Flashcards in Nose Deck (46)
what type of epithelium lines the nasal cavity?
roof = olfactory epithelium (allows receptor cells from the olfactory bulb to send information about smell
rest is lined by respiratory epithelium
what bones form the nasal septum?
perpendicular plate of the ethmoid bone
what nerve supplies the upper half of the nasal cavity?
what nerve supplies the lower half of the nasal cavity?
describe arterial supply to the lateral wall of the nasal cavity
- anterior ethmoidal arteries
- posterior ethmoidal arteries
posterior = sphenopalatine artery (traverses sphenopalatine foramen)
inferior = greater palatine artery
anterior = lateral nasal branches of facial artery
what is kieselbachs area?
area on nasal septum which is rich an anastomosing arteries
common site of bleeding
- anterior and posterior ethmoidal arteries
- septal branch of labial artery
- greater palatine artery
- branch of sphenopalatine artery
where is the sphenoethmoidal recess and what drains here?
above the superior nasal concha
drains the sphenoidal sinus
where is the superior meatus and what drains here?
below the superior nasal concha
drains posterior ethmoidal air cells
where is the middle meatus and what are the 2 parts of it?
below the middle meatus
- semilunar hiatus
- ethmoidal bulla
what drains into each part of the middle meatus?
- frontal sinus
- maxillary sinus
- anterior ethmoidal cells
- middle ethmoidal air cells
where is the inferior meatus and what drains here?
below the inferior nasal concha
drains nasolacrimal duct
how may a nasal fracture present and how is it managed?
bruising, swelling, tenderness, deviation, epistaxis
review after 2-3 weeks once swelling has reduced and manipulate under anaesthetic
4 risks which accompany nasal fracture?
what are the dangers of a septal haematoma?
can lead to perichondrium separation, de vascularisation of the cartilage, necrosis and infection
where does epistaxis usually occur from?
kiesselbachs area (anastomising arteries on the septal wall)
how is mild epistaxis managed?
how is moderate epistaxis managed?
silver nitrate vessel cautery or electrocautery
how is severe epistaxis managed?
post nasal packing
consider arterial ligation in severe bleeds
viral vs bacterial vs secondary bacterial sinusitis?
viral = lasts less than 10 days
bacterial = lasts over 10 days, but less than 4 weeks
secondary bacterial = viral infection which seems to get better then worsens a few days later
symptoms of sinusitis?
purulent nasal discharge
facial pain/pressure over sinuses
how is acute viral sinusitis managed?
how is acute bacterial sinusitis managed?
watchful waiting for >10 days and then commence antibiotics
- 1st line = penicillin for 7 days
- 2nd line = doxycycline for 7 days
plus same management as viral
how is sinusitis managed in immunosuppressed?
immediate antibiotic treatment and ENT specialist referral
what is chronic sinusitis?
lasting more than 12 weeks
how is chronic sinusitis investigated?
- sinus CT (for pre surgical staging)
sinus MRI (shows intracranial spread, fungal infections etc)
how is chronic sinusitis managed medically?
oral corticosteroids (if oedema or polyps present)
anti-histamines/anti-leukotrienes if complicated with allergic rhinitis
how is chronic sinusitis managed surgically?
FESS (functional endoscopic sinus surgery)
- increases diameter of sinus opening to allow drainage of sinuses
what are the 2 groups of rhinitis?
what is allergic rhinitis?
inflammation of the nasal cavity due to a type 1, IgE associated response to indoor and/or outdoor environmental allergens
e.g - pollens, mould spores, animals, feathers, dust mites