Download Rhinology (Rhinitis and Sinusitis)

Rhinitis and Sinusitis
Chia-Ming Liu, M.D. March , 2012
1. Anatomy
1) Nose: septum, turbinates (supreme, superior, middle and inferior), meatus (common, inferior, middle,
superior, sphenoethmoid recess)
2) Sinus: anterior group (frontal, anterior ethmoidal, maxillary), posterior group (posterior ethmoidal,
sphenoidal)
3) Mucosa: respiratory epithelium and sinusoid-rich lamina propria
4) Innervation: CNV(1,2), olfactory (CN1), autonomic (Vidian N)
5) Artery: external (sphenopalatine) and internal (ethmoidal) carotid artery
6) Vein: ophthalmic, facial, sphenopalatine vein
7) Lymphatics: preauricular, submadibular, retropharyngeal, jugular L-Ns
2. Physiology
1) Air conditioning（warming, humidity）
2) Filtration（vibrissae, mucociliary clearance）
3) Olfaction（perception, identification, memory, conductive or neurosensory deficit）
）
4) Resonance (rhinolalia clausa, aperta)
5) Defense mechanisms (innate and adaptive immunity)
3. Deformity and anomaly
saddle nose, hump nose, twisted nose, nasal cleft, glioma, dermoid cyst,
encephalocele, choanal
atresia, septal deviation, septal perforation, empty nose syndrome (secondary atrophic rhinitis)
4. Cutaneous diseases
vestibulitis, furunculosis, erysipelas, herpes, acne rosacea (rhinophyma)
5. Mucosal diseases
1) Acute rhinitis (coryza, common cold), acute suppurative rhinitis, septal abscess, toxic shock
syndrome
2) Chronic rhinitis (infectious, allergic, vasomotor, rhinitis medicamentosa, hormonal, drug-induced,
atrophic)
3) Congenital (Kartagener’s syndrome, cystic fibrosis, pneumosinus dilatans)
4) Acute sinusitis: Stretococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis.
5) Chronic sinusitis: inflammation (infection, allergy, systemic dzs i.e. DM or uremia), mechanical
obstruction (septal deviation), pollution)---edema of mucosa---obstruction of ostium—impair
ventilation and drainage--- vicious cycle of mucosal inflammatory change
6. Concepts of functional endoscopic sinus surgery (mucociliary function, key area of persistent sinusitis,
reversibility of diseased mucosa, emdoscopic guidance, sinus CT)
7. Complications
orbital Cx (preseptal cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, cavernous
sinus thrombophlebitis), mucocele, osteomyelitis, CNS Cx, sinobronchial syndrome,
focal infection.