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

Adenocarcinoma of the Nasal Cavity

Esthesioneuroblastoma

Juvenile Angiofibroma

Miscellaneous

Epistaxis

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

Sinusitis

Orbital Complications of Sinusitis; Chandler's Classification:

• 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.