Term
Congenital Midline Mass: Nontender, non-compressible, firm mass that does not transilluminate.
What is your differential? |
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Definition
Likely dermoid.
Potentially glioma (similar appearing), encephalocele (pulsatile, expands with crying), or teratoma (plain film with calcification).
Need CT/MRI to determine intracranial extent and therapy is surgical |
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Term
| How is rhinitis medicamentosa managed? |
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Definition
After 5-7d use of Afrin, desensitization of alpha receptors occurs with rebound congestion.
Stop decongestant and give intranasal steroids. Sometimes short course of systemic steroids needed |
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Term
| What are Mikulicz cells and Russel bodies and how is the associated condition treated? |
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Definition
Mikulicz cells: large macrophages with clear cytoplasm containing bacilli
Russel bodies present in plasma cells
Indicates Rhinoscleroma from Klebsiella rhinoscleromatis.
Treat with long-term antibiotics, biopsy and debridement |
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Term
| How is CRS differentiated from ARS? |
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Definition
Acute is <4 weeks with complete resolution
Subacute is 4-12 weeks
Chronic is >12 weeks without complete resolution |
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Term
| How does the pathophysiology of CRSwNP differ from CRSsNP? |
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Definition
Nasal polyposis: Neutrophil
No polyposis: Eosinophilic
Can also be allergic fungal |
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Term
| What are the characteristic imaging findings of allergic fungal sinusitis? |
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Definition
1) CT
- Rim of hypointensity with hyperdense central material (allergic mucin)
- Speckled areas of increased fungal material
2) MRI:
- Peripheral hyperintensity with central hypointensity on T1/T2
- MRI central "void" on T2 |
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Term
| What are the stages of the Chandler classification? |
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Definition
Orbital complications of sinusitis
1) Preseptal cellulitis: inflammatory edema, no EOMI deficit
- Outpatient antibiotics, sinus management
2) Orbital cellulitis: chemosis, impairment of EOM, proptosis, possible visual impairment. Admit with IV abx and sinus managment
3) Subperiosteal abscess: pus between medial periorbital and bone, worsening visual impairment
- Usually surgery, but at least IV abx
4) Orbital abscess: pus collection in orbital tissue, complete opthalmoplegia with severe visual impairment
5) Cavernous sinus thrombosis: bilateral extension |
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Term
| What is a Pott puffy tumor? |
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Definition
| Subperiosteal abscess (frontal bone osteomyelitis to erosion of anterior bony table) |
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Term
| What antibiotic is appropriate in a case of acute bacterial rhinosinusitis not improvement after 72h on Augmentin? |
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Definition
| Try respiratory quinolone (Levofloxacin) |
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Term
| What is the appropriate management of CRS with nasal polyps? |
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Definition
1) Nasal corticosteroids (drops > spray)
2) Systemic steroids: 1mg/kg and taper over 10 days
3) Nasal saline irrigation
4) Long-term abx, usually macrolide
Surgery for anatomical variants, massive polyposis, mucocele, suspected fungal, failure of medical therapy |
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Term
| Which organism is classic for Atrophic rhinitis? |
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Definition
Klebsiella Ozaenae
Degeneration of nasal mucosa and loss of mucociliary function with foul smell and yello/green nasal crusting, anosmia.
Nasal saline, abx, surgical approach to reduce nasal cavity size. |
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Term
| What are common work exposures for SCCa and adenocarcinoma of paranasal sinuses? |
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Definition
1) SCCa
- Nickel, Aflatoxin, chromium, mustard gas
2) Adenocarcinoma
- Leather, wood dust, woodworking |
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Term
| Differentiate between the 3 primary paranasal sinus/olfactory groove malignant tumor types |
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Definition
From least to most aggressive
1) Esthesioneuroblastoma (ENG) is CK negative and NOT a carcinoma. Maintains neuronal differentiation. It is SYN and CHR +
2) Sinonasal neuroendocrine carcinoma (SNEC) maintains neuronal differentiation, but is a carcinoma with CK+
3) Sinonasal undifferentiated carcinoma (SNUC) is undifferentiated carcinoma with small round blue cells without neuronal differentiation. CK+, EMA+, weak neuron specific enolase |
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Term
| What is the Kadish system for Esthesioneuroblastoma staging? What about Hyams histopathology? |
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Definition
Kadish
A: nasal fossa
B: paranasal sinuses
C: beyond sinuses
D: beyond dura
Hyams Histo
Grades 1-2, Homer Writght pseudorossettes Grade 3-4 Flexner-Wintersteiner rosettes |
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Term
| What vascular flaps are available for anterior skull base reconstruction? |
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Definition
Intranasal
1) Nasoseptal flap: SPA
2) Inferior turbinate flap: ITA: small clival defects
3) Middle turbinate flap (MTA): small ACF or TSA defects
Regional
1) Pericranial: supraorbital and supratrochlear artery: ACF to sella, hearty flap if NSF not available
2) Temporaoparietal fascia flap: Superficial temporal artery: clival and parasellar defects, 90 degree rotation is limiting |
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Term
| What are the four ethmoid lamellae and their? clinic relevance |
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Definition
1) First lamella is Uncinate
2) Second lamella is Ethmoid bulla
3) Third lamella is basal lamella of middle turbinate
- Divides anterior/posterior ethmoids
4) Fourth lamella is superior turbinate
- medial to superior turbinate is SE recess where sphenoid sinus drains |
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Term
| What is an Onodi cell and why is it clinically relevant? |
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Definition
Sphenoethmoidal posterior ethmoid cell that is highly pneumatized and extending posteriorly along LP and superiorly into anterior wall of sphenoid sinus.
Danger to optic nerve and carotid artery during posterior ethmoid dissection. |
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Term
| What is the proposed pathophysiology of aspirin-exacerbated respiratory disease (AERD)? |
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Definition
Dysregulated eicosanoid synthesis
- AA normally cleaved by plA2 and shunted to LKE pathway by 5LPO or down PGE pathway via cyclooxygenase.
- LKE pathway is overactive in AERD, and aspirin inhibits cyclooxygenase, resulting is less pgE2, and ultimately net increase in LKE |
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Term
| What is the feared consequence of anterior ethmoid artery injury during ESS? |
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Definition
| Lateral aspect of vessel can retract within orbit and cause dramatic orbital hematoma |
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