Ossicle/Nose and Paranasal Sinuses

__NOTOC__ Nose and Paranasal Sinuses Back to TOC 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: left 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. Image:sphenoid-axial-study.jpg Image:sphenoid-coronal-study.jpg __NOTOC__