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
Inverting Papilloma
see Head & Neck Squamous Cell Carcinoma
Adenocarcinoma of the Nasal Cavity
Juvenile Angiofibroma
CSF Leak & CSF Rhinorrhea
Granulomatous Disease
Granulomatosis with polyangiitis, systemic lupus erythematosus, Sarcoidosis, Tuberculosis, Relapsing Polychondritis, Behcet, Eosinophilic granulomatosis with polyangiitis, IMDD, etc
Nasal Valve Prolapse



Orbital Complications of Sinusitis; Chandler's Classfication:

  • Group I. Periorbital Cellulitis: aka pre-septal cellulitis. Extraocular muscles and globe unaffected.
  • Group II. Orbital Cellulitis: aka post-septal cellulitis. Globe/EOM findings.
  • Group III. Subperiosteal Abscess: Globe displaced inferolaterally; proptosis.
  • Group IV. Orbital Abscess: Collection of pus within orbit proper; proptosis, chemosis, ophthalmoplegia.
  • Group V. Cavernous Sinus Thrombosis: Bilateral eye findings, ophthalmoplegia, 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 non-septated hyphae, variable branch angle.
  • On pathology angioinvasion and neuroinvasion.
  • Clinically dusky or blackened necrotic turbinates.
  • Treatment is aggressive debridement and Amphotericin B.

Sphenoid Sinus has 12 close structures: II, III, IV, V1, V2, VI, Vidian Nerve, Carotid artery, Brain, Dura, Pituitary.

Pertinent Sinonasal Anatomy


Schematic of Cavernous Sinus Anatomy:

II = Optic Nerve: 25-50% with bony dehiscence into sphenoid sinus.
III = Oculomotor 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.