- the nasolacrimal duct drains into this nasal structure

Inferior meatus

- posterior ethmoid cells drain to this nasal structure

Superior meatus

- maxillary sinus, frontal sinus, and anterior ethmoid cells all drain to this nasal structure

Middle meatus

- this nasal structure is the primary nasal component of the warming capacity of the upper respiratory tract

Turbinate cavernous plexi

- Cold air primarily impacts this structure by increasing the overall blood capacity, which correlates to the overal warming capacity

- it also enlarges this structure

Turbinate

- there is normal physiologic presence of this throughout the day in the nose

Turbinate swelling and position

- these cells move secretions and trapped particulates from the nose to the posterior pharynx for swallowing

Ciliated epithelial cells

- can be caused by chronic infection (syphilis & TB), cocaine abuse, trauma, collagen vascular disease, Wegener's granulomatosis and carcinoma

- Nasal piercing also can cause this

Perforated nasal septum

- common deformity that can lead to nasal obstruction

- snoring, sleep apnea, epistaxis, facial pain and recurrent sinusitis are all possible side effects

Septal deviation

- this nostril develops mucosal erosion sooner in relation to obstruction (deviation)

side of obstruction

- sometimes this structure can enlarge in the larger nostril of a long standing deviated septum and cause obstruction

Inferior turbinate

- affects about 20% of the population

- symptoms include clear nasal discharge, congestion, sneezing, itching of eyes/noes/roof of mouth

- mucous membrane appears edematous and blue/grey

Allergic rhinitis

Allergic Rhinitis

- blue-grey discoloration of the edematous mucous membranes

- chronic use of topical decongestants may lead to this

- form of congestion caused by release of tonic vasoconstriction when medications are withdrawn

rhinitis medicamentosa

- usually originates from lower anterior septum at highly vascular Kiesselbach's plexus

- may be controlled by firm pressure to alar cartilages on both sides of septum

Epistaxis (nose bleeding)

- anterior ethmoid, posterior ethmoid, superior labial, sphenopalatine and greater palatine arteries

Arteries that supply Little's area

- most often secondary to trauma or drying

- may also be from aspirin (platelets) or warfarin (clotting factors)

- not caused by uncontrolled hypertension

Anterior nosebleeds

- originate from back third of the inferior meatus (sphenopalatine artery)

- may manifest from severe systemic hypertension

- must be treated with packing due to probable arterial origin

Posterior nosebleeds

- this GI finding could possibly be caused by iron deficiency or from swallowing blood related to epistaxis

Guaiac positive stools

- frequently accompany allergic rhinitis

- overgrowths of mucosa from lateral/medial nasal mucosa and often from middle meatus

- freely moveable, non-tender

Nasal polyps

- nasal polyps, asthma, sensitivity to aspirin

- precipitates asthma

Allergic triad

- infection of paranasal sinuses

- caused by bacteria or fungi

- most often develops from upper respiratory viral infection leading to stasis of secretions --> infection

- produces facial pain and tenderness, headache, fever, eye pain and purulent or bloody discharge

Sinusitis

- cause of 5-10% of maxillary sinusitis

- can be checked by tapping maxillary teeth with tongue blade

Dental root infection

- causes pain and tenderness in the forehead above supraorbital ridge

- predicted on physical exam by same findings as maxillary sinusitis

Frontal sinusitis

- maxillary toothache, purulent secretions, poor response to decongestants, abnormal transillumination and history of colored nasal discharge

Signs and symptoms of maxillary sinusitis

- causes retro-orbital pain and pain medial to the eye

- no tenderness or abnormal transillumination

- diagnosis relies on radiographic exam

- may cause orbital infection

Ethmoid sinusitis

- causes pain behind the ey and at the vertex of the skull

- no tenderness or abnormal transillumination

- diagnosis relies on radiographic exam

Sphenoid sinusitis