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93 Cards in this Set

  • Front
  • Back
Where is the uncinate process located?
Medial to the ethmoid infundibulum and Lateral to the middle turbinate
What drains into the ethmoid infundibulum?
Maxillary, anterior ethmoid and frontal sinuses
What determines the spatial relationship of frontal sinus drainage into the ethmoid infundibulum?
Superior attachment (80% attach to the lamina papyracea = drainage medial to the uncinate, 20% attach to the skull base or middle turbinate resulting in frontal sinus drainage lateral to the uncinate and into the infundibulum
What is the semilunar hiatus?
Gap that empties the ethmoid infundibulum - located between the uncinate and ethmoid bulla
Location of the sphenopalatine foramen?
Posterior to the inferior attachment of the middle turbinate
What traverses the sphenopalantine foramen?
Sphenopalantine artery, sensory serve fibers and secretomotor fibers (parasympathetic fibers from vidian nerve to pteryopalatine ganglion)
What is a concha bullosa?
Aerated middle turbinate
What is the osteomeatal complex?
Region containing the ostia of the maxillary, frontal and ethmoid sinuses - lateral to the middle turbinate
What are turbinates?
Three shelves of bone covered by erectile mucosa - increases surface area
What opens into the inferior meatus?
Nasolacrimal duct
What are the nasal fontanelles?
Areas of lateral nasal wall with no bone - above in insertion of the inferior turbinate - may have accessory ostia
Where is the nasolacrimal duct and sac?
Duct is lateral to the anterior uncinate process and the sac is lateral to the agger nasi cell and opens into the inferior meatus
When does the frontal sinus appear?
5-6 years old
What is the volume of the frontal sinus?
4-7mL by 12-20
Where does the frontal sinus drain?
Frontal recess in anterior middle meatus either medial or lateral to the uncinate (posterior and medial to agger nasi cells)
What is the vascular supply to the frontal sinus mucosa?
Supraorbital an supratrochlear arteries, ophthalmic (cavernous sinus) and supraorbital veins
What is the innervation of the frontal sinus mucosa?
supraorbital and supratrochear nerves (V1)
What plain film views can show the frontal sinus?
Lateral and Caldwell View
What is the frontal recess?
Drainage space between the frontal sinus and hiatus semiluminaris - Bounded by the posterior wall of the agger nasi cell, laminia papyracea and middle turbinate
What are the foramina of Breschet?
Small venules that drain the sinus mucosa into the dural veins
When does the maxillary sinus develop?
First to develop in utero - biphasic growth at 3 and 7-18 years old
What is the volume of the adult maxillary sinus?
15 mL (largest of all the sinuses)
Where does the maxillary sinus drain?
Ethmoid infundibulum (middle meatus) - 10-30% hae accessory ostium
What is the vascular supply of the maxillary sinus?
Maxillary and facial artery - maxillary vein
Innervation of the maxillary sinus?
infraorbital nerve
What plain film view can show the maxilary sinus?
Waters view
What is the floor of the maxillary sinus?
Alveolar process of the maxilla - contains the second bicuspid and first and second molars
When does the ethmoid sinsus develop?
3-4 cells at birth - formed from 5 ethmoid turbinals (1. agger nasi, 2. uncinate, 3. ethmoid bulla, 4. ground lamella, 5. posterior wall of the most posterior ethmoid cell)
What is the volume of the adult ethmoid sinuses?
10-15 aerated cells with total volume of 2-3 mL (adult size @ 12-15 years)
What is the drainage of the ethmoid sinuses?
Anterior cells drain into the ethmoid infundibulum, posterior cells drain into the sphenoethmoid recess (superior meatus)
Vasculature of the ethmoid sinuses?
Anterior and posterior ethmoid arteries (from ophthalmic artery) and maxillary and ethmoid veins (cavernous sinus)
Innervation of the ethmoid sinuses?
anterior and posterior ethmoid nerves (from nasocilliary nerve - V1)
What plain film views show the ethmoid sinuses?
Lateral and Caldwell views
What are Agger Nasi Cells?
Most anterior of the anterior ethmoid cells - found anterior and superior to the middle turbinate attachment to the lateral wall - Posterior wall of the agger nasi cells forms the anterior wall of the frontal recess
What is the Ethmoid Bulla
Largest of the anterior ethmoid cells that lies above the infundibulum - Anterior ethmoid artery courses the roof of this cell
What is the Ground (Basal) Lamella of the Middle Turbinate?
Posterior bony attachment of the middle turbinate which separates the anterior and posterior ethmoid cells. Anterior part of the ground lamella inserts vertically into the crista ethmoidalis, middle part inserts obliquely into the lamina papyracea and the posterior third ataches to the lamina horizontally
What are onodi cells?
Ethmoid cells that pneumatize lateral or posterior to the anterior wall of the sphenoid - commonly mistaken as sphenoid cells. Optic nerve or carotid artery may indent into the lateral wall
What are Haller Cells?
Ethmoid cells that extend into the maxillary sinus above the ostium. Pneumatize the medial and inferior orbital walls
What is the fovea ethmoidalis ?
Roof of the ethmoid sinus
What is the embryoogy of the sphenoid sinus?
evagination of nasal mucosa into the sphenoid bone
What is the volume of the sphenoid sinus?
0.5-8mL (adult size 12-18 years old)
Drainage of the sphenoid sinus?
Sphenoethmoid recess in the superior meatus
Vasculature of the sphenoid sinus?
Sphenopalatine artery, maxillary vein
Innervation of the sphenoid sinus?
sphenopalatine nerve
Plain flim views of the sphenoid sinus
Lateral and submentovertex (basal)
Sphenoid ostium - anataomic relationship (anterior nasal spine, floor of nose, choanae)
6-8cm posterior from anterior nasal spine, 30 degrees from the floor of the nose, 1.5 cm above the choanal floor
What are the cartilages of the nose?
Upper lateral cartilage, Lower Lateral (Alar) Cartilage - paired cartilage composed of lateral and medial crura, Seamoid cartilage and Lesser Alar Cartilage
What is the quadrangular cartilage?
Septal Cartilage
Where is the vomer?
Posterior and inferior to the perpendicular plate of the ethmoid
What is the anterior nasal spine?
Bony projection anterior to piriform aperture
What is the sensory innervation of the nasal dorsum?
Supratrochlear and Infratrochlear nerves
Sensory innervation of the nasal tip?
External Nasal branch of the Anterior Ethmoid
Sensory innervation of the malar, lateral nose and subnasal regions?
infraorbital nerve
Sensory innervation of the anterosuperior nasal cavity?
Internal nasal branch of anterior ethmoid - CN V1
Sensory innervation of the posterior nasal cavity?
Posterior ethmoid nerve
Sensory innervaton of the posterior/inferior nasal cavity?
Sphenopalantine nerve (V2)
Where does the greater palantine vein drain?
Posterior facial vein (EJ) and Caverous sinus
What part of the brain stimulates sympathetic tone to maintain a level of nasal vasocontriction (via superior cervical sympathetic ganglia)?
Hypothalamus
Define nasal flow
Pressure divided by resistance (laminar or turbulent)
What is the sneeze reflex?
Stimulation of trigeminal afferents - complex efferents result in slow inspiratory phase, glottic and velopharyngeal closure followed by sudden glottic opening
What are the two types of regulation of the nasal cycle?
Asymmetric Congestive Response (Nasal Cycle) and Symmetric Congestive Response
What induces a symmetric nasal congestive response?
Exercise, body position, hyperventillation, cold air, sulfur, histamine, irritants (lasts 15-30 mins)
Describe the components to the nasal microvascular?
Resistance vessels (arterioles), Subepithelial capillaries (fenestrated), Venous sinusoids, Arteriovenous anastomoses
What is the regulation of the nasal microvasculature?
Sympathtic innervation - tone to arteries and capacitance veins via norepinephrine, neuropeptide Y an avian pancreatic polypeptide; Parasympathetic innervation controls secretions (mediated via acetylcholine, vasoactive intestinal peptide and peptide histamine isoleucine)
What is the speed of normal mucociliary system?
1cm/min
What is the histology of the nasal epithelium?
Ciliated, pseudostratified columnar epithelium
What is the anterior border of the ciliated pseudostratified columnar epithelium of the nose?
Limen Nasi (boundary = nasal vestibule)
Describe the mucous blanket in the nose
Double layered mucous blanket - Deep less viscous serous periciliary fluid (sol phase); Superficial more viscous mucous fluid (gel phase)
Major components of nasal mucus?
95% water, 3% glycoproteins (mucin), 2% salts, immunoglobuluins (IgA), lysozymes (bacteriolytic), and lactoferrin (bacteriostatic)
What are the 4 olfactory cell types?
1. Ciliated olfactory receptor cells, 2. microvillar cells, 3. supporting cells (sustenacular cells) and 4. Basal cell
What is the olfactory pathway?
Odorant dissolves in mucous, odorant binding proteins concentrate odorant, binds olfactory receptor, stimulates Golf (cAMP), depolarization, sensory portion of the brain (dentate and semilunate gyri)
What are common drugs that cause rhinorrhea and nasal congestion?
antihypertensives, psychotropic meds, oral contraceptives, chronic nasal decongestants, cocaine, tobacco, antithyroid meds, aspirin, marijuana
What test provides an objective measure of nasal airway resistance?
Rhinomanometry
What is the fronticulus frontalis?
Embryologic space that normally fuses in the development of the frontal bones
What is the prenasal space?
Embryologic space between the nasal bone and nasal cartilage
What is the pathophysiology of congenital nasal neurogeneic tumors?
Dura projects through the foramen cecum, through the fronticulus frontalis (intranasal), through the prenasal space into skin (extranasally) with failure of closure of neuropore
What are three types of neurogeneic nasal tumors?
Encephalocele, Nasal Glioma and Nasal Dermoid
Pathophysiology of nasal encephalocele?
Failed closure of neuropore or failed migration of neural crest cells results in ependymal-lined meninges herniation through the skull base - communicates with the subarachnoid space
What are the three types of encephaloceles (by content)?
Meningocele, Meningoenceophaolcele, Meningoencephalocytocele (meninges, brain and ventricle
What are the three types of encephaloceles (by location)?
1. Occipital 2. Sincipital (frontoethmoid - can be nasofrontal, nasoethmoid, nasoorbital) 3. Basal (transethmoidal, sphenoethmoidal, transphenoidal and sphenmaxillary)
How can you diagnose a encephaolcele?
CT or MRI, Furtenburg test (compression of jugular increases size of the mass)
What is the Furstenburg test?
compression of jugular increases size of the mass (encephaolocele) from increased CSF pressure
Pathophysiology of a nasal glioma?
Sequestered glial tissue or "pinched off" enceophaocele - unencapsulated collection of heterotrophic glial cells
What % of nasal gliomas are extranasal vs. intranasal
60% extranasal, 30% intranasal
What % of nasal gliomas are connected to dura by a fibrous stalk?
15%
What are the signs/symptoms of nasal gliomas?
Firm nonpulsitile mass, skin covered, does not change size with straining, broad nasal dorsum
Pathophysiology of a nasal dermoid
Defective obliteration of dural tissue in prenasal space or fronticulus frontalis - forms an epithelial-lined cyst (can contain other ectodermal components including hair follicles, adnexal tissue)
Signs and symptoms of a nasal dermoid
Presents at birth, forms a fistulous tract, pit or cyst on midline or off mid-line of nasal dorsum or septum; tuft of hair may protrude from pit
Pathophysiology of a Rathke's Pouch Cyst
Persistent craniopharyngeal canal from failure of the obliteration of Rathke's pouch (diverticulum of ectoderm which invaginates to form the anterior lobe of the hypophysis and pars intermedius)
Location of a Rathke's Pouch Cyst
Nasopharynx
Signs and symptoms of a rathke's pouch cyst?
Typically asymptomatic, smooth mass in nasopharyn, may enlarge and impinge on the pituitary
Treatment of Rathke's Pouch Cyst
Antibiotics with endoscopic marsupialization or excision of infected lesion
Pathophysiology of a thorwaldts cyst
Pharyngeal notochord remnant (pharyngeal bursa or pouch of Luschka)