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 Classfication: Intracranial Complications of Sinusitis, in order of prevalence
 * 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!
 * 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

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

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.