Frontal Sinus And Noe

Front 1

Where does the Naso-frontal duct empty into?

Back 1

The ethmoid air cells of the middle meatus of the nose

Front 2

What are the muscles that bound the frontal sinus? (3)

Back 2

Orbicularis, Frontalis and Procerus

Front 3

What are the bony boundaries of the frontal sinus?

Back 3

lacrimal and ethmoid bones inferiorly, the sphenoid inferiorly and posteriorly, the
parietal posteriorly and superiorly, the zygoma laterally, the nasal bones anteriorly, and the maxilla anteriorly and inferiorly.

Front 4

What arteries vascularize the frontal sinus?

Back 4

Anterior ethmoid arteries, and the supraorbital artery

Front 5

Which nerve passes through the anterior ethmoid foramen?
What does it do?

Back 5

The nasociliary nerve which is a branch of V1 and carries the long ciliary nerve (the afferent limb of the corneal blink reflex)

Front 6

What are the 3 portions of the orbicularis oculi muscle?
Which portion unites to form the medial canthal tendon?

Back 6

Orbital, preseptal, pretarsal
The preseptal

Front 7

What structure lies between the superficial and deep portions of the medial canthal tendon?

Back 7

Lacrimal sac

Front 8

What is another name for the deep portion of the medial canthal tendon?

Back 8

Horner's muscle (pars lacrimalis)

Front 9

Describe the lacrimal apparatus from lacrimal lake to inferior meatus

Back 9

The lacrimal lake is drained by inferior and superior canaliculi. The two canaliculi pierce the lacrimal sac which continues inferiorly as the nasolacrimal duct, empties into the inferior meatus.

Front 10

What is hyposmia?

Back 10

Reduced ability to smell.

Front 11

What is the radix of the nose?

Back 11

Radix means base. In this case, the base of the nose is the area of the nasal bones. In the case of NOE fractures, you get depression of the radix

Front 12

How can you definitively check for CSF fluid leakage?

Back 12

Collect liquid and check for presence of Beta2-transferrin. Alternatively, high chloride and low glucose levels in the fluid.

Front 13

What is another name for exophthalmos?

Back 13

Proptosis

Front 14

What is normal intercanthal distance?

Back 14

~29 to 33mm for women
~29 to 33mm for men

Front 15

What is the bowstring test?

Back 15

Involves pulling the lateral canthus inferiorly and laterally while palpating the medial tendon

Front 16

What is the bimanual examination?

Back 16

Place an instrument like a kelly hemostatat high into the nose just inferior to the MCT. Lift at the MCT with the other hand.

Front 17

What are the 3 types of NOE fracture?

Back 17

Type I: MCT is attached to one large NE fragment
Type II: MCT is attached to one segment, but fracture is more comminuted
Type III: Severe comminution with possible avulsion of the MCT.

Front 18

What is the main reason to repair anterior frontal table fractures?

Back 18

Esthetics

Front 19

What is the main reason to repair posterior frontal table fractures?

Back 19

Neurologic sequelae: Meningitis, brain abscess

Front 20

What is the possible sequelae of an unrepaired nasofrontal duct?

Back 20

Mucoceles (mucus)
Pyocele (pus)

Front 21

What are the layers of the scalp?

Back 21

S: Skin
C: Connective tissue (fat)
A: Aponeurosis
L: Loose areolar tissue
P: Periosteum (pericranium)

Front 22

What are the subclassifications of a Posterior table fracture?

Back 22

1) non-displaced
2) displaced
3) displaced with gross neurologic injury

Front 23

What is the difference between a nasofrontal duct obstruction and sinus obliteration?

Back 23

Nasofrontal duct obstruction is done with another material to protect the sinus. Sinus obliteration is the elimination of dead space.

Front 24

Why do you remove all of the sinus mucosa when obliterating the fronal sinus?

Back 24

Because any mucosa left behind will continue to grow and can lead to mucoceles or pyoceles

Front 25

What is a Dacrocystorhinotomy?

Back 25

Dacryocystorhinostomy (DCR) is the repair of the lacrimal drainage system through the creation of a new “ostomy” or
track from the lacrimal canaliculi to the nasal cavity.

Front 26

When does the initial pneumatization of the frontal sinus begin?

Back 26

During the 4th month in utero

Front 27

When is the peneumatization of the frontal sinus complete?

Back 27

Between 12 to 16 years old (so around puberty) but it can continue until age 40!

Front 28

What type of epithelium lines the frontal sinus?

Back 28

Pseudostratified ciliated epithelium (respiratory epithelium)

Front 29

What arteries vascularize the frontal sinus?

Back 29

The anterior ethmoid arteries and the supraorbital arteries.

Front 30

What nerve passes thru the anterior ethmoid foramen?

Back 30

The nasociliary nerve

Front 31

What are the 3 portions of the orbicularis oculi muscle?

Back 31

1) Orbital
2) Preseptal
3) Pretarsal

Front 32

Which portion of the orbicularis oculi muscle unites its upper and lower segments to form the medial canthal tendon?

Back 32

The Pretarsal

Front 33

Why shouldn't electrocautery be used for the first incision of a coronal flap procedure?

Back 33

Because of the damage to the hair follicles

Front 34

How deep is the initial incision made to?

Back 34

To the loose aponeuretic layer

Front 35

What clips are used to aid in hemostasis during the coronal flap?

Back 35

Raney clips