Ethmoid and sphenoid sinus surgery can be simple and straightforward at times, but also complex and challenging, due to the close proximity to brain, orbit and important neurovascular structures. Both inflammatory and neoplastic conditions are commonly found in this region. In order to perform these surgeries safely, a thorough anatomic understanding is imperative to understand this complex region.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is diagnosed based on the presence of nasal polyps in addition to meeting criteria for CRS. Although not known to be associated with mortality risk, the morbidity and severe impact on quality of life reported by patients with severe CRS is worse than major illness such as COPD, CHF, and Parkinsons disease. Though quality of life improvements after treatment appear to be most substantial for patients with CRSwNP. CRSwNP is most commonly associated with a Th2 driven inflammatory process.
Rhinosinusitis (non-polypoid) is a very prevalent disease in the general population. It can be classified into acute, sub-acute and chronic in nature. The causes of rhinosinusitis are multifactorial and can be related to various environmental, anatomical and genetic factors. The diagnosis is based on specific cardinal symptoms along with abnormal findings on endoscopy and imaging. The medical treatment option include nasal saline irrigation, topical intranasal corticosteroid sprays, oral antibiotics and oral steroids.
The maxillary sinus is the most commonly affected sinus in chronic rhinosinusitis. Maxillary antrostomy is usually the first step in the process of a more extensive sinus surgery. Over the last three decades, endoscopic techniques have been developed and refined to address the full range of maxillary sinus pathologies.
Nonallergic rhinitis (NAR) is a common inflammatory condition of the nasal airway which may be due to a variety of causes. As the name states, it is not caused by allergic disease, nor is it of infectious etiology. Diagnosis is made by ruling out allergic and infectious disease, as well as other inflammatory diseases such as chronic rhinosinusitis. Effective management depends on correct diagnosis of the underlying etiology of NAR and appropriate medical and, occasionally, surgical treatment.
Nasal obstruction is an extremely common presenting symptom to the otolaryngologist. A comprehensive understanding of nasal/sinus embryology and anatomy will aid in proper diagnosis. Patient evaluation and workup always begins with a complete and thorough history and physical examination. Nasal endoscopy as well as diagnostic imaging aid in confirmation of the disease process and selection of appropriate treatment options. Treatment modalities include both medical and surgical options.
Epistaxis is frequently encountered in an otolaryngology practice in both pediatric and adult populations. A variety of underlying disease, systemic, and therapeutic factors can cause bleeding. Being able to recognize the severity of blood loss, having an understanding of vascular anatomy, and the ability to quickly and appropriately select which is the best therapeutic option for each patient will lead to the successful treatment of epistaxis.
Chemosensory disorders are encountered frequently in the practice of otolaryngology and have a significant impact on patient quality of life. True disturbances in taste are less common, but usually an alteration in the perception of flavors occurs because of dysfunction in the sense of smell. There is an extraordinary capacity of the olfactory system to regenerate, and although disorders in the sense of smell are relatively uncommon they can occur at every step of odorant transduction.
Although the majority of people are more concerned about the external shape of their nose, its internal anatomy and physiologic activity are of greater curiosity for otolaryngologists. A review of the functions of the nose would consider the following classifications:
Understanding the embryology of the sinonasal pathway is crucial in appreciating its anatomy and pathophysiology. Congenital anomalies occur because of errors during embryogenesis. Depending on the affected period during prenatal development, different structures and malformations may be observed. The abnormalities may range from full absence of development to a mild malformation, easily reparable. Given the complexity of the sinonasal procedures, it is imperative to truly understand the anatomy prior to operating.
