answer 2

Bit just inside nostril - lined with skin

Has sebaceous glands and hairs

Question 3

What makes up the floor of the nasal cavity?

Answer 3

Hard (maxilla and palatine bones) and soft palate (muscles and CT)

Question 4

What is the external nose made of?

Answer 4

Hyaline cartilage

Bone = nasal and frontal process of maxilla

Question 5

What is the most commonly fractured bone in the face?

Answer 5

Nasal bone

Question 6

What forms the lateral wall of nasal cavity?

Answer 6

Maxilla - with bony projections (conchae)

Question 7

What is the medial boundary of the nasal cavity?

Answer 7

Nasal septum

Question 8

What makes up the nasal septum?

Answer 8

Anterior = cartilage
Vomer - bone coming up from floor
Perpendicular plate of ethmoid bone

Question 9

What makes the roof of the nasal cavity?

Answer 9

Bones - frontal, ethmoid and sphenoid

Question 10

What is the crista galli?

Answer 10

Bony projection superiorly on the ethmoid bone
Thin and sharp
Into anterior fossa of cranium

Question 11

Describe a septal haematoma

Answer 11

Rare
Trauma to nose - bucking of septum and shearing of vessels
Blood accumulation between perichondrium and cartilage - AVN or pressure necrosis
Must examine for
Unilateral or bilateral

Question 12

What Mx does a septal haematoma need?

Answer 12

Drain it and pack it

Make sure blood doesn’t accumulate again and press perichondrium back to cartilage

Question 13

How do you get a saddle-nose deformity?

Answer 13

Untreated septal haematoma leading to AVN of cartilaginous septum

Question 14

How many conchae do we have and what are they called?

Answer 14

3

Superior, middle and inferior

Question 15

What type of epithelium covers the conchae?

Answer 15

Pseudostratified columnar ciliated with goblet cells

Question 16

What is the spheno-ethmoid recess?

Answer 16

Right above superior concha

Sphenoid sinus drains here

Question 17

Where does the maxillary sinus drain?

Answer 17

Middle meatus

Question 18

General sensation to nasal cavity is via …

Answer 18

Trigeminal nerve

V1 and V2

Question 19

What are nasal polyps?

Answer 19

Fleshy, benign swellings arising form nasal mucosa

Usually bilateral

Question 20

How do nasal polyps typically present?

Answer 20

Age > 40 yrs
Blocked nose and rhinorrhoea 
Post-nasal drips
Decreased smell and taste
Bilateral

Question 21

What would make you suspect a tumour over a nasal polyp?

Answer 21

Unilateral

Blood tinged secretion

Question 22

How do we know if we are touching a polyp or a concha?

Answer 22

Polyp = mobile and won't hurt to touch
Concha = immobile and will hurt to touch

Question 23

What is rhinitis?

Answer 23

Inflammation of the nasal mucosal lining

Question 24

What are the Sx of rhinitis?

Answer 24

Nasal congestion
Sneezing 
Rhinorrhoea 
Irritation 
Post-nasal drip

Question 25

What is the arterial supply to the medial and lateral walls of the nasal cavity?

Answer 25

``` Ophthalmic artery (ICA) Maxillary artery (ECA) ```

Question 26

What do we call the point of anastomosis in the anterior septum?

Answer 26

Kiesselbach's triangle | Little's area

Question 27

Why is Kiesselbach's triangle important?

Answer 27

Most common source of bleeding in epistaxis | 90%

Question 28

What is the first method of stopping a nose bleed?

Answer 28

Pinch nasal septum (just past bridge) | Lean forward

Question 29

Venous drainage from the nasal cavity goes to ...

Answer 29

Cavernous sinus Facial vein > IJV Pterygoid plexus

Question 30

What is the pterygoid plexus?

Answer 30

Large venous plexus between the temporalis muscle and the lateral pterygoid muscle

Question 31

What are the branches of the ophthlamic artery that supply the nose?

Answer 31

Anterior ethmoid | Posterior ethmoid

Question 32

What is the sphenopalatine artery?

Answer 32

Right at back of nasal cavity Branch of maxillary artery 5% of nose bleeds

Question 33

What are the para-nasal sinuses?

Answer 33

Air filled spaces - extensions of the nasal cavity Lined with resp mucosa Named according to bone found it

Question 34

What is the purpose of nasal sinuses?

Answer 34

Humidify and warm air | Reduce weight of skull

Question 35

Where do most of the paranasal sinuses drain?

Answer 35

Middle meatus

Question 36

Which sinus is most commonly affected with sinusitis and why?

Answer 36

Maxillary sinus | Hard to drain as duct is at top - must be full or go against gravity - therefore blocks easily

Question 37

What are ethmoid air cells and why are they of significance?

Answer 37

Air cells in medial wall of orbit | Infections can pass from ethmoid sinus into orbit

Question 38

Dental abscesses and infections can spread into ...

Answer 38

Maxillary sinus

Question 39

Describe acute sinusitis

Answer 39

Inflammation lasting < 4 weeks Commonly infective and often secondary to viral infection of nasal cavity Usually self limiting

Question 40

Describe the Hx/examination of someone with sinusitis

Answer 40

``` Cold/flu like Sx Pyrexia Rhinorrhoea (green/yellow) Headache/facial pain worse on leaning forward Blocked nose ```

Question 41

What histological effects does a primary infection of the nasal cavity have?

Answer 41

Decreased ciliary function Oedema of mucosa and ostia Increased nasal secretions

Question 42

What are the most likely types of organism to cause sinusitis?

Answer 42

Strep | Haemophilus

Question 43

Which nerves innervate the sinuses?

Answer 43

Maxillary sinus = maxillary branch trigeminal (V2) | Other sinuses = ophthlamic branch trigeminal (V1)

Question 44

What epithelium lies on the tongue?

Answer 44

Stratified squamous non-keratinised

Question 45

The SNS to the nasal cavity comes form ...

Answer 45

T1 | Ascend on carotid artery

Question 46

What regulates blood flow to nasal mucosa?

Answer 46

Pterygopalatine ganglion | PNS (largely greater petrosal nerve)