SM_14b-15b: Paranasal Sinuses and Nose I and II

Question 1

Function of nasal and paranasal sinuses are ____, ____, ____, and ____

Answer 1

Function of nasal and paranasal sinuses are breathing, warming / humidifying air, filtering particulates, and olfaction

(effects: vocal resonance, immunologic deficiencies, reduce weight of head)

Question 2

Nasal septum is a ____ structure that receives blood supply and nutrients from the ____

Answer 2

Nasal septum is a midline structure that receives blood supply and nutrients from the mucosa

Question 3

Septal hematoma occurs after ____ and results in ____ and ____ if not drained due to ____

Answer 3

Septal hematoma occurs after trauma and results in infection and septal perforation if not drained due to loss of blood supply to the septum

Question 4

Nasal turbinates are responsible for ____, ____, ____, and ____

Answer 4

Nasal turbinates are responsible for increasing mucosal surface area, directing airflow, the nasal cycle, and sensation of nasal airflow

• Dynamic: venous sinusoids - the nasal cycle
• Sensation of nasal airflow: evaporative cooling tells your brain that things are working properly

Question 5

Airflow is brought to the top of the nose during a ____

Answer 5

Airflow is brought to the top of the nose during a sniff

Question 6

Lifespan of olfactory sensory nerve is ___

Answer 6

Lifespan of olfactory sensory nerve is 6-8 weeks

(suffer a lot of wear and tear, progenitor cells sprout to replace each neuron)

Question 7

Chemosensory perception involves a lot of genes for ____

Answer 7

Chemosensory perception involves a lot of genes for odorant receptors

Question 8

Common etiologies of olfactory loss are ____, ____, ____, ____, and ____

Answer 8

Common etiologies of olfactory loss are head trauma, viral, sinonasal, aging, and neurodegenerative disease

(head trauma, viral, and sinonasal account for 80%)

Question 9

Olfactory testing is conducted using the ____

Answer 9

Olfactory testing is conducted using the University of Pennsylvania Smell Inventory Test

(normative data by gender and age)

Question 10

Internal carotid artery turns into the ____ and ____ in the nose

Answer 10

Internal carotid artery turns into the anterior and posterior ethmoid arteries in the nose

Question 11

External carotid artery turns into the ____ in the nose

Answer 11

External carotid artery turns into the sphenopalatine artery in the nose

Question 12

Blood to the supply to the nose includes the ____, ____, and ____ arteries

Answer 12

Blood to the supply to the nose includes the anterior and posterior ethmoid and sphenopalatine arteries

(ICA -> anterior and posterior ethmoid arteries, ECA -> sphenopalatine artery)

Question 13

____ feeds the ophthalmic artery

Answer 13

Internal carotid artery feeds the ophthalmic artery

Question 14

____ artery can be embolized to treat epistaxis

Answer 14

Sphenopalatine artery artery can be embolized to treat epistaxis

(anterior and posterior ethmoid arteries should not be embolized because come from ICA which feeds the ophthalmic artery -> can blind someone)

Question 15

Describe treatment for epistaxis

Answer 15

Treatment for epistaxis

• Pressure: packing (gauze, sponge, and balloon)
• Cauterization: silver nitrate, electrical
• Ligation: internal maxillary, sphenopalatine, anterior and posterior ethmoids
• Embolization, internal maxillary, sphenopalatine (only)

Question 16

Common causes of nasal obstruction include ____ and ____

Answer 16

Common causes of nasal obstruction include nasal septum deviation (nasal valve obstruction) and enlarged inferior turbinates

Question 17

Image on the right shows ____

Answer 17

Image on the right shows deviated nasal septum

Question 18

Sinuses develop as ____

Answer 18

Sinuses develop as face develops

Question 19

This is ____ to ____

Answer 19

This is lateral to middle turbinate

Question 20

Describe the anatomy of the maxillary sinus

Answer 20

Maxillary sinus anatomy

• Expansion of lateral nasal wall into maxillary bone
• Natural ostium (opening) at the top of the sinus
• Roof of the maxillary sinus is the orbital floor
• Roof of maxillary sinus contains infraorbital nerve (V2)
• Roots of teeth may project into floor of maxillary sinus

Question 21

Describe the anatomy of the ethmoid sinuses

Answer 21

Ethmoid sinuses anatomy

• Complex arrangement of sinuses developing within the ethmoid bones
• Divded into anterior and posterior ethmoids
• Lateral boundary of ethmoid is the orbit
• Roof of ethmoid is anterior cranial fossa
• Medial boundary of ethmoid is cribriform plate

Question 22

Describe the anatomy of the sphenoid sinus

Answer 22

Sphenoid sinus anatomy

• Centrally located within the skull base
• Lateral to sphenoid sinus: carotid artery, optic nerve, cavernous sinus, 3rd / 4th / 5th / 6th CN

Question 23

Describe the anatomy of the frontal sinus

Answer 23

Frontal sinus anatomy

• Extension of ethmoid sinuses into frontal bone
• Most complex drainage pattern
• Valveless veins through posterior table

Question 24

Paranasal sinus cells of the anterior skull base include the ___, ___, ___, and ___

Answer 24

Paranasal sinus cells of the anterior skull base include the ethmoid bulla, posterior ethmoids, sphenoid sinus, and frontal sinus

Question 25

Label the sinuses on this coronal view

Answer 25

Question 26

Label everything

Answer 26

Question 27

Common variants of paranasal anatomy that are not pathologic are ____ and \_\_\_\_

Answer 27

Common variants of paranasal anatomy that are not pathologic are concha bullosa and Haller cell (infraorbital ethmoid)

Question 28

Mucociliary flow functions to ___ and \_\_\_

Answer 28

Mucociliary flow functions to humidify and filter inspired air (up to 95% humidity of inspired air, water filter)

Question 29

Sinuses generate ___ whose drainage is driven by \_\_\_

Answer 29

Sinuses generate mucus whose drainage is driven by cilia

Question 30

Sinuses in the front of the nose, including the \_\_\_\_, \_\_\_\_, and \_\_\_\_, drain under the \_\_\_\_

Answer 30

Sinuses in the front of the nose, including the frontal, ethmoid, and maxillary sinuses, drain under the middle turbinate

Question 31

\_\_\_\_ and ____ sinuses drain into ____ behind the \_\_\_\_

Answer 31

Posterior ethmoids and sphenoid sinus drian into sphenoethmoid recess behind the middle turbinate

Question 32

Describe the uncinate process

Answer 32

Uncinate process * Cuts off anterior pathway drainage system * All secretions drain to middle meatus lateral to middle turbinate - uncinate process sticks out here (frontal drainage has some recirculation but mainly small pathway anterior to the face)

Question 33

Rhinosinusitis is \_\_\_\_

Answer 33

Rhinosinusitis is inflammation of the nasal cavity and paranasal sinuses due to acute infections or chronic inflammation (lots of individual variability but symptoms include nasal blockage, nasal discharge, facial pain / headache, reduction / loss of smell)

Question 34

Describe the cycle of ostial obstruction

Answer 34

Cycle of ostial obstruction

Question 35

Viral rhinosinusitis is ____ and involves symptoms that are present for ____ and \_\_\_\_

Answer 35

Viral rhinosinusitis is acute rhinosinusitis caused by viral infection and involves symptoms that are present for \< 10 days and are not worsening * Caused by rhinovirus, coronavirus, RSV, adenovirus, influenza, parainfluenza * Majority of URIs are viral

Question 36

Symptoms of URI \_\_\_\_

Answer 36

Symptoms of URI vary by person

Question 37

Acute bacterial rhinosinusitis is caused by ____ and may be present if ____ or \_\_\_\_

Answer 37

Acute bacterial rhinosinusitis is caused by bacterial infection and may be present if symptoms / signs fail to improve within 10 days or so after the onset of upper respiratory symptoms or symptoms / signs of acute rhinosinusitis worsen at 5-10 days (double worsening) (most often caused by S. pneumonia, H. influenzae, and M. catarrhalis)

Question 38

Describe diagnosis of acute bacterial rhinosinusitis

Answer 38

Diagnosis of acute bacterial rhinosinusitis * Up to 4 weeks of purulent nasal drainage * Purulent nasal discharge is cloudy or colored * Nasal obstruction * Facial pain / pressure / fullness

Question 39

Describe diagnosis of chronic rhinosinusitis

Answer 39

Diagnosis of chronic rhinosinusitis ≥ 12 weeks with ≥ 2 of the following * Mucopurulent drainage: anterior, posterior, or both * Nasal obstruction: congestion, stuffy, blocked * Facial pain / pressure / fullness * Decreased sense of smell AND inflammation documented by * Purulent mucus or edema in middle meatus or anterior ethmoid * Polyps in nasal cavity or middle meatus and/or * Radiographic imaging showing inflammation of paranasal sinuses

Question 40

Chronic rhinosinusitis without nasal polyps presents as \_\_\_, \_\_\_, \_\_\_, and \_\_\_

Answer 40

Chronic rhinosinusitis without nasal polyps presents as stuffy, pressure / pain, mucus, and frequent exacerbations (may be infections)

Question 41

Chronic rhinosinusitis presents as ____ and \_\_\_\_

Answer 41

Chronic rhinosinusitis presents as stuffy -\> obstruction and decreased olfaction

Question 42

Allergic fungal sinusitis involves \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_

Answer 42

Allergic fungal sinusitis involves fungal growth, polyps, eosinophils, and possibly bone remodeling

Question 43

Pathophysiology of chronic rhinosinusitis involves \_\_\_\_

Answer 43

Pathophysiology of chronic rhinosinusitis involves inflammation (results from many factors)

Question 44

Medial management of chronic rhinosinusitis primarily involves ___ and \_\_\_

Answer 44

Medial management of chronic rhinosinusitis primarily involves non-pharmacologic treatment such as saline lavage and corticosteroids (sprays, lavage, oral) (also antibiotics, antihistamines, decongestants)

Question 45

Describe surgery for chronic sinusitis

Answer 45

Surgery for chronic sinusitis * Surgery alters anatomy: enlarges sinus ostia * Opens areas of anatomic restriction in the nose: septal deviation, concha bullosa * Improves sinus ventilation * No direct change in mucosal physiology * Improves access of intranasal meds to sinus mucosa: sprays, irrigated medications

Question 46

Goal of surgery for chronic sinusitis is \_\_\_\_

Answer 46

Goal of surgery for chronic sinusitis is improved quality of life * Improve mucociliary clearance * Relieve obstruction * Improve olfaction * Improve access for topical medications * Decrease severity / frequency of acute exacerbations

Question 47

\_\_\_ is effective for nasal polyps through blocking IL-4 and IL-13

Answer 47

Dupilimab is effective for nasal polyps through blocking IL-4 and IL-13