OBR: Nose and Paranasal Sinuses

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  1. When does aeration of the frontal sinus begin?
    Age 4-5 years, continues into the late teens
  2. What percentage of the population has a unilateral frontal sinus?
    10%
  3. At what age can the maxillary sinuses be visualized on CT?
    Age 4-5 months
  4. The            is fully formed by the 5th week gestation and goes on to develop into the floor of the nose/palate.
    Oronasal membrane
  5. What are the nasal anatomic subunits?
    • nasal dorsum
    • nasal sidewalls
    • nasal tip
    • alar lobules
    • depressions of the supra-alar facets
  6. Which muscles elevate the nose?
    • Procerus
    • Levator labii superioris alaeque nasi
    • Anomalous nasi muscles
  7. Which muscles depress the nose?
    • Alar nasalis
    • Depressor septi nasi muscles
  8. What are the other muscles of the nose (the compressor and dilators)?
    • Transverse nasalis
    • Compressor narium minor
    • Dilator naris anterior muscles
  9. What is the narrowest portion of the nasal cavity?
    Nasal valve
  10. What is the nasal valve?
    The angle between the caudal quadrangular cartilage and the distal upper lateral cartilages
  11. What is the only septal component that is paired?
    The vomer, which may be bilaminar owing to its dual embryonic origin
  12. What makes up the superior portion of the bony nasal septum?
    Perpendicular plate of the ethmoid
  13. What are the major tip support mechanisms?
    • Contour, size, and strength of the lateral crura
    • Attachment of the medial crural footplate to the caudal septum
    • Attachment of the caudal edge of the upper lateral cartilages to the cephalic border of the alar cartilages
  14. What are the minor tip support mechanisms?
    • Nasal tip ligamentous aponeurosis
    • Cartilaginous septum
    • Nasal spine
    • Strength and resilience of the medial crura
    • Thickness of tip skin and subcutaneous tissue
    • Supportive strength of the alar sidewalls
  15. What are the major anatomic features that determine tip projection?
    • Thickness and character of tip skin
    • Shape and strength of alar cartilages
    • Length of infratip lobule and columella
    • Anatomy of the quadrangular cartilage (esp the anterior septal angle)
    • Size of the nasal spine and premaxilla
  16. What type of epithelium lines the nasal cavity?
    Ciliated pseudostratified epithelium
  17. What neuropeptide is thought to be a mediator of pain in the nose and paranasal sinuses?
    Substance P
  18. What are odorous substances made of?
    Either gases or volatile liquids
  19. How is sensory epithelium of the olfactory system different from the surrounding respiratory epithelium?
    Both have cilia, but the cilia of the olfactory epithelium do not beat synchronously
  20. What are Bowman's glands?
    They secrete mucus and yellow pigment in the olfactory epithelium.  The odorant must dissolve in this layer of mucus to reach the sensory receptors.
  21. How are the receptor cells in the olfactory system different from those of the ear, eye, and tongue?
    They are bipolar nerve cells (others are specialized epithelial cells)
  22. Unlike the taste pathway to the cerebral cortex, the olfactory pathway does not relay in the         .  The olfactory nerve terminates in the          and sends axons via the olfactory tract to the piriform cortex, the periamygdaloid area, and the         .
    • Thalamus
    • Olfactory bulb
    • Olfactory tubercle
  23. What is the most common cause of taste loss?
    Olfactory dysfunction
  24. What is dysosmia?
    Perception of an unpleasant odor
  25. What is phantosmia?
    Perception of an odor in the absence of a stimulus
  26. What is parosmia?
    Distorted perception of an odor
  27. Where does the nasolacrimal duct lie in relation to the osmium of the maxillary sinus?
    3-6mm anteriorly
  28. The majority of posterior ethmoid cells empty into which meatus?
    Superior meatus
  29. What percent of the population has a supreme nasal concha?
    60%
  30. What are the 5 basal or ground lamella of the paranasal sinuses?
    • Uncinate process
    • Bulla ethmoidalis
    • Basal lamella of the middle turbinate
    • Lamella of the superior turbinate
    • Lamella of the supreme turbinate (if present)
  31. What structure separates the anterior and posterior ethmoid complexes?
    Basal lamella of the middle turbinate
  32. Where does the natural ostium of the maxillary sinus empty?
    Ethmoid infundibulum
  33. What is the most posterior part of the middle turbinate attached to?
    Crista ethmoidalis of the perpendicular process of the palatine bone
  34. Where does the anterior portion of the middle turbinate most often attach superiorly?
    Laterally onto the lamina papyracea (may also attach to the skull base)
  35. What is an agger nasi cell?
    • Pneumatized area of the lateral nasal wall immediately anterior and superior to the insertion of the middle turbinate.
    • The most anterior ethmoid air cell
  36. What problem can an enlarged agger nasi cell cause?
    Narrowing of the frontal recess
  37. What is the term for a persistent, nonpneumatized second basal lamella?
    Torus ethmoidalis/lateralis
  38. What is the term for a pneumatized second basal lamella?
    Bulla ethmoidalis
  39. What is the most posterior aspect of the anterior ethmoids?
    Retrobullar recess
  40. When may the suprabullar recess extend into the retrobullar recess?
    If the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate
  41. What is another name for the retrobullar recess?
    Sinus lateralis
  42. What does the retrobullar recess drain into?
    hiatus semilunaris superior
  43. What recess does the suprabullar recess open into?
    Frontal recess; anteriorly is is separated from the recess by the bulla lamella
  44. What are the borders of the ethmoid infundibulum?
    • Medially, the uncinate process
    • Laterally, the lamina papyracea and frontal process of the maxilla
    • Posteriorly, the ethmoid bulla
  45. Into what does the ethmoid infundibulum drain posteriorly?
    Hiatus semilunaris inferior
  46. Where does the maxillary sinus ostium lie in relation to the ethmoid infundibulum?
    At the floor and lateral aspect of the infundibulum, between its middle and posterior 1/3
  47. Where is the anterior ethmoid artery found intranasally?
    Anterior to the vertical portion of the basal lamella, immediately below the skull base, and posterior to the frontal recess
  48. What is the distance from the posterior ethmoid artery to the optic foramen?
    5-10mm
  49. Which table of the frontal sinus is thinner?
    Posterior
  50. Where is the natural ostium of the fontal sinus?
    The posteromedial aspect of the sinus floor
  51. What is the frontal recess?
    The drainage pathway from the frontal sinus to the nasal cavity
  52. What forms the anterior boundary of the frontal recess?
    The posterior wall of the agger nasi and frontoethmoid cells, if present
  53. What structures form the posterior boundary of the frontal recess?
    The ethmoid bullae, suprabullar space, anterior skull base, and anterior ethmoid artery; frontal bulla cell
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315623
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OBR: Nose and Paranasal Sinuses
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Pearls of Wisdom, Ch 2
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