Nasal Obstruction Case
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Gross Anatomy Assignment Name: Olorunfemi Peace Toluwalase Matric No: 17/Mhs01/257 Dept: Mbbs Course: Gross Anatomy of Head and Neck
GROSS ANATOMY ASSIGNMENT NAME: OLORUNFEMI PEACE TOLUWALASE MATRIC NO: 17/MHS01/257 DEPT: MBBS COURSE: GROSS ANATOMY OF HEAD AND NECK QUESTION 1 Write an essay on the carvernous sinus. The cavernous sinuses are one of several drainage pathways for the brain that sits in the middle. In addition to receiving venous drainage from the brain, it also receives tributaries from parts of the face. STRUCTURE ➢ The cavernous sinuses are 1 cm wide cavities that extend a distance of 2 cm from the most posterior aspect of the orbit to the petrous part of the temporal bone. ➢ They are bilaterally paired collections of venous plexuses that sit on either side of the sphenoid bone. ➢ Although they are not truly trabeculated cavities like the corpora cavernosa of the penis, the numerous plexuses, however, give the cavities their characteristic sponge-like appearance. ➢ The cavernous sinus is roofed by an inner layer of dura matter that continues with the diaphragma sellae that covers the superior part of the pituitary gland. The roof of the sinus also has several other attachments. ➢ Anteriorly, it attaches to the anterior and middle clinoid processes, posteriorly it attaches to the tentorium (at its attachment to the posterior clinoid process). Part of the periosteum of the greater wing of the sphenoid bone forms the floor of the sinus. ➢ The body of the sphenoid acts as the medial wall of the sinus while the lateral wall is formed from the visceral part of the dura mater. CONTENTS The cavernous sinus contains the internal carotid artery and several cranial nerves. Abducens nerve (CN VI) traverses the sinus lateral to the internal carotid artery. -
Normal and Abnormal Findings in Rhinoscopy
3/18/2016 Normal and Abnormal Findings in Rhinoscopy Brian C. Spector, MD Ear, Nose Throat and Plastic Surgery Associates Assistant Professor FSU College of Medicine Assistant Professor UCF College of Medicine Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL No Disclosures Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL Learning Objectives • Maximize diagnostic yield by understanding best technique for Rhinoscopy • Identify normal anatomy and variants of normal anatomy visualized in Rhinoscopy • Identify abnormal findings visualized in Rhinoscopy Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL 1 3/18/2016 Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL Nasal Septum Lateral Nasal Wall Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL 2 3/18/2016 Nasopharynx Mucosa Intact Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL Ehab Zayyan MD, PhD Anterior Rhinoscopy Non Dominant Hand. Index Finger on Nasal Tip. Keep open until fully removed to avoid pulling hairs. Headlight Illumination Nasal Septum: deviation, perforation, stigmata of recent or active bleeding Inferior Turbinates: color of mucosa, congestion, secretions Internal Nasal Valve ‐ Septum, floor, caudal border of upper lateral cartilage, anterior head of inferior turbinate. Narrowest part of nasal airway Middle Turbinates Mucosa Sixth Annual ENT for the PA-C | March 30 – April 3, 2016| Orlando, FL 3 3/18/2016 Nasal Endoscopy Flexible Nasal Endoscopy: Technique -
Surgical Anatamic of Paranasal Sinuses
SURGICAL ANATAMIC OF PARANASAL SINUSES DR. SEEMA MONGA ASSOCIATE PROFESSOR DEPARTMENT OF ENT-HNS HIMSR MIDDLE TURBINATE 1. Anterior attachment : vertically oriented, sup to the lateral border of cribriform plate. 2. Second attachment :Obliquely oriented- basal lamella/ ground lamella, Attached to the lamina papyracea ( medial wall of orbit anterior, posterior air cells, sphenopala‐ tine foramen 3. Posterior attachment :medial wall of maxillary sinus, horizontally oriented. , supreme turbinate 3. Occasionally 4. fourth turbinate, 5. supreme meatus, if present 6. drains posterior ethmoid drains inferior, middle, superior turbinates and, occasionally, the supreme turbinate, the fourth turbinate. e. Lateral to these turbinates are the corresponding meatuses divided per their drainage systems ANATOMICAL VARIATIONS OF THE TURBINATES 1. Concha bullosa, 24–55%, often bilateral, 2. Interlamellar cell of grunwald: pneumatization is limited to the vertical part of middle turbinate, usually not causing narrowing of the ostiomeatal unit 3. Paradoxic middle turbinate: 26%,. Occasionally, it can affect the patency of the ostiomeatal unit 4. Pneumatized basal lamella, falsely considered, posterior ethmoid air cell Missed basal lamella – attaches to lateral maxillary sinus wall Ostiomeatal unit Anterior ostiomeatal unit, maxillary, anterior ethmoid, frontal sinuses, (1) ethmoid infundibulum, (2) middle meatus, (3) hiatus semilunaris, (4) maxillaryOstium, (5) ethmoid bulla, (6) frontal recess, (7) uncinate process. , sphenoethmoidal recess Other draining osteomeatal unit, posterior in the nasal cavity, posterior ethmoid sinus, lateral to the superior turbinate, . sphenoid Sinus medial to the superior turbinate Uncinate Process Crescent‐shaped, thin individual bone inferiorly- ethmoidal process of inferior turbinate, anterior, lacrimal bone, posteriorly- hiatus Semilunaris, medial -ethmoid infundibulum, laterally, middle meatus superior attachment- variability, direct effect on frontal sinus drainage pathway. -
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Braz J Otorhinolaryngol. 2015;81(1 Supl. 1):S1-S49 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org CONSENSUS Rhinosinusitis: evidence and experience October 18 and 19, 2013 - São Paulo Coordination Although VAS has only been validated for CRS in adults, Wilma T. Anselmo-Lima e Eulalia Sakano the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 20121 also recommends its use in ARS. There are sev- Participants eral specific questionnaires for rhinosinusitis, but in practice, 2-4 André Alencar, Atílio Fernandes, Edwin Tamashiro, most have limited application, particularly in acute cases. Elizabeth Araújo, Érica Ortiz, Fabiana Cardoso Pereira Valera, Fábio Pinna, Fabrizio Romano, Francini Padua, João Mello Jr., Acute rhinosinusitis João Teles Jr., José E. L. Dolci, Leonardo Balsalobre, Macoto Kosugi, Marcelo H. Sampaio, Márcio Nakanishi, Definition Marco César, Nilvano Andrade, Olavo Mion, Otávio Piltcher, Reginaldo Fujita, Renato Roithmann, Richard Voegels, ARS is an inflammatory process of the nasal mucosa of sud- Roberto E. Guimarães, Roberto Meireles, Shirley Pignatari, Victor Nakajima den onset, lasting up to 12 weeks. It may occur one or more times in a given period of time, but always with complete For the purpose of citation remission of signs and symptoms between episodes. Wilma Terezinha Anselmo Lima, Eulalia Sakano, Edwin Tamashiro, Elizabeth Araújo, Érica Ortiz, Fábio Pinna, Fabrizio Romano, Francini Padua, João Mello Jr., João Teles Jr., José E. L. Dolci, Classification Leonardo Balsalobre, Macoto Kosugi, Marcelo H. Sampaio, Márcio Nakanishi, Marco César, Nilvano Andrade, Olavo Mion, There are several classifications for RS. One of the most Otávio Piltcher, Reginaldo Fujita, Renato Roithmann, often used is the etiological classification, which is based Richard Voegels, Roberto E. -
ABCDEF Checklist" Based on 3D Radiological Images for Preoperative Planning of Endoscopic Sinus Surgery*
ORIGINAL CONTRIBUTION “ABCDEF Checklist" based on 3D radiological images for preoperative planning of endoscopic sinus surgery* 1 1 1 J.M. Maza-Solano , J. González-García , R. Moreno-Luna , J. Ambrosiani- Rhinology Online, Vol 1: 133 - 142, 2018 2 1 1 Fernández , E. Domínguez-Durán , S. Sánchez-Gómez http://doi.org/10.4193/RHINOL/18.054 1 Rhinology and Anterior Skull Base Department Section, University Hospital Virgen Macarena, Seville, Spain *Received for publication: 2 Department of Anatomy and Human Embryology, University of Seville, Seville, Spain August 21, 2018 Accepted: October 4, 2018 Published: October 6, 2018 Abstract Background: Endoscopic sinus surgery (ESS) is performed on endonasal landmarks that have great anatomical variability, there- fore a detailed preoperative study of these structures is necessary. Objective: To develop a checklist for the systematic identification of the paranasal sinuses and the skull base, based on 3D images that guide the planning and implementation of ESS to minimize complications and improve surgical outcomes. Methods: This study evaluates the usefulness of the “ABCDEF Checklist”, in a randomized study involving 30 otolaryngologists with more than 2 years of practical experience in ESS evaluating preoperative radiological examination and subsequent surgical performance in the sinus of 30 cadavers. Results: Differences between groups in identifying the essential anatomical references were significant in 9 of the 11 essential anatomical references for the Checklist Group Surgical procedures and surgical mistakes were performed systematically less often in the Checklist group but the differences did not reach significance after Bonferroni correction. Conclusions: The use of "ABCDEF Checklist" prior to ESS facilitates the identification of the essential anatomical references for the preoperative and systematized planning of the surgical procedures. -
Radiographic Evaluation of the Nasal Cavity, Paranasal Sinuses and Nasopharynx for Sleep-Disordered Breathing
RADIOGRAPHIC EVALUATION OF THE NASAL CAVITY, PARANASAL SINUSES AND NASOPHARYNX FOR SLEEP-DISORDERED BREATHING Dania Tamimi, BDS, DMSc Diplomate, American Board of Oral and Maxillofacial Radiology ROLE OF CBCT • To discover the anatomic truth DISCOVER FACTORS THAT • Lead to Abnormal Upper Airway Anatomy • Increase Resistance • Cause Turbulent or Laminar Air Flow • Increase Collapsibility • Airway lumen • Soft tissue component • Osseous component CHECKLIST – EVALUATE FOR • Nasal obstruction • Sinus pathology • Nasopharynx pathology • Oropharyngeal morphologic predisposing factors and pathology • Maxillary and mandible morphologic predisposing factors • TMJs • Hyoid bone position • Evaluate for Head position (false positive or negative) • C-spine for pathology • Cranial base CHECKLIST – EVALUATE FOR • Nasal obstruction • Sinus pathology • Nasopharynx pathology • Oropharyngeal morphologic predisposing factors and pathology • Maxillary and mandible morphologic predisposing factors • TMJs • Hyoid bone position • Evaluate for Head position (false positive or negative) • C-spine for pathology • Cranial base NASAL CAVITY AND SINUSES • Patency of external and internal nasal valves • Morphology of nasal septum • Morphology and symmetry of turbinates • Patency of sinus drainage pathways • Presence of sinonasal pathology THE NOSE HAS THREE MAJOR FUNCTIONS 1. Breathing 2. Olfaction 3. Conditioning the air THE NASAL VALVE • Turbulence distributes the air in the nasal fossa for conditioning and olfaction. • When there is stenosis of the nasal valve, -
NASAL ANATOMY Elena Rizzo Riera R1 ORL HUSE NASAL ANATOMY
NASAL ANATOMY Elena Rizzo Riera R1 ORL HUSE NASAL ANATOMY The nose is a highly contoured pyramidal structure situated centrally in the face and it is composed by: ü Skin ü Mucosa ü Bone ü Cartilage ü Supporting tissue Topographic analysis 1. EXTERNAL NASAL ANATOMY § Skin § Soft tissue § Muscles § Blood vessels § Nerves ² Understanding variations in skin thickness is an essential aspect of reconstructive nasal surgery. ² Familiarity with blood supplyà local flaps. Individuality SKIN Aesthetic regions Thinner Thicker Ø Dorsum Ø Radix Ø Nostril margins Ø Nasal tip Ø Columella Ø Alae Surgical implications Surgical elevation of the nasal skin should be done in the plane just superficial to the underlying bony and cartilaginous nasal skeleton to prevent injury to the blood supply and to the nasal muscles. Excessive damage to the nasal muscles causes unwanted immobility of the nose during facial expression, so called mummified nose. SUBCUTANEOUS LAYER § Superficial fatty panniculus Adipose tissue and vertical fibres between deep dermis and fibromuscular layer. § Fibromuscular layer Nasal musculature and nasal SMAS § Deep fatty layer Contains the major superficial blood vessels and nerves. No fibrous fibres. § Periosteum/ perichondrium Provide nutrient blood flow to the nasal bones and cartilage MUSCLES § Greatest concentration of musclesàjunction of upper lateral and alar cartilages (muscular dilation and stenting of nasal valve). § Innervation: zygomaticotemporal branch of the facial nerve § Elevator muscles § Depressor muscles § Compressor -
Nasal Cavity
NASAL CAVITY Wedge shaped spaces; 5 cm in height, 5-7 cm in length Large inferior base- 1-5cm Narrow superior apex- 1-2 mm Anterior aperture- External nares- 1.5-2 cm ; 0.5-1 cm (flexible) posterior nasal apertures (choanae)– 2.5 by 1.3 cm (rigid) Separated from : each other- nasal septum oral cavity-hard palate cranial cavity-parts of frontal, ethmoid, sphenoid bones Lateral to nasal cavity- orbit each half- roof , floor medial wall, lateral wall three regions- vestibule respiratory region olfactory region Skeletal framework • Medial wall (nasal septum) Anterior - septal cartilage Vo m e r Perpendicular plate of ethmoid Minor contributions- nasal, frontal, sphenoid, maxilla, palatine bones • Often deflected • Lateral wall - Maxilla- anteroinferiorly Perpendicular plate of palatine Ethmoid labyrinth- superiorly & uncinate process Other bones- nasal, frontal process of maxilla, lacrimal Irregular projections- three conchae Superior concha- shortest, shallowest Middle concha- large, articulates with palatine Inferior concha- independent bone, articulates with maxilla Skeletal framework-contd. • Floor: Smooth, concave, wider than roof Palatine process of maxilla Horizontal plate of palatine (hard palate) Soft tissue • Roof: narrow, highest in the center Cribriform plate of ethmoid Anteriorly- nasal spine of frontal, nasal bones, septal cartilage, major alar cartilage Posteriorly: sphenoid, ala of vomer, palatine, medial pterygoid plate Roof is perforated by openings in the cribriform plate and a separate foramen for anterior ethmoidal Ns -
Imaging of Chronic and Exotic Sinonasal Disease: Review Arash K
AJR Integrative Imaging LIFELONG LEARNING FOR RADIOLOGY Imaging of Chronic and Exotic Sinonasal Disease: Review Arash K. Momeni1, Catherine C. Roberts2, and Felix S. Chew3 Objective This review focuses on the anatomy, pathophysiology, mi- Chronic sinusitis is one of the most commonly diagnosed crobiology, and diagnosis of sinonasal disease, including illnesses in the United States. The educational objectives of chronic and fungal sinusitis, juvenile nasopharyngeal angio- this review article are for the participant to exercise, self- fibroma, inverted papilloma, and chondrosarcoma. assess, and improve his or her understanding of the imaging evaluation of sinonasal disease. Anatomy and Pathophysiology Understanding the normal anatomy and physiology of Conclusion the paranasal sinuses is important to understanding the This article describes the anatomy, pathophysiology, mi- pathogenesis of sinus disease. There are four pairs of sinuses crobiology, and diagnosis of sinonasal disease, including named for the bones of the skull they pneumatize. They are chronic and fungal sinusitis, juvenile nasopharyngeal angio- the maxillary, ethmoid, frontal, and sphenoid sinus air cells fibroma, inverted papilloma, and chondrosarcoma. and they are lined by pseudostratified columnar epithelium- bearing cilia. The mucosa contains goblet cells that secrete Introduction mucus, which aids in trapping inhaled particles and debris. Chronic sinusitis is one of the most commonly diagnosed The maxillary antrum consists of a roof, floor, and three illnesses in the United States. It is estimated to affect more walls: the medial, anterior, and posterolateral. The roof and than 30 million individuals and is increasing in incidence [1]. medial walls are shared with the orbit and nasal cavity, forming The number of office visits and the annual expenditures on the orbital floor and lateral wall of the nose, respectively [3]. -
Human Anatomy
Human Anatomy د.فراس عبد الرحمن Lec.3 The Nasal region The Nose The nose consists of the external nose and the nasal cavity, both of which are divided by a septum into right and left halves. External Nose The external nose has two elliptical orifices called the nostrils, which are separated from each other by the nasal septum (Fig. 1). The lateral margin, the ala nasi, is rounded and mobile. The framework of the external nose is made up above by the nasal bones, the frontal processes of the maxillae, and the nasal part of the frontal bone. Below, the framework is formed of plates of hyaline cartilage (Fig. 1). Nerve Supply of the External Nose The external nose is supplied by the infratrochlear and external nasal branches of the ophthalmic nerve (CN V), and the infraorbital branch of the maxillary nerve (CN V). Blood Supply and Venous Drainage of the External Nose The skin of the external nose is supplied by branches of the ophthalmic and the maxillary arteries. The skin of the ala and the lower part of the septum are supplied by branches from the facial artery. Venous blood from the external nose drains mostly into the facial vein via the angular and lateral nasal veins. Nasal Cavity The nasal cavity extends from the nostrils in front to the posterior nasal apertures or choanae behind, where the nose opens into the nasopharynx. The nasal vestibule is the area of the nasal cavity lying just inside the nostril (Fig. 2). The nasal cavity is divided into right and left halves by the nasal septum (Fig. -
Nose, Nasal Cavity & Paranasal Sinuses & Pharynx
Nose, Nasal cavity, Paranasal Sinuses & Pharynx Objectives . At the end of the lecture, the students should be able to: . Describe the boundaries of the nasal cavity. Describe the nasal conchae and meati. Demonstrate the openings in each meatus. Describe the paranasal sinuses and their functions . Describe the pharynx and its parts Nose . The external root (anterior ) nares or nostrils, lead to the tip nasal cavity. ala septum external nares Formed above by: 1 Bony skeleton 2 . Formed 3 below by plates of hyaline cartilage. Nasal Cavity . Extends from the external (anterior) nares to the posterior nares (choanae). Divided into right & left halves by the nasal septum. Each half has a: . Roof . Lateral wall . Medial wall (septum) . Floor Roof . Narrow & formed (from 3 2 4 behind forward) by the: 1 1. Body of sphenoid. 2. Cribriform plate of ethmoid bone. 3. Frontal bone. 4. Nasal bone & cartilage Floor • Separates it from the oral cavity. • Formed by the hard (bony) palate. Medial Wall (Nasal Septum) . Osteocartilaginous partition. Formed by: 1. Perpendicular plate of ethmoid 1 bone. 3 2. Vomer. 2 3. Septal cartilage. Lateral Wall . Shows three horizontal bony projections, the superior, middle & inferior conchae . The cavity below each concha is called a meatus and are named as superior, middle & inferior corresponding to the conchae. The small space above the superior concha is the sphenoethmoidal recess. The conchae increase the surface area of the nasal cavity. The recess & meati receive the openings of the: .Paranasal sinuses. .Nasolacrimal duct. Nasal mucosa – Olfactory : – It is delicate and contains olfactory nerve cells. It is present in the upper part of nasal cavity: . -
Recurring Patterns of Inflammatory Sinonasal Disease Demonstrated on Screening Sinus CT
Recurring Patterns of Inflammatory Sinonasal Disease Demonstrated on Screening Sinus CT 1 2 1 Robert W . Babbel, H. Ric Harnsberger, 1.3 Jerry Sonkens, and Steven Hunt Purpose: In order to define specific features on screening sinus CT (SSCT) that will aid the endoscopic surgeon in his approach to patients with inflammatory sinonasal disease, we sought to answer four questions: 1) what recurring patterns of inflammatory sinonasal disease are evident on SSCT; 2) what is the relative frequency of these recurring patterns; 3) how do these CT patterns correlate with the known sinus mucociliary drainage routes; and 4) what are the characteristic radiologic features of each pattern? Methods: We reviewed the clinical and radiologic records of 500 consecutive patients who underwent SSCT as a prelude to possible functional endoscopic sinus surgery. Results: Five recurring radiologic patterns of sinonasal inflammatory disease were identified: 1) infundibular (129/500 or 26% ), 2) ostiomeatal unit (126/ 500 or 25 %) 3) sphenoeth moidal recess (32/500 or 6%), 4) sinonasal polyposis (49/ 500 or 10%), and 5) sporadic (unclas sifiable) (121/500 or 24%) patterns. Normal SSCT was seen in 133/ 500 patients (27 %). Conclu sion: Identification of specific patterns of sinonasal disease permits grouping of patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess patterns) surgical groups. Assignment of patients to radiologic patterns allows a tailored surgical approach. Index terms: Paranasal sinuses, computed tomography; Paranasal sinuses, inflammation; Nose, computed tomography AJNR 13:903-912, May/June 1992 Functional endoscopic sinonasal surgery during our routine interpretation of SSCT exams (FESS) is widely utilized for the evaluation and that there are recurring patterns of inflammatory treatment of inflammatory sinonasal disease (1- sinonasal disease.