By Raza Pasha
The bestselling "Pasha" pocket advisor Otolaryngology-Head and Neck surgical procedure: scientific Reference Guide is again in an broadly revised, up to date, and multiplied fourth version.
Spanning the breadth of the full box, this "high-yield" ebook keeps a "by citizens, for citizens" believe, whereas additionally together with professional content material necessary to complete physicians.
scholars, citizens, attendings, and speech/hearing pros will locate the concise, define structure to be important for medical occasions in addition to a final minute cram prior to a seek advice or rounds. The consultant has confirmed crucial for board evaluate and upkeep of certification tests in addition to a brief resource for basic care prone.
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The bestselling "Pasha" pocket advisor Otolaryngology-Head and Neck surgical procedure: medical Reference advisor is again in an broadly revised, up to date, and elevated fourth variation. Spanning the breadth of the total box, this "high-yield" booklet keeps a "by citizens, for citizens" suppose, whereas additionally together with professional content material invaluable to finished physicians.
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Extra resources for Otolaryngology- Head and Neck Surgery: Clinical Reference Guide
Anatomy of the septum including vascular supply. 8 Otolaryngology-Head and Neck Surgery Vascular Anatomy (see Figures 1–1 and 1–2) External Carotid Artery Branches Maxillary Artery (Internal Maxillary Artery) • descending palatine artery ® greater palatine and lesser palatine arteries • sphenopalatine artery ® sphenopalatine foramen (posterior to the middle turbinate) ® medial (nasoseptal) and lateral nasal artery (middle and inferior turbinates) Facial Artery • superior labial artery ® nasal septum and alar branches • lateral nasal artery • angular artery Internal Carotid Artery ® Ophthalmic Artery • anterior ethmoid artery (larger than the posterior ethmoid artery) ® lateral nasal wall and septum • posterior ethmoidal artery ® superior concha and septum • dorsal nasal artery ® external nose Venous System • greater palatine vein ® posterior facial vein (external jugular vein) and cavernous sinus • septal vein drains ® anterior facial vein (internal jugular vein) • sphenopalatine vein ® cavernous sinus and maxillary vein (internal jugular vein) • anterior and posterior ethmoidal veins ® ophthalmic veins (cavernous sinus) • angular vein ® anterior facial vein (internal jugular vein) PHYSIOLOGY OF THE NOSE AND PARANASAL SINUSES Physiology of the Nasal Airway Nasal Cycle and Respiratory Airflow • nasal airflow is regulated through the volume of the venous sinusoids (capacitance vessels) in the nasal erectile tissue (located primarily in the inferior turbinate and to a lesser extent in the anterior septum) Chapter 1 Rhinology and Paranasal Sinuses 9 • the hypothalamus continuously stimulates a sympathetic tone (via the superior cervical sympathetic ganglia) to maintain a level of nasal vasoconstriction • inspired air is warmed to body temperature and is humidified to almost 100% humidity • Nasal Flow = Pressure / Resistance; flow may be laminar (normal) or turbulent (may cause eddied currents that may be perceived as nasal obstruction) • Sneeze Reflex: induced by allergens, ammonia, viral infections, exercise, and other irritants, which stimulate trigeminal afferents; complex efferent input results in a slow inspiratory phase, glottic and velopharyngeal closure (increases subglottic pressure), followed by a sudden glottic opening (sneeze) • Regulation Response Types 1.
Microvillar Cells: neuronal cells of unknown function 3. Supporting Cells: sustenacular cells 4. Basal Cells: allow capability of olfactory fiber regeneration (unlike most other sensory cells) • Olfactory Mechanism: odorant enters olfactory cleft ® odorant dissolves in mucus ® odorant binding proteins (OBP) concentrate the solubilized odorant ® binds to olfactory receptor at the sensory cilia ® stimulates a specific G-protein (cAMP-dependent) cascade for depolarization ® synaptic connections form a complex network Chapter 1 Rhinology and Paranasal Sinuses 11 of secondary neurons (suggesting peripheral processing) before entering the brain (dentate and semilunate gyri) • each odorant receptor cell detects a single type of odorant; there are hundreds of types of receptor cells EVALUATION FOR NASAL OBSTRUCTION History and Physical Exam History • Character of Nasal Obstruction: onset and duration, constant versus intermittent, unilateral (tumors, normal nasal cycle) versus bilateral obstruction, associated mouth breathing, snoring, anosmia/ hyposmia/taste disturbances, tearing (nasolacrimal duct obstruction or allergy) • Contributing Factors: potential toxin and allergen exposure, known drug allergies, medications (see Table 1–1), history of immunodeficiency, asthma, rhinosinusitis, otitis media, allergy, sleep disturbances, facial trauma or surgery • Associated SSx: allergic component (sneezing, itchy and watery eyes, clear rhinorrhea), sinus involvement (facial pain, headaches), acute infection (fevers, malaise, purulent or odorous nasal discharge, pain) • H&N: sore throat, postnasal drip, cough, ear complaints, halitosis, ocular pain, hoarseness • think “KITTENS” for differential diagnosis (see Table 1–2) able 1–1.
2 Paranasal Sinus Anatomy...................................................... 2 Nasal Anatomy.................................................................... 6 Physiology of the Nose and Paranasal Sinuses.............. 8 Physiology of the Nasal Airway............................................. 8 Olfactory Physiology.......................................................... 10 Evaluation for Nasal Obstruction................................ 11 History and Physical Exam.................................................
Otolaryngology- Head and Neck Surgery: Clinical Reference Guide by Raza Pasha