Rhinology Review

Preface
Contents
About the Authors
1: Development of the Nose, Paranasal Sinuses
1.1 The Nasal Cavity
1.2 The Paranasal Sinuses
1.3 The Ethmoid Sinuses
1.4 The Maxillary Sinuses
1.5 Sphenoid Sinuses
1.6 Frontal Sinus
2: Anatomy of Nose and Sinuses
2.1 The External Nose
2.1.1 Surface Landmarks
2.1.2 Structural Anatomy
2.1.3 Blood Supply of the External Nose
2.1.3.1 Arterial Supply
2.1.3.2 Venous Drainage
2.1.3.3 Lymphatic Drainage
2.1.4 Nerve Supply
2.2 The Nasal Cavity
2.2.1 The Nasal Septum
2.2.2 Lateral Basal Wall
2.2.2.1 The Inferior Turbinate
2.2.2.2 The Middle Turbinate
2.2.2.3 The Superior Turbinate
2.2.2.4 The Uncinate Process
2.2.2.5 The Ostiomeatal Complex
2.2.2.6 Bony Lamellae Encountered during Endoscopic Sinus Surgery
2.2.3 Blood Supply of the Nasal Cavity
2.2.4 Nerve Supply of the Nasal Cavity
2.3 The Sinuses
2.3.1 The Ethmoid Sinuses
2.3.2 The Maxillary Sinus
2.3.3 The Frontal Sinus
2.3.4 The Sphenoid Sinus
2.4 Histology of the Nasal Mucosa
3: Nasal Physiology and Functions
3.1 Important Nasal Functions
3.2 Olfaction
3.3 Nasal Airflow and Conditioning
3.4 Defense Functions of the Nose
3.4.1 Mechanical Mechanisms
3.4.2 Humoral Mechanisms
3.4.3 Cellular Mechanisms
3.4.4 Reflex Mechanisms
3.5 Speech
4: Imaging of the Nose and Sinuses
4.1 Computed Tomography (CT)
4.2 Cone Beam CT
4.3 Magnetic Resonance Imaging
4.4 General Radiologic Findings of Inflammatory Lesions
4.5 General Radiologic Findings of Neoplastic Lesions
5: Investigative Rhinology
5.1 Allergy Tests
5.1.1 Skin Prick Tests
5.1.2 Tests for IgE
5.1.3 Nasal Smears
5.1.4 Blood Eosinophils
5.1.5 Nasal Provocation Test
5.2 Airway Tests
5.2.1 Rhinomanometry
5.2.2 Acoustic Rhinometry
5.2.3 Nasal Inspiratory Peak Flow
5.3 Olfactory Tests
5.3.1 Subjective Methods
5.3.2 Objective Methods
5.4 Tests of Mucociliary Transport
5.5 Other Objective Tests
5.5.1 Nitric Oxide Measurement
5.5.2 Nasal Lavage
5.6 Subjective Tests
5.6.1 SNOT 22
5.6.2 NOSE Scale
5.6.3 Visual Analog Scale (VAS)
5.6.4 Quality of Life (QOL) Questionnaires
6: Symptoms of Sinonasal Diseases
6.1 Epistaxis
6.1.1 Vascular Anatomy
6.1.2 The Sphenopalatine Artery (SPA)
6.1.3 The Anterior and Posterior Ethmoid Arteries
6.1.4 Definition and Classification
6.1.5 Primary (Idiopathic) Epistaxis
6.1.6 Secondary Epistaxis
6.1.6.1 Local Causes
6.1.6.2 General Causes
6.1.7 Management of Epistaxis
6.1.8 First-Aid Measures
6.1.9 General Measures
6.1.10 Control of Bleeding
6.1.10.1 Nasal Cautery
6.1.10.2 Nasal Packs
6.1.10.3 Nasal Balloons
6.1.10.4 Hot Water Irrigations
6.1.10.5 Tranexamic Acid
6.1.10.6 Arterial Control
6.1.11 Treatment of the Cause
6.1.12 Hereditary Hemorrhagic Telangiectasia (Osler–Weber–Rendu Disease)
6.1.12.1 Treatment
6.2 Nasal Obstruction
6.2.1 Classifications of Nasal Obstruction
6.2.2 Etiology of Nasal Obstruction
6.2.3 Causes of Nasal Obstruction in Children
6.2.4 Assessment of Nasal Obstruction
6.3 Olfactory Disorders
6.3.1 Classification of Olfactory Disorders
6.3.1.1 According to Etiology
6.3.1.2 According to Type
Quantitative Olfactory Disorders
Qualitative Olfactory Disorders
6.3.2 Causes of Olfactory Dysfunction
6.3.2.1 Conductive Olfactory Dysfunction
6.3.2.2 Sensory Olfactory Dysfunction
6.3.2.3 Neural Olfactory Dysfunction
6.3.2.4 Psychogenic (e.g., schizophrenia)
6.3.3 Assessment of Olfactory Function
6.3.3.1 Subjective Methods
6.3.3.2 Objective Methods
6.3.4 Treatment
6.4 Headache
6.4.1 Tension Headache
6.4.2 Migraine Headaches
6.4.3 Cluster Headaches
6.4.4 Neuralgias
7: Choanal Atresia and Congenital Nasal Masses
7.1 Choanal Atresia
7.1.1 Clinical Picture
7.1.1.1 Bilateral Choanal Atresia
7.1.1.2 Unilateral Choanal Atresia (Fig. 7.1)
7.1.2 Investigations
7.1.3 Differential Diagnosis
7.1.4 Management
7.2 Pyriform Aperture Stenosis
7.3 Congenital Nasal Masses
7.4 Meningoceles and Encephaloceles
7.5 Gliomas
7.6 Nasal Dermoids
8: Nasal Trauma
8.1 Foreign Bodies in the Nose
8.1.1 Clinical Picture
8.1.2 Investigations
8.1.3 Treatment
8.2 Fractures of the Nasal Bones
8.2.1 Types of Fracture of the Nasal Bones
8.2.2 Clinical Features
8.2.3 Investigations
8.2.4 Management
8.3 Septal Hematoma
8.4 Fractures of the Midface (Le Fort Fractures)
8.5 Frontal Sinus Fractures
9: Nasal Septum, Nasal Valves, and Turbinates
9.1 Septal Deviation
9.2 Septal Perforations
9.3 Nasal Valves
9.4 The Turbinates
9.4.1 Inferior Turbinates
9.4.2 Middle Turbinate
10: Rhinitis and Nasal Allergy
10.1 Classification of Rhinitis
10.2 Allergic Rhinitis
10.2.1 Classifications of Allergic Rhinitis
10.2.2 ARIA Classification
10.2.3 Pathophysiology
10.2.4 Comorbidities of Allergic Rhinitis
10.2.5 Clinical Picture
10.2.6 Investigations
10.2.7 Management
10.2.8 Aspirin-Exacerbated Respiratory Disease (AERD - Samter’s Triad)
10.2.8.1 Clinical Features
10.2.8.2 Investigations
10.2.8.3 Treatment
10.2.9 Rhinitis and Asthma
10.3 Non-Allergic Rhinitis
10.3.1 Etiology
10.3.2 Vasomotor Rhinitis (VMR)
10.3.3 Treatment
10.3.4 Non-Allergic Rhinitis with Eosinophilia Syndrome (NARES)
10.3.5 Non-Allergic Inhalant/Occupational Induced Rhinitis
10.3.6 Hormonal Rhinitis
10.3.7 Food-Induced Rhinitis
10.4 Infectious Rhinitis
10.4.1 Acute Viral Rhinitis (Coryza - Common Cold)
10.4.1.1 Clinical Picture
10.4.1.2 Treatment
10.4.2 Scleroma
10.4.2.1 Incidence
10.4.2.2 Pathology
10.4.2.3 Clinical Picture
10.4.2.4 Involvement of Other Regions
10.4.2.5 Investigations
10.4.2.6 Differential Diagnosis
10.4.2.7 Treatment
10.4.3 Rhinosporidiosis
10.5 Special Types of Rhinitis
10.5.1 Drug-Induced Rhinitis (Rhinitis Medicamentosa)
10.5.2 Atrophic Rhinitis
10.5.3 Primary Atrophic Rhinitis (Ozena)
10.5.3.1 Clinical Picture
10.5.3.2 Anterior Rhinoscopy Shows
10.5.3.3 Treatment
10.5.4 Secondary Atrophic Rhinitis
10.5.5 Rhinitis Sicca Anterior
11: Rhinosinusitis
11.1 Acute Rhinosinusitis
11.1.1 Etiology
11.1.2 Microbiology
11.1.3 Symptoms
11.1.4 Signs
11.1.5 Imaging
11.1.6 Treatment
11.2 Complications of Rhinosinusitis
11.2.1 Classification
11.2.2 Osteomyelitis of the Frontal Bone
11.2.3 Orbital Complications
11.2.3.1 Chandler Classification of Orbital Complications
11.2.3.2 Pre-Septal (Periorbital) Cellulitis
11.2.3.3 Orbital Cellulitis (Post-Septal Cellulitis)
11.2.3.4 Subperiosteal Abscess
11.2.3.5 Orbital Abscess
11.2.3.6 Treatment of Orbital Infections
11.2.4 Intracranial Complications
11.2.4.1 Meningitis
11.2.4.2 Epidural (Extradural) Abscess
11.2.4.3 Subdural Abscess
11.2.4.4 Frontal Lobe Abscess
11.2.4.5 Cavernous Sinus Thrombosis
11.2.4.6 Treatment of Intracranial Infections
11.2.4.7 Alarm Symptoms and Signs of Sinusitis
11.3 Chronic Rhinosinusitis
11.3.1 Diagnosis of CRS
11.3.2 Classification
11.3.3 CRS with Nasal Polyps (CRSwNP)
11.3.4 CRS without Nasal Polyps (CRSsNP)
11.3.5 Symptoms of CRS
11.3.6 Signs
11.3.7 Investigations
11.3.8 Treatment
11.3.9 Chronic Rhinosinusitis in Children
11.4 Sinonasal Polyposis
11.4.1 The Meltzer Clinical Scoring System
11.4.2 Medical Treatment of Sinonasal Polyposis
11.4.3 Surgical Treatment of Sinonasal Polyposis
11.4.4 Antrochoanal Polyp
11.5 Recalcitrant Sinusitis
11.5.1 Cystic Fibrosis (CF)
11.5.2 Primary Ciliary Dyskinesia or Kartagener Syndrome
11.5.3 Odontogenic Sinusitis
11.5.4 Aspirin-Exacerbated Respiratory Disease (AERD)
11.5.5 Wegener’s Granulomatosis (GPA—Granulomatosis with Polyangiitis)
11.5.6 Eosinophilic Granulomatous Polyangiitis (EGPA—Churg-Strauss Syndrome)
11.5.7 Sarcoidosis
11.5.8 Immunodeficiency
11.5.9 Laryngopharyngeal Reflux (LPR)
11.6 Fungal Sinusitis
11.6.1 Classification of Fungal Rhinosinusitis
11.6.2 Fungal Colonization
11.6.3 Fungal Ball (Mycelia Mass)
11.6.4 Allergic Fungal Rhinosinusitis (AFRS)
11.6.5 Eosinophilic Fungal Rhinosinusitis (EFRS)
11.6.6 Acute Invasive Fungal Sinusitis
11.6.7 Granulomatous Invasive Fungal Rhinosinusitis
11.6.8 Chronic Invasive Fungal Rhinosinusitis
11.7 Mucoceles
11.7.1 Clinical Picture
11.7.2 Radiologic Diagnosis
11.7.3 Treatment
12: Sinonasal Neoplasms
12.1 Fibro-Osseous Lesions
12.1.1 Osteomas
12.1.2 Ossifying Fibroma
12.1.3 Fibrous Dysplasia
12.2 Hemangioma
12.3 Inverted Papilloma
12.4 Juvenile Angiofibroma (JNA)
12.4.1 Clinical Picture
12.4.2 Extensions of the Tumor
12.4.3 Radiologic Evaluation
12.4.4 Radkowski Staging System
12.4.5 Treatment
12.5 Esthesioneuroblastoma
12.6 Nasopharyngeal Carcinoma
12.6.1 Clinical Picture
12.6.2 Investigations
12.6.3 Differential Diagnosis
12.6.4 Prognosis
12.6.5 Treatment
12.7 Sinonasal Carcinoma
12.7.1 Clinical Picture
12.7.2 Investigations
12.7.3 Treatment
12.8 Adenocarcinoma
12.9 Malignant Melanoma
12.10 Hemangiopericytoma
12.11 Lymphoma
13: Basic Endoscopic Sinus Surgery
13.1 Introduction to Basic Endoscopic Sinus Surgery
13.1.1 Concepts of Endoscopic Sinus Surgery (ESS)
13.1.2 Indications
13.1.3 Preoperative Preparation
13.1.4 Steps of Basic Stepwise ESS for Chronic Sinusitis (Figs. 13.1 and 13.2)
13.1.5 Postoperative Care
13.2 Endoscopic Frontal Sinus Approaches
13.2.1 General Principles
13.2.2 Draf Procedures (Figs. 13.3 and 13.4)
13.2.3 Wormald’s Classification of Frontal Sinus Procedures
13.2.4 The Axillary Flap Procedure
13.3 Endoscopic Maxillary Sinus Approaches
13.3.1 Indications of Endoscopic Surgery of the Maxillary Sinus
13.3.2 Canine Fossa Trephine
13.3.3 Middle Meatal Antrostomy
13.3.4 Endoscopic Inferior Meatal Antrostomy
13.3.5 Endoscopic Medial Maxillectomy
13.3.6 Prelacrimal Approach
13.4 Endoscopic Sphenoid Sinus Surgery
13.4.1 Endoscopic Approaches to the Sphenoid Artery
13.4.1.1 Steps of Sphenoidotomy
13.5 Complications of Endoscopic Sinus Surgery
13.5.1 Complications of Endoscopic Sinus Surgery (ESS)
13.5.2 Risk Factors for Complications
13.5.3 Cerebrospinal Fluid Leak
13.5.4 Orbital Complications
13.5.4.1 Orbital Fat Herniation
13.5.5 Extraocular Muscle Injury
13.5.6 Intraorbital Hematoma
13.5.7 Optic Nerve Injury
13.5.8 Damage to the Nasolacrimal Duct
13.5.9 Damage to the Internal Carotid Artery
13.5.10 Bleeding from the Posterior Nasal (Septal) Artery
13.5.11 Craniofacial Growth after ESS
13.5.12 Avoidance of ESS Complications
13.6 Revision ESS
13.6.1 Factors Indicative of Poor Outcome
13.6.2 Causes of Failure of Endoscopic Sinus Surgery
13.6.3 Important Landmarks in Revision Sinus Surgery
14: Advanced Endoscopic Sinus Surgery
14.1 Cerebrospinal (CSF) Rhinorrhea
14.1.1 Causes
14.1.2 Traumatic CSF Leaks
14.1.3 Spontaneous CSF Leaks
14.1.4 Clinical Presentation of CSF Leaks
14.1.5 Investigations
14.1.6 Treatment
14.2 Endoscopic Dacryocystorhinostomy (DCR)
14.2.1 Anatomy
14.2.2 Lacrimal tract obstruction may be:
14.2.3 Symptoms of Lacrimal Blockage
14.2.4 Diagnosis
14.2.5 Radiologic Evaluation
14.2.6 Endoscopic DCR
14.3 Endoscopic Anterior Skull Base Surgery
14.3.1 Sagittal Plane Approaches
14.3.1.1 Transcribriform Approach
14.3.1.2 Transplanum/Transtuberculum Approach
14.3.1.3 Trans-Sellar Approach
14.3.1.4 Transclival Approaches
14.3.1.5 Transodontoid Approach
14.3.2 Middle Coronal Plane Approaches
14.3.2.1 Transpterygoid Approach
14.3.2.2 Infratemporal Approach
14.3.2.3 Petrous Apex Approach
14.3.3 Flaps for Anterior Skull Base Reconstructions
14.4 Optic Nerve Decompression
14.5 Orbital Decompression
14.5.1 Indications of Orbital Decompression
14.5.2 Graves’ Ophthalmopathy
14.6 Approaches to the Sphenopalatine and Maxillary Arteries
14.6.1 Indications
14.6.2 Sphenopalatine Artery (SPA)
14.6.2.1 Surgical Approach
14.6.3 The Maxillary Artery (MA)
14.6.4 Transantral Approach to the Maxillary Artery
15: Rhinoplasty
15.1 Basic Facial Aesthetics
15.1.1 The Tripod Concept
15.1.2 Tip Support Mechanisms
15.1.3 Photography
15.2 Rhinoplasty Approaches
15.2.1 Closed Rhinoplasty
15.2.1.1 Advantages
15.2.1.2 Disadvantage
15.2.1.3 Basic Steps
15.2.2 Open Rhinoplasty
15.2.2.1 Advantages
15.2.2.2 Disadvantages
15.2.2.3 Indications
15.2.2.4 Basic Steps
15.2.3 Common Grafts in Rhinoplasty
15.2.3.1 Sources of Grafts
15.2.3.2 Commonly Used Grafts
16: External Sinonasal Approaches
16.1 Caldwell–Luc Operation (Sublabial Antrostomy)
16.2 External Ethmoidectomy
16.3 Frontal Sinus Trephination
16.4 Howard’s Eyebrow Approach
16.5 Frontal Osteoplastic Flap
16.5.1 Steps
16.5.2 Complications
16.6 Other External Approaches (Fig. 16.2)