Final Ana Lec Eval: Respiratory

1. Enumerate the different facial sinuses and determine the effects or symptoms on the
person if there would be (injuries, infection, etc.) on each of the said sinuses. Provide a
situational analysis for the effect. Give atleast 2 injuries for each sinuses.
PARANASAL SINUSES

Paranasal Sinuses: a cavity lined with mucous membrane within a bone or other tissue,
especially one in the bones of the face or skull connecting with the nasal cavities
It is group of four paired air-filled spaces that surround the nasal cavity:
 The Frontal sinuses are above the eyes.
 The Sphenoidal sinuses are behind the eyes.
 The Ethmoidal sinuses are between the eyes.
 The Maxillary sinuses are located under the eyes.
1. Frontal Sinuses
A type of paranasal sinus (a hollow space in the bones around the nose). There are two,
large frontal sinuses in the frontal bone, which forms the lower part of the forehead and
reaches over the eye sockets and eyebrows. The frontal sinuses are lined with cells that
make mucus to keep the nose from drying out.
The two frontal sinuses are situated in the frontal bone immediately above and between
the eye sockets, or orbits. They are usually unequal in size and have the shape of an
irregular pyramid with its apex directed upward. The thin bony wall separating the two
cavities sometimes is absent.
It is rare to recognize the frontal sinuses until the age of seven years, and their maximum
growth occurs after puberty. They vary considerably in size and are usually larger in the
male than in the female, averaging, when fully developed, approximately 3 cm (1.2
inches) in height, 2.5 cm (1 inch) in width, and 2 cm (0.8 inch) in depth. The front, or
anterior, wall is thick skull bone; behind the sinuses lies bone covering the brain, and the
floor of the sinuses slopes toward their openings into the nose.
Walls:
 Anterior and posterior table of the frontal bone
 Intersinus septum
 Orbital roof, nasoethmoidal floor

Blood supply:
 Supraorbital artery
 Supratrochlear artery

Venous drainage:
 Small vein that unites the supraorbital and superior opthalmic nerve
 nerve supply
 Supraorbital nerve (ophthalmic nerve)
 Supratrochlear nerve (ophthalmic nerve)

Lymphatic drainage:
 1. Submandibular nodes

Situational Analysis

1. The patient has a respiratory and sinus illness, with four days of worsening cough
productive of green sputum. He has had yellow sinus drainage, sinus congestion, and
sinus pressure. No fever or chills. No flu-like symptoms. He used Mucinex over the
weekend. No neck pain or stiffness.

Diagnosis: Acute frontal sinusitis, unspecified

Signs and Symptoms

o Negative for activity change, appetite change, chills, diaphoresis, fatigue, fever,
and unexpected weight change.
o Positive for congestion, rhinorrhea (yellow), sinus pain (frontal) and sinus
pressure.
o Negative for photophobia, pain, discharge, redness, itching, and visual
disturbance.
o Positive for cough (productive of green sputum, no blood).
o Negative for chest pain, palpitations, and leg swelling.
o Negative for environmental allergies.
o Positive for headaches (+Sinus HA).

2. A 22-year-old male sustained injury to frontal bone following road traffic accident was
referred to us from rural hospital. After 2 days of sustaining injury. Patient lost
consciousness immediately after sustaining trauma and was admitted in some rural
hospital for 2 days following which he was referred to SPMC.

Diagnosis: Frontal Sinus Fracture

 Signs and Symptoms
o Open fracture of the frontal bone in the midline with loss of outer table.
o The defect was 3 × 2 cm in size with the frontal sinus directly open to external
environment
o Pain
o Tenderness
o Contour Irregularities
o Hematoma

2. Sphenoidal Sinuses: Sphenoidal sinuses are situated back of the nose in the sphenoidal
bone, which forms a forward part of the base of the skull and contains the depression, or
fossa, for the pituitary gland. The sinuses are separated from each other by a bony wall,
or septum, that is rarely in the midline, and they discharge their mucus through an
opening in the front wall of the sinus into the nose.
These sinuses appear before birth but remain small until the age of 10, when they grow
rapidly; rapid growth also occurs at about puberty. Sphenoidal sinuses are important in
the surgical approach to the pituitary gland for patients with breast cancer or pituitary
tumours.

Boundaries
1. Maxillary ostium:
- post part of the medial wall
- drains into mddle meatus through ethmoidal infundibulum
2. Accessory ostium:
- When present seen post to natural ostia
- Almost always circular
- Easily seen during endoscope
-Myerson 1932-31 %
Blood supply:

 Facial artery
 Infrorbital artery
 Greater palatine artery
 Sphenopalatine artery

Nerve supply:

 Greater palatine nerve

 Post lateral nasal nerve
 Superior alveolar ( infraorbital nerve)

Situational Analysis

1. A 7 year old previously healthy female presents to her primary care physician with a 12
day history of persistent thick nasal discharge, nasal congestion, cough, and intermittent
low grade fever, neck pain and pressure around the eyeball. On further questioning, her
parents reveal that the cough is worse at night but there is no wheezing, currently or in
the past. She also seems to have one temperature spike daily to about 38.2 degrees (100.8
degrees F). She is not taking any medications. They deny the possibility of a nasal
foreign body. She denies any vomiting, headache, earache, or rashes.
Diagnosis: Sphenoid Sinusitis

Signs and Symptoms

o Throbbing pain and pressure around the eyeball, which is made worse by bending
forwards
o Negative for Earache
o Positive for Neck pain, pressure behind the eyes, at the top of the head, or in the temples.
o Positive for Nasal discharges with thick yellow purulent mucus
o Positive for Cough
o Positive for Intermittent low grade fever
o Positive mild tenderness to palpation of sphenoid sinuses
 2. A 27-year-old female patient was referred to us from the emergency department for an
alleged history of gunshot injury from point blank range. The patient was unconscious on
arrival to the emergency department and her vitals were stabilized over 2 days. Primary
examination of the patient showed the presence of a 3 × 3 cm defect over the forehead
with exposed bone fragments within the defect

Upon X-Ray Examination: Metallic artifact seen in the right sphenoid sinus impinging on the
right optic canal

Diagnosis: Gunshot wound related to the posterior ethmoids and anterolateral wall of the
sphenoid sinus

Signs and Symptoms

o Positive for Dilated pupils

o Positive for Absent papillary reflexes
o Positive for No perception of light in the right eye
o Positive for Hemorrhagic Contusions
o Positive for Subdural hemorrhage

3. Maxillary Sinuses: are not only the largest of the air sinuses but also the first to appear,
being present in the fourth month of intrauterine life. Each is a pyramidal space, its roof
formed by the floor of the eye socket, and its floor by the palate and teeth-bearing bone.
The roots of the upper-jaw teeth may project through the floor into the sinus cavity or
may be so closely related to the floor that extraction leads to the formation of an opening
between mouth and sinus (oro-antral fistula). The maxillary sinuses reach their maximum
size by about age 12, when all the permanent teeth except the third molars have erupted.
The nerves supplying the upper teeth run through the front wall of the sinus and may be
irritated during acute antral infections with resultant toothache.

5 Walls

 Anterior surface of maxilla

 Posteriolateral: zygomatic bone and the greater wing of the spenoidal bone.
  Median lateral wall of the nasal cavity at the level of the middle and inferior meatus.
 Superior floor of orbital cavity
 Inferior- alveolar and palatine process of maxilla.

Situational Analysis

1. A 35-year-old man presents to his primary care physician’s office with complaints of
nasal stuffiness with yellow nasal drainage, watery eyes, nonproductive cough, sore
throat, and muscle aches for 7 days’ duration. Prior to his admission, he sought
consultation in there nearest clinic and requested a course of antibiotics. The patient
describes mild right facial discomfort for which acetaminophen has provided no relief.
He has no toothache.
Diagnosis: Acute Maxillary Sinusitis

Signs and Symptoms

o Watery eyes
o Nonproductive cough
o Sore throat
o Muscle aches
o Yellow nasal drainage
o Nasal stuffiness
o Mild Right Facial Discomfort
o Maxillary sinus tenderness
o Drainage of mucus in the back of your throat
o Nasal Congestion

2. A 16-year-old male patient suffered from maxillofacial trauma with the first and second
molars in the left maxilla were missing, and an orificium fistula to the maxillary sinus
appeared in the dentition region of molars.
Diagnosis: Displacement of teeth into the maxillary sinus as secondary to
Maxillofacial Trauma
Signs and Symptoms

o First and second molars in the left maxilla were missing

o Orificium fistula to the maxillary sinus appeared in the dentition region of molars.
o Hemorrhage
o Pain
o Tenderness
o Swelling
o Nasal discharges
o Contour deformities
o Bleeding during nose blowing

4. Ethmoid Sinuses: The ethmoidal sinuses, from 3 to 18 thin-walled cavities between the nasal
cavities and the eye sockets, make up the ethmoidal labyrinths. Their walls form most of the
inner walls of the eye sockets and are joined together by a thin perforated plate of bone at the
roof of the nose. This bone, the cribriform plate, transmits the olfactory nerves that carry the
sense of smell.

The sinuses contained within each labyrinth are arranged in three noncommunicating groups, all
of which open into the nasal cavity. All produce mucus whose function is to lubricate the cilia
lining the nasal passages.

Consist of 5 parts:

1. Superior prominence (crista galli)

2. Horizontal plate (cribriform plate)

3. Midline perpendicular plate (perpendicular plate of ethmoid)

4.-5. Two lateral masses or labyrinths suspended from horizontal arms in the shape of the cross.

CRIBRIFORM PLATE

o Separates the anterior cranial cavity above from the nasal cavity below.
 o Compose of 2 narrow plates on either sides perforated by olfactory nerve fibers process
of dura and ethmoid vessels and nerves.

Blood Supply

 Anterior ethmoid artery (ophthalmic artery)

 Post. Ethmoidal artery
 Sphenoid artery (maxillary artery)

Venous drainage

 nasal veins
 Anterior ethmoid vein
 Posterior ethmoid vein

Situational Analysis:

1. LG is a 19-year-old woman who had chronic pain between her eyes and tenderness when
she touch the bridge of your her nose. She described this pain as an aching with some
intermittent pressure component. She had been seen by several ophthalmologists with
diagnoses ranging from allergy to dry eye. Clinical examination was basically
unremarkable, and a plain film sinus x-ray had been read as normal.
Diagnosis: Ethmoid Sinusitis

Signs and Symptoms

o Facial swelling
o Runny nose lasting longer than 10 days
o Thick nasal secretions
o Post-nasal drip, which is mucus that moves down the back of your throat
o Sinus headaches
o Sore throat
o Cough
o Decreased sense of smell and taste
o General fatigue or malaise
o Fever
o Ear pain or mild hearing loss

2. A 30-year-old farmer was admitted to the emergency room due to a fracture associated
with bilateral anterior and posterior ethmoid sinus wall fractures caused by a horse kick.

Diagnosis: Type II naso-orbito-ethmoid (NOE) fracture associated with bilateral

anterior and posterior frontal sinus wall fractures

Signs and Symptoms

o Nasal and forehead swelling or lacerations.

o Eye, forehead, and nose pain.
o Forehead paraesthesias.
o Diplopia.
o Telecanthus.
o CSF rhinorrhea.