Pathology of Nose and Paranasal Sinuses Flashcards Preview

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

Flashcards in Pathology of Nose and Paranasal Sinuses Deck (67):
1

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

The nasal septum 

2

What does the nasal septum consist of? 

  • The perpendicular plate of the ethmoid bone
  • Septal cartilage 
  • Vomer

 

 

3

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

The overlying perichondrium 

4

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

For injuries involving the nasal septum 

5

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

Septal haemotoma

6

What causes a septal haematoma? 

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

7

What happens in a septal haemotoma? 

Blood collects in the space between the septum and its perichondrium 

8

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

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

9

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

It causes ischaemia of the cartilage

10

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

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

 

11

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

Cosmetic distortion of the nose - saddle deformity 

12

What does septal abscess formation increase the likelihood of? 

Avascular necrosis of the septum

13

What is sinusitis? 

Acute inflammation of the lining of the sinuses

14

How long does sinusitis last? 

Under 4 weeks

15

When can sinusitis occur? 

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

16

What does sinusitis cause? 

  • Mucosal oedema
  • Impedence of ciliary function
  • Increase in mucosal secretions

 

17

When may drainage from the sinuses become obstructed?

If the oedema involves their opening into the nasal cavity 

18

What does obstruction of the sinuses cause in sinusitis? 

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

19

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

It can become secondarily infected with bacteria

20

Which sinus is particularly prone to infection? 

The maxillary sinus

21

Why is the maxillary sinus the most prone to infection? 

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

22

What increases the risk of sinusitis?

Conditions which may block the ostia of sinuses

23

Which conditions may block the ostia of sinuses? 

  • Nasal polyps 
  • Deviated septum

 

24

When may a dental infection cause sinusitis? 

When it involves the upper teeth

25

How is a diagnosis of sinusitis made? 

Based on history and clinical examination alone

26

What are the symptoms of sinusitis? 

  • 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

 

27

How is sinusitis managed?

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

28

When may a course of antibiotics be required in sinusitis?

If secondary bacterial infection is suspected

29

What complications can arise from sinusitis? 

Orbital cellulitis

30

How may orbital cellulitis occur in sinusitis?

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

31

What is problem with orbital cellulitis? 

Spread of infections into the orbit can be potentially sight threatening 

32

Why may infections of the orbit be sight threatening? 

They may involve the optic nerve

33

How may orbital cellulitus progress? 

May track back further to involve intracranial structures

34

What is an epistaxis?

A nosebleed

35

Describe the prevalence of epistaxis

Very common

36

How are epistaxis usually managed? 

 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

What is the arterial supply of the nasal cavity from? 

Mainly from branches of the maxillary artery

38

What branches of the maxillary artery supply the nasal cavity? 

  • Sphenopalatine
  • Greater petrosal

 

39

What % of nosebleeds come from the sphenopalatine artery? 

10%

40

Why can nosebleeds from the sphenopalatine area be particularly problematic? 

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

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

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

42

What is the opthlamic artery a branch of? 

The internal carotid artery

43

What forms Little's area? 

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

44

What is Little's area also known as? 

Keiselbach's Area or Plexus

45

What is Little's Area? 

A cartilaginous part of the septum 

46

What % of nosebleeds originate from Little's area? 

90%

47

When may nosebleeds occur? 

Spontaneously, or with very minor trauma to the nose

48

What may sometimes be the cause of nosebleeds? 

Underlying systemic causes; 

  • Abnormal coagulation
  • Connective tissue disorders

 

49

What can happen is serious nosebleeds occur? 

Can potentially risk significant blood loss, and rarely even death

50

How is a serious nosebleed managed? 

  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

What do nasal tampons do? 

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

52

What surgical interventions are taken in a serious nosebleed? 

  • Embolism
  • Ligation of blood vessels

 

53

What should be monitored in severe epitaxis?

  • ABCs
  • Blood tests to check Hb levels and clotting

 

54

What should happen regarding underlying systemic consequences in severe epitaxis?

They should be sought and treated

55

What are nasal polyps?

Benign, fleshy swellings arising from nasal mucosa

56

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

Both

57

Describe the appearance of nasal polyps

Pale or yellow in appearance, or flesh coloured and reddened

58

Who are nasal polyps most common in?

Those over 40 years

59

What are the symptoms of nasal polyps?

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

 

60

What might suggest a tumour instead of a polyp?

Unilateral polyp, with or without blood-tinged secretion 

61

How are nasal polyps treated?

Nasal spray, to reduce size

62

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

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

63

What is rhinitis?

Inflammation of the nasal mucosal lining

64

What are the common causes of rhinitis?

  • Simple acute infective rhinitis
  • Allergic rhinitis

 

65

What causes simple acute infective rhinitis?

Common cold

66

What causes allergic rhinitis?

Hayfever

67

What are the symptoms of rhinitis?

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