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ESA 4 - Head and Neck > Pathology of Nose and Paranasal Sinuses > Flashcards

Pathology of Nose and Paranasal Sinuses Flashcards

1
Q

What is the medial wall of the nasal cavity formed by?

A

The nasal septum

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2
Q

What does the nasal septum consist of?

A
  • The perpendicular plate of the ethmoid bone
  • Septal cartilage
  • Vomer
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3
Q

What does the septal cartilage rely on for its blood supply?

A

The overlying perichondrium

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4
Q

Where does the septal cartilages’ blood supply have important clinical implications?

A

For injuries involving the nasal septum

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5
Q

What is the clinical implication for injuries involving the nasal septum?

A

Septal haemotoma

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6
Q

What causes a septal haematoma?

A

Trauma to the nose leading to buckling of the septum, and shearing of the blood vessels

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7
Q

What happens in a septal haemotoma?

A

Blood collects in the space between the septum and its perichondrium

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8
Q

What is the result of blood developing between the septum and its perichondriuM?

A

It lifts the perichondrium off the cartilage, stripping away its blood supply

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9
Q

What does the pressure of the accumulating blood do in a septal haemotoma?

A

It causes ischaemia of the cartilage

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10
Q

What happens if a septal haemotoma is not recognised and drained in a timely fashion?

A
  • Irreversible avascular necrosis of the cartilage can occur
  • Infection development in collecting haemotoma
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11
Q

What does avascular necrosis of the cartilage cause in a septal haemotoma?

A

Cosmetic distortion of the nose - saddle deformity

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12
Q

What does septal abscess formation increase the likelihood of?

A

Avascular necrosis of the septum

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13
Q

What is sinusitis?

A

Acute inflammation of the lining of the sinuses

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14
Q

How long does sinusitis last?

A

Under 4 weeks

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15
Q

When can sinusitis occur?

A

Following a viral infection of the nasal mucosae, e.g. a cold

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16
Q

What does sinusitis cause?

A
  • Mucosal oedema
  • Impedence of ciliary function
  • Increase in mucosal secretions
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17
Q

When may drainage from the sinuses become obstructed?

A

If the oedema involves their opening into the nasal cavity

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18
Q

What does obstruction of the sinuses cause in sinusitis?

A

This, combined with increased mucosal secretions, leads to a stagnant pool collection within the sinus

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19
Q

What can sometimes happen when a stagnant pool collects in sinusitis?

A

It can become secondarily infected with bacteria

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20
Q

Which sinus is particularly prone to infection?

A

The maxillary sinus

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21
Q

Why is the maxillary sinus the most prone to infection?

A

Most likely becasue of the location opening high on the medial wall of the nasal cavity

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22
Q

What increases the risk of sinusitis?

A

Conditions which may block the ostia of sinuses

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23
Q

Which conditions may block the ostia of sinuses?

A
  • Nasal polyps
  • Deviated septum
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24
Q

When may a dental infection cause sinusitis?

A

When it involves the upper teeth

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25
Q

How is a diagnosis of sinusitis made?

A

Based on history and clinical examination alone

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26
Q

What are the symptoms of sinusitis?

A
  • Non-resolving cold or flu-like illness that persists for more than a week
  • Pyrexia
  • Rhinorrhoea +/- green/yellow discharge
  • Headahe/facial pain (in area of affected sinus), worse on leaning forward
  • Blocked nose
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27
Q

How is sinusitis managed?

A

Most cases are self limiting, and can be treated with simple analgesics. They start to improve within 1-2 weeks

28
Q

When may a course of antibiotics be required in sinusitis?

A

If secondary bacterial infection is suspected

29
Q

What complications can arise from sinusitis?

A

Orbital cellulitis

30
Q

How may orbital cellulitis occur in sinusitis?

A

Infections of the air cells of the ethmoidal sinuses may break through the thin medial wall of the orbit, causing orbital cellulitis

31
Q

What is problem with orbital cellulitis?

A

Spread of infections into the orbit can be potentially sight threatening

32
Q

Why may infections of the orbit be sight threatening?

A

They may involve the optic nerve

33
Q

How may orbital cellulitus progress?

A

May track back further to involve intracranial structures

34
Q

What is an epistaxis?

A

A nosebleed

35
Q

Describe the prevalence of epistaxis

A

Very common

36
Q

How are epistaxis usually managed?

A

Often minor, so usually self-treated with simple first-aid measures, by pinching in front of (not on) the bony bridge of the nose, and applying a cold compress

37
Q

What is the arterial supply of the nasal cavity from?

A

Mainly from branches of the maxillary artery

38
Q

What branches of the maxillary artery supply the nasal cavity?

A
  • Sphenopalatine
  • Greater petrosal
39
Q

What % of nosebleeds come from the sphenopalatine artery?

A

10%

40
Q

Why can nosebleeds from the sphenopalatine area be particularly problematic?

A

Blood in this vessel tends to be at higher pressure, and as it is posteriorly located in the nasal cavity, harder to reach to stop the bleed

41
Q

Other than branches of the maxillary artery, what contributes to the nose’s rich blood supply?

A

Ethmoidal branches from the opthalmic artery, and a branch of the facial artery

42
Q

What is the opthlamic artery a branch of?

A

The internal carotid artery

43
Q

What forms Little’s area?

A

Anastomoses of the opthlamic artery (ethmoidal branches), facial artery, greater petrosal, and sphenopalatine artery

44
Q

What is Little’s area also known as?

A

Keiselbach’s Area or Plexus

45
Q

What is Little’s Area?

A

A cartilaginous part of the septum

46
Q

What % of nosebleeds originate from Little’s area?

A

90%

47
Q

When may nosebleeds occur?

A

Spontaneously, or with very minor trauma to the nose

48
Q

What may sometimes be the cause of nosebleeds?

A

Underlying systemic causes;

  • Abnormal coagulation
  • Connective tissue disorders
49
Q

What can happen is serious nosebleeds occur?

A

Can potentially risk significant blood loss, and rarely even death

50
Q

How is a serious nosebleed managed?

A
  1. Applying simple compression and leaning forwards
  2. Cauterise a visible bleeding point using silver nitrate
  3. Anterior packing using nasal tampons
  4. Posterior packing
  5. Surgical intervention
51
Q

What do nasal tampons do?

A

Expand within the nasal cavity, and tamponade the area of bleeding

52
Q

What surgical interventions are taken in a serious nosebleed?

A
  • Embolism
  • Ligation of blood vessels
53
Q

What should be monitored in severe epitaxis?

A
  • ABCs
  • Blood tests to check Hb levels and clotting
54
Q

What should happen regarding underlying systemic consequences in severe epitaxis?

A

They should be sought and treated

55
Q

What are nasal polyps?

A

Benign, fleshy swellings arising from nasal mucosa

56
Q

Do nasal polyps usually affect one or both sides of the nasal cavity?

A

Both

57
Q

Describe the appearance of nasal polyps

A

Pale or yellow in appearance, or flesh coloured and reddened

58
Q

Who are nasal polyps most common in?

A

Those over 40 years

59
Q

What are the symptoms of nasal polyps?

A
  • Blocked nose and watery rhinorrhea
  • Post nasal drip
  • Decreased smell and reduced taste
60
Q

What might suggest a tumour instead of a polyp?

A

Unilateral polyp, with or without blood-tinged secretion

61
Q

How are nasal polyps treated?

A

Nasal spray, to reduce size

62
Q

How do you differentiate between a nasal polyp and a turbinate?

A

Polyps are mobile if poked, and can’t be felt, whereas turbinates are immobile and painful if poked

63
Q

What is rhinitis?

A

Inflammation of the nasal mucosal lining

64
Q

What are the common causes of rhinitis?

A
  • Simple acute infective rhinitis
  • Allergic rhinitis
65
Q

What causes simple acute infective rhinitis?

A

Common cold

66
Q

What causes allergic rhinitis?

A

Hayfever

67
Q

What are the symptoms of rhinitis?

A
  • Nasal congestion
  • Rhinorrhoea
  • Sneezing
  • Nasal irritation
  • Postnasal drip

ESA 4 - Head and Neck (30 decks)

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