Ossicle/Nose and Paranasal Sinuses
Nose and Paranasal Sinuses
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Rhinitis & Sinusitis
- Allergic Rhinitis
- Vasomotor Rhinitis
- The Osteomeatal Complex
- Nasal Polyps & Polyposis
- Sinusitis, Acute
- Sinusitis, Chronic
- Sinusitis, Allergic Fungal
- Sinusitis, Invasive Fungal
- Septal Deviation
- Turbinate Hypertrophy
- Nasal Valve Prolapse
Tumor & Neoplasia
- Papilloma
- Inverting Papilloma
- see Head & Neck Squamous Cell Carcinoma
- Adeoncarcinoma of the Nasal Cavity
- Esthesioneuroblastoma
- Juvenile Angiofibroma
Miscellanea
- Epistaxis
- CSF Leak & CSF Rhinorrhea
- Granulomatous Disease
- Wegener's, SLE, Sarcoid, Tuberculosis, Relapsing Polychondritis, Behcet, Churg-Strauss, IMDD, etc
- Nasal Valve Prolapse
Sinusitis
Orbital Complications of Sinusitis; Chandler's Classfication:
- Group I. Periorbital Cellulitis: aka preseptal cellulitis. Extraoccular muscles and globe unaffected.
- Group II. Orbital Cellulitis: aka postseptal cellulitis. Globe/EOM findings.
- Group III. Subperiosteal Abscess: Globe displaced inferolaterally; proptosis.
- Group IV. Orbital Abscess: Collection of pus within orbit proper; proptosis, chemosis, opthalmoplegia.
- Group V. Cavernous Sinus Thrombosis: Bilateral eye findings, opthalmoplegia, meningismus, prostration. MRI best for diagnosis. Veins of face are valveless!
Intracranial Complications of Sinusitis, in order of prevalence
- Meningitis
- Epidural Abscess
- Subdural Abscess
- Intracerebral Abscess
- Thrombophlebitis of venous sinuses
- Frontal Sinus is most commonly implicated in intracranial complications
- Foramina Brescht allows frontal sinus to communicate with brain
- Invasive Fungal Sinusitis
- Aspergillus: septated hyphae branching at 45-degrees. PAS or silver stain.
- Mucormycosis: 70% of DKA patients. Broad nonseptated hyphae, variable branch angle.
- On pathology angioinvasion and neuroinvasion.
- Clinically dusky or blackened necrotic turbinates.
- Treatment is aggressive debridement and Amphoteracin B.
Sphenoid Sinus has 12 close structures: II, III, IV, V1, V2, VI, Vidian Nerve, Carotid artery, Brain, Dura, Pituitary.
Pertienent Sinonasal Anatomy
Schematic of Cavernous Sinus Anatomy:
- II = Optic Nerve: 25-50% with bony dehiscence into sphenoid sinus.
- III = Occulomotor Nerve
- IV = Trochlear Nerve
- V1 = Ophthalmic division, Trigeminal Nerve
- V2 = Maxillary division, Trigeminal Nerve: exits foramen rotundum, superomedial to V3's foramen ovale.
- VI = Abducens Nerve
- C = Carotid Artery: often with bony dehiscence into sphenoid. Together with CN II forms opticocarotid recess.
Sinus communicates posteriorly, so thrombosis is bilateral.
