ENT 2-Mark Notes (Based on Dhingra)
High Priority Topics
Osteomeatal Complex:
- Functional unit for drainage of frontal, maxillary & anterior ethmoid sinuses.
- Located in middle meatus.
- Composed of uncinate process, bulla ethmoidalis, hiatus semilunaris.
- Common site of blockage in sinusitis.
- Visualized via CT PNS coronal section.
Lateral Wall of Nose & Nasal Septum (Diagram):
- Label turbinates and meatuses (inferior, middle, superior).
- Show osteomeatal complex and nasolacrimal duct opening.
- Septum: quadrilateral cartilage, perpendicular plate of ethmoid, vomer.
- Include crests of maxilla & palatine.
- Important for surgical orientation.
Paranasal Sinuses (Formation, Blood & Nerve Supply):
- Maxillary: 3rd month IU; Frontal: 5-7 years; Sphenoid: 3 years; Ethmoid: at birth.
- Blood: Maxillary artery (sphenopalatine), ophthalmic (ethmoidal branches).
- Nerve: Trigeminal (V1 - ethmoid, frontal; V2 - maxillary).
- Venous drainage to facial and pterygoid plexus.
- Drainage important for sinus infections.
Mucociliary Clearance:
- Defense mechanism of respiratory epithelium.
- Cilia beat towards sinus ostia.
- Mucus traps pathogens and dust.
- Impaired in smokers, sinusitis, Kartagener's.
- Maintained by hydration and ciliary function.
Agger Nasi:
- Most anterior ethmoid air cell.
ENT 2-Mark Notes (Based on Dhingra)
- Located anterior to bulla ethmoidalis.
- Landmark for frontal sinus drainage.
- Can obstruct frontal recess if enlarged.
- Seen in CT and endoscopy.
Rhinolith:
- Calcified mass around foreign body.
- Foul-smelling unilateral nasal discharge.
- Common in children.
- Can cause obstruction and bleeding.
- Removed endoscopically.
Little's Area (Kiesselbach's Plexus):
- Located in anterior nasal septum.
- Rich arterial anastomosis.
- Vessels: anterior ethmoidal, septal labial, greater palatine.
- Most common site of epistaxis.
- Managed by cautery or packing.
Woodruff's Plexus:
- Venous plexus in posterior inferior meatus.
- Common site for posterior epistaxis.
- Seen in elderly, hypertensives.
- Bleeds profusely, difficult to control.
- Managed with posterior nasal packing.
Vestibulitis:
- Infection of nasal vestibule (Staph aureus).
- Pain, swelling, redness, crusting.
- Caused by trauma/nose picking.
- Risk of cavernous sinus thrombosis.
- Treat with antibiotics and ointments.
ENT 2-Mark Notes (Based on Dhingra)
Deformities of External Nose:
- Hump, saddle, crooked nose deformities.
- Causes: trauma, congenital, infection.
- May cause obstruction.
- Requires cosmetic and functional correction.
- Surgery: septorhinoplasty.
Structures Seen in Posterior Rhinoscopy:
- Posterior choanae.
- Eustachian tube openings.
- Posterior ends of turbinates.
- Nasopharynx.
- Upper part of soft palate.
2nd Priority Topics
Nasal Cycle:
- Physiological congestion-decongestion cycle.
- Alternates every 4-6 hours.
- Controlled by autonomic nervous system.
- Maintains mucosal hydration.
- Exaggerated in nasal obstruction.
Epithelia of Nose:
- Vestibule: stratified squamous epithelium.
- Respiratory part: pseudostratified ciliated columnar.
- Olfactory area: neuroepithelium.
- Goblet cells produce mucus.
- Supports mucociliary clearance.
Bulla Ethmoidalis:
- Largest anterior ethmoid air cell.
ENT 2-Mark Notes (Based on Dhingra)
- Located posterior to uncinate process.
- Drains into middle meatus.
- Part of osteomeatal complex.
- Visualized during endoscopy.
Fungal Infections of Nose:
- Types: allergic, mycetoma, invasive.
- Common agents: Aspergillus, Mucor.
- Seen in diabetics/immunocompromised.
- Symptoms: crusting, discharge, proptosis.
- Treatment: antifungals, surgery.
Choanal Atresia:
- Congenital blockage of posterior choana.
- Bilateral causes neonatal cyanosis.
- Unilateral presents later with obstruction.
- Diagnosed with CT or catheter test.
- Managed by endoscopic surgery.
Blowout Fracture of Orbit:
- Fracture of orbital floor (maxilla).
- Diplopia, infraorbital numbness.
- Entrapment of inferior rectus muscle.
- CT scan for diagnosis.
- Surgical repair needed.
Tripod Fracture:
- Fracture at zygomatic arch, maxillary, and frontal processes.
- Caused by blunt trauma to cheek.
- Flattened face, diplopia, trismus.
- CT scan shows fracture lines.
- Surgical fixation required.
ENT 2-Mark Notes (Based on Dhingra)
Nasal Myiasis:
- Infestation by fly larvae (maggots).
- Seen in poor hygiene and debilitated.
- Foul smell, crusting, tissue necrosis.
- Treated by turpentine oil and removal.
- Antibiotics and debridement needed.
Foreign Body Nose:
- Common in children.
- Unilateral nasal discharge, foul smell.
- May lead to rhinolith if retained.
- Diagnosed on anterior rhinoscopy.
- Removed under endoscopic vision.
3rd Priority Topics
Coryza (Common Cold):
- Acute viral rhinitis, self-limiting.
- Rhinoviruses are most common.
- Sneezing, congestion, watery discharge.
- Low or no fever.
- Treat symptomatically.
Rhinitis Sicca:
- Dryness and crusting of nasal mucosa.
- Common in hot dry climate.
- Caused by sprays, atrophic rhinitis.
- Leads to bleeding, obstruction.
- Treated with humidification and ointments.
Proptosis - Causes:
- ENT causes: tumors, mucormycosis.
ENT 2-Mark Notes (Based on Dhingra)
- Orbital: cellulitis, thyroid eye disease.
- Trauma: retro-orbital hemorrhage.
- Eye pushed forward visibly.
- CT/MRI to evaluate cause.
Furuncle:
- Staph infection of vestibular hair follicle.
- Pain, swelling, erythema.
- Avoid squeezing (can spread to brain).
- May form abscess.
- Treated with antibiotics and warm compress.
Rhinitis Medicamentosa:
- Rebound congestion from decongestant overuse.
- Chronic nasal obstruction.
- Caused by xylometazoline, oxymetazoline.
- Leads to mucosal damage.
- Stopped abruptly and treated with steroids.
Mucormycosis:
- Invasive fungal infection in diabetics.
- Black crusts, proptosis, facial swelling.
- Rapid progression, high mortality.
- Diagnosed by KOH, biopsy.
- Amphotericin B + debridement.
Olfactory Pathway:
- Starts in olfactory epithelium.
- Passes through cribriform plate.
- Synapses in olfactory bulb.
- Olfactory tract -> cortex (temporal lobe).
- No thalamic relay involved.
ENT 2-Mark Notes (Based on Dhingra)
Rhinitis Caseosa:
- Chronic rhinitis with cheesy discharge.
- Foul smell, crusting, yellowish material.
- Seen in elderly.
- Diagnosis is clinical.
- Treatment: cleaning, antibiotics.
Syphilis Lesions of Nose:
- Congenital: saddle nose.
- Acquired: gummatous ulceration.
- Septal destruction, nasal deformity.
- Diagnosed via serology.
- Treatment: penicillin.
X-ray Water's View:
- Occipitomental view.
- Best for maxillary sinus.
- Also shows frontal and ethmoids.
- Detects sinusitis, fractures.
- Patient faces film with mouth open.
Pterygopalatine Fossa:
- Fossa behind maxillary sinus.
- Contains maxillary nerve, ganglion.
- Connects to orbit, palate, nasal cavity.
- Tumor spread pathway.
- Accessed in endoscopic surgery.
