ENT ORL otorhinolaryngology Rhinology Kian Kianoosh Nahid
Flashcards about rhinology
Sinking of what part of embryonic face results in olfactory pit?
olfactory or nasal placode
what separates the nasal and oral cavity in embryo?
bucconasal membrane which thins later and form primitive choannae.
Name the parts of maxillary bone
floor of the orbit
Which paranasal sinus appears first?in what age it reaches to final size?
Maxillary (7 to 10 weeks)
final size: 17-18 years
When is the time for ethmoid sinus to appear?
9-10 weeks of gestation
How the ethmoid aircells and nasal turbinates are formed in emryogenesis period?
9-10 weeks of gestation, 6-7 folds appear on the lateral nasal wall:
Nasoturbinal makes aggar nasi and uncinate process.
Ethmoturbinals make aircells, middle, superior and supreme turbinates.
Maxilloturbinal makes inferior turbinate
When is sphenoid sinus first appearance?
3rd intrauterine month as an invagination from sphenoethmoidal recess.
When is the frontal sinus first appearance?
4th month of foetal age from frontal recess.
It is the last to complete in adulthood.
Blood supply of nasal septum?
What are anterior and posterior fontanelles of nasal lateral wall? Their significance?
Parts of maxillary hiatus which are covered by only mucous membrane in front and behind ethmoid bulla. may contain maxillary accessory ostia.( mostly in the posterior one) and are considered to be due to infection ( like TM perforation)
Variation of uncinate process attachment?
What is the lining of the maxillary sinus?
Cilliated collumnar epithelium with goblet cells
What is the benefit of nasal airway resistance?
Adults breathe preferentially from their nose, and positive pressure in the nose during expiration keeps the alveoli patent.
What is the cause and length of the cyclic changes of nasal pressure?
4 to 12 hours
Composition of nasal mucus?
Water and ions
Glycoproteins (80% of dry weight)
Enzymes circulatory proteins (complenet, CRP)
cells (WBC, EOS, ..)
structure of nasal cillia?
9 outer pairs of microtubules around 1 inner pair. outer pairs have Dynein arms which has ATPase (lost in Kartagener's syn), 200 for each cell.
Beat frequency 7-16Hz
What interferes with nasal cilliary function?
URTI (destroys epithelium)
What is the action of Menthol in nose?
It stimulates the cold receptors in the nose, causing apparent increase in airflow.
What are the effects of thyroid disturbance on nose?
Hypothyroidism: nasal blockage (deposition of mucopolysaccarides)
Keros classification for ethmoid roof?
What is the definition and Pathophysiology of Young's syndrome?
A genetic disease causing Bronchiestasis, nasal polyps, rhinosinusitis, Azoospermia.
It is due to thick viscous mucus in nasal, pulmonary and epididimal spaces.
Definition of rhinolalia aperta?
A nasal quality of the voice from some disease or defect of the nasal passages.
Describe Osler weber rendu syndrome in brief.
Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia (HHT), is an autosomal dominant disorder typically identified by the triad of telangiectasia, recurrent epistaxis, and a positive family history for the disorder. Mostly in whites, m=f.
The main areas of involvement: nasal mucosa, skin, the GI tract.
What is Esthesioneuroblastoma?
Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare neoplasm originating from olfactory epithelium.
No sex discrimination.
Bimodal peak of occurrence in the third and sixth decades of life.
A mucocoele is an epithelial-lined, mucus-containing sac completely filling the sinus and capable of expansion. This is in contradistinction to a blocked sinus cavity which simply contains mucus.
where is the most common site for mucocoele?
The fronto-ethmoidal region IS by far the most commonly affected overall and the maxillary sinus the least, but a proportion of sphenoidal mucocoeles present to neurosurgeons and the number is therefore probably more common.
The cause and main theories of pathogenesis of mucocoele?
Mucocoeles are thought to arise as a consequence of obstruction plus inflammation. Three main theories of pathogenesis are found in the literature:
1. pressure erosion;
2. cystic degeneration of glandular tissue;
3. active bone resorption and regeneration.
What is one of the possible symptoms of maxillary mucocoele?
nasal obstruction due to expansion of the lesion into nasal cavity
surgical treatment options for frontal sinus mucocoele?
Combined endoscopic and external approach
Chandler classification of Orbital complications of rhinosinusitis?
Postseptal cellulitis or orbital cellulitis without abscess Subperiosteal abscess
Orbital or intra periosteal abscess
Cavernous sinus thrombosis
What are the main complications of rhinosinusitis?
Intracranial (meningitis, abscess)
Bony (Pott's puffy tumour)
prevalence in population?
Mean age of onset?
Main causes of nasal polyposis?
Nonallergic rhinitis with asthma and aspirin intolerance.
Allergic fungal rhinosinusitis (90% of patients).
Cystic fibrosis (40% patients, polyps in children).
Kartagener's syn ( 40% of patients).
Where is the commonest site of nasal polyposis? What are theories about it?
1) touching that mucosa releases the proinflammatory citokines
2) influence of special airflow and pressure in upper part of nose (narrow passage causes faster arflow and reduced pressure which sucks the fluid toward the mucosa)
3) Damage of thin regulatory nerve ending of the area by cytotoxic proteins of eosinophils causes abnormal vascular permeability and tissue edema.
What is Surface epilthelium of nasal polyp?
The major part of the polyp surface is covered by a ciliated pseudostratified epithelium, but, in addition, transitional and squamous epithelia are found, especiallyin anterior polyps, influenced by the inhaled aircurrents.
Lund-McKay Endoscopic staging of nasal polyps?
1) Restricted to middle meatus
2) Below middle turbinate
3) Massive polyposi
Indications for septoplasty:
Nasal obstruction, crusting, rhinorrhoea, post-nasal discharge, recurrent sinus pressure or pain, epistaxis, headache, snoring and sleep apnoea.
Principal symptoms in septal perforation?
crusting, epistaxis, whistling, dryness, emptiness in nose, and general discomfort
Clinical types of epistaxis?
--Childhood < 16 years
--Adult >16 years
--Anterior (Bleeding point anterior to piriform aperture)
--Posterior (Bleeding point posterior to piriform aperture)
Why consumption of alcohol can cause epistaxis?
Due to prolonged bleeding time in presence of normal platelets count.
Where and what is woodruff's plexus?
posterior to middle turbinate, spot for epistaxis in adult due to athersclerosis of feeding arteries.
Classes of nasal fracture?
1) low-moderate degrees of force causing depressed nose and Chevallet fracture in septal cartilage.
2) greater force: causing deviation and Jarjarvay fracture in septal cartilage.
3) naso-orbito-ethmoid: classic pig-like nose and telecanthus
Stranc- Robertson's classification for nasal bone #?
-Plane I: nasal spine
-Plane II: Maxillary process
-Plane III: orbital-ethmoidal
Markowitz classification of naso-orbito-ethmoid #?
A: solid central segment which medical canthus is attached to.
B: More comminuted but still has a central segment for medial canthus.
C: No solid bone for medial canthus to attach to.
Types of Septal cartilaginous fracture in nasal trauma?
Lateral fracture: Jarjaway
Frontal fracture: Chevallet
Types of Lefort fracture?
Le Fort 1: runs above the floor ofthe nasal cavity, through the nasal septum,maxillary sinuses and inferior parts of the medialand lateral pterygoid plates.
Le Fort 2: This is a fracture which runs from the floor of the maxillary sinuses superiorly to the infraorbital margin and through the zygomaticomaxillary suture. Within the orbit it passes across the lacrimal bone to the nasion. The infraorbital nerve is often damaged by involvement in this fracture.
Le Fort 3: This represents a disconnection of the facial skeleton from the cranial base. The fracture traverses the medial wall of the orbit to the superior orbital fissure and exits across the greater wing of the sphenoid and zygomatic bone to the zygomaticofrontal suture. Posteriorly, the fracture line runs inferior to the optic foramen, across the lesser wing of the sphenoid to the pterygomaxillary fissure and sphenopalatine foramen. The arch of the zygoma is also broken.
Signs of orbital fracture?
enophthalmos and hypoglobus (depressed pupillary level). Enophthalmos is most apparent when the contralateral eye is normal.
Other signs include supratarsal hollowing, hooding of the eye, narrowing of the palpebral fissure width and an infraorbital nerve deficit.
A small fracture of the orbital floor can lead to a trap door phenomenon. If the orbital fat or inferior oblique muscle becomes trapped in the fracture configuration, then interference with muscular function results in diplopia on upward gaze.
where Beta2 transferrin can be found?
aqueous humour (secreted from the ciliary epithelium, a structure supporting the lens)
How to use Flourcein in detecting CSF leak?
0.25 mL of 5 percent fluorescein is mixed with 10 mL of CSF from a routine lumbar puncture, the mixture is introduced via a spinal needle and the patient is placed in the Trendelenberg position for approximately one hour.Then, endoscopic examination is performed, and if positive the fluorescein can be seen coming from the defect. The use of a blue filter on the endoscope light source can increase the ease of detection.
Sarcoidosis in brief:
systemic granulomatoisis with unknown origin, more in USA and scandinavia, f/m 2/1, more in black (12 times whites), 30-50 years old, involves LRT (lower respiratory tract) more.
A condition, characterized by granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small- to medium-sized vessels (e.g.capillaries, venules, arterioles and arteries) with necrotizing glomerulonephritis.
Pathologic hallmark and triad of wegener's ?
coexistence of vasculitis and granulomas disease.
It classically involves a triad of lower airway, lung and kidney.