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< >
 � University of Pennsylvania Identification Test
(UPSIT)
''scratch and sniff' booklets, each containing 10 odorants
< >
Cross-Cultural Smell Identification Test
(CC-SIT).
, This test is a variant of the UPSIT. It comprises 12 items

Parkinson disease and Alzheimer disease

 SeptaI perforations most commonly found in the septum
Anterior septum
Most commonly 1 to 2 cm

Septal button
Large perforation (> 2 cm)

< >
 Front of the nose filter upto 3 µm
Nasal mucosa trap 0.5-3.0 µm

< asal septum and turbinates filter particles 10 to 30 µm >

Nasal vibrissae filter particles 20 to 30 µm

, Particles 0.2 to 0.5 µm in diameter tend to remain

, suspended and are exhaled.
 What are the three jnfundibular cells that are anterior ethmoid air cells
• Agger nasi cells (MOST ANT)
• Terminal cell (recessus terminalis)
• Suprainfundibular cell

What structure separates the anterior and posterior ethmoid sinuses

< Ground or basal lamella >
 Nose and the voice
• Nose adds quality by allowing air to

< escape
• Rhinolalaia dausa too little air escapes >
• Rhinolalia aperta too much escapes
< >

Treatment of choice for nasal synechiae-

• Surgical removal of adhesions
• Topical mitomycin
• Nasal stent
 Occipitomental View Nose Chin Position

• Frontal process of maxilla

• Superior orbital fissure
• Inf ratem po ral fossa
• Sphenoid sinus ?

< >
 I Water's View I
Key structures
1 = Frontal sinus
2 = Maxillary sinus
3 = Frontal process of
Zygoma
4 = Body of Zygoma (malar
eminence)

< 5 = Temporal process of

Zygoma >
Dotted line = zygomalico­
frontal suture

Dolan's tines of reference

LineA. B. C

Rule:
smooth, non-disrupted,
same contour on both sides
 Occi pitofrontal Nose -Forehead position

• Frontal process of zygoma

and zygomatic process of
maxilla
• Superior margin of orbit
• Superior orbital fissure
< • Foramen rotundum >

Ell VIE
 ....

• Anterior and posterior

Antrum
extent of sphenoid,frontal
and maxillary sinuses
• Sella turcica
• Ethmoidal sinuses
< • Alveolar process >
• Condyle and neck of
mandible

LVIE
 Submentovertical View

• Sphenoid > posterior

ethmoid >maxillary sinuses

< >

Basal view
 Figure 1. Coronal View Of The Paranasal
Sinuses

< >
·- ..

t Mo.xJllaty GmUS
2. Ethmoidal buDa
3. Eth11l01d.:ll oells
4. Frontll sinus
5. Uncinate Pf'ClCeSS
6. Middle turbnate
7. lnfenor turbinate
8. N-'Sal septum
9. Osteome:ital complex
< 0.bt
C
>
 •• Ethmoid Bulla

o Bulla = hollow,
thin-walled bony
•
prominence Ethmo1d
o Most consistent
.-
_ -, Bulla
and well
< pneumatized >
anterior ethmoid
air cell
o Makes up
posterior boarder
of frontal recess
< >
 Concha Bullosa
•pneumatization of
the bulbous portion
of the middle
< turbinate >
•An enlarged
conch a bul losa may
impede drainage
from the middle
meatus
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TYPEl TYPE II TYPE Ill
 Sometimes the free edge of

the uncinate process

adheres to the orbital floor,

< or inferior aspect of the >

lamina papyracea. This i s

referred to as an atelectatic

uncinate ��"-"--
rocess- - - - -·-- --
 Paradoxic Curvature
Ncw111ally, the convexity of the middle

turbinate bone is directed medially, toward

< the nasal septum.

When paradoxically curved, the convexity
>
of the bone is directed laterally toward the
la11!ral sinus wall.
The inferior edge of the middle turbinate

may assume various shapes, which may

n11,ow and/or obstruct the nasal cavity,

lnfundlbulum, and middle meatus.
 ••
1) Crista Galli , 9

2) Cribiform (lamina
< cribosa)
3) Nasal Septum • >
4) Cribiform (lateral 3

lamella)
7
5) Olfactory Fossa
6) Lamina Papyracea ••

9) Fovea Ethmoidalis
 Keros Classification
..,..,. ...
,
I rr

• Type 1: 1-3mm � ..
Type 2: 4- 7mm MC
< Type 3: 8-16mm m >
IATROGENIC TRAUMA

OLFACTORY FOSSA
HEIGHT OF LATERAL
LAMINA OFCP
< >
 Sphenoethmoid cell
-- o Aka Onodi Cell
0 Posterior ethmoid cell that extends ------
over sphenoid sinus
�

o Close relationship to CN II
< >
 Maxillary sinus Present at birth 4-5months after 15 years
birth
< >
Ethmoid sinus Present at birth 1 year 12 years

Sphenoid sinus Not Present 4 years 15years­

adult age

Frontal Sinus Not Present 6 years Size increases

until teens
 •• Frontal Sinus Cells
• Type S: Single cell
superior to the
agger nasi but not

<
extending into the
frontal sinus
• Type fl: Tier of
two or more cells
IS
above the agger
nasi but below the
orbital roof
• Type Ill: Single
cell extending from
the agger nasi into
the frontal sinus
• Type IV: Isolated
cell within the
frontal sinus
 4
F
SOE

AN

< >
M M

recess. M, maxillary sinus; F, frontal sinus; AN, agger

nasi cell; 1-4, type 1-4 frontal cells; SOE, supraorbital
ethmoid cell; I, frontal intersinus septal cell.
 ••
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8) Pre Sellar 11 °/o
C) Conchal 3°/o
 •
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I
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< >
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 Most common location for the maxillary ostium within the infundibulum
Inferior third (Gs,�)

< What arterial structure typically runs through the roof of the ethmoid >
bulla
An' terior ethmoid artery
 When removing the intersinus septum within a
sp·henoid sinus, attachment of this septation to what
critical structure must be considered:
< Internal carotid artery >

The carotid artery is reported to be dehiscent in the

sphenoid sinus in what percent of patients
15%
 STANKIEWICK'S SIGN - indicate orbital iajury during
< FESS. at protrudes into nasal cavi on compression o >
eye ball om ouside
 ...
COTTLE MANEUVER

< >

1) )

l l)m,
1 wutr111.,u:.. the ffll.->di:bed Cotllc IU\.31 � manC\1,-n ((u) • ottJm!, \r. ) = mtam! ,1tl,r) ht rontl I
altrl on!� 10 Jtmanstmr" t-:l lO be ;,potttd tam .
 Normal Sinuses

< >
Acute Maxillary
Sinusitis
 What pathogens are most commonly involved in ABRS?
• Streptococcus pneumoniae {30%)
• Haemophilus influenzae (20 to 30%)
• Moraxella catarrhalis (10 to 20%)
< >
Two most common pathogens associated with viral rhinosinusitis
Rhinovirus and Influenza virus

Nonallergic rhinitis of eosinophilia syndrome (NARES)

 X ray-Water's view & caldwell view

< >
Ct- gold standard. Coronal & axial sections

MRI is predominantly used for pre and p ost operative

management of naso sinus malignancy

The chief disadvantage of MRI is its inability to show the bony

< >
 ALLERGIC FUNGAL SINUSITIS
Bent and Kuhn Diagno�ic Criteria

Major Minor
Type I hypersensitivity Asthma
Nasal polypos,s
< Charactenstic CT findings
Unilateral disease
Bone erosion >
Eosinophllic mucin without invasion Fungal cultures
Positive fungal stain Charcot-Leyden crystals
Serum eosinophilia
CT • Mucosal thickening w•th hyperdense areas
- Bone eros on
- Expansion of s nus bu no fungal invasion nto
mucosa.
< >
lntraorb1tal
foramen

Air embolism
--
_I
I
I
Area available
for antrostomy

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buttress I
. . .. .• : • . .
•

••

The Caldwell-Luc Operation ..,,

< >

MUCOCELE
 Primary:Chancre of Vestibule..Rare
Secondaty:CrustJFissu1·e .. Rare
< Tertiary: Most commom
Gumma-----Saddlc Nose >
ANTERIOR PART OF �OSE
TB L PUS LEPROSY
 •

< >

...
< >
 Nasal involvement staging
I. Catarrhal Stage: foul smelling purulent
nasal discharge (carpenter's glue)
< 2. Adhesions & stenosis coarse & distorted >
external nose (Tapir nose)
3. Non-ulcerative, painless nodules which
widen lower nose (Hebra nose)
 Nasopharyngoscopy
• Obliteration of nasopharynx due to
adhesions between deformed V-shaped
< soft palate & posterior pharyngeal wall >
(Gothic sign)
 RHINOSPORODIOSIS

< >

...
< >

MAGGOTS/NASAL MYIASIS
 ONE LINERS
CHRYSOMIA
200 EGGS WITHIN 24 HRS
< ON /4 DAY THEY CRAWL OUT
3 >
CHLOROFOR M WATER
 Anterior Rhino-scopy Nasal Endoscopy

< >
Et
pol
< >
 TREATMENT OF EPISTAXIS

< •
>
< >

-
 Tespal: (Trans nasal endoscopic sphenopalatine artery ligation)

location of �e sp�eno�alatine a rte� for en�o)topic ligation.

Po.sterior to t�e inferior attac�ment of t�e mi��le turninate, su�mucosa1 on
t�e lateral nasal si�ewall
< >
&ternal liiation of t�e anterior et�moi� arteij
l�nc� incision
A�proximate� 24 mm posterior to t�e anterior lacrimal crest
 Osler-Weber-Rendu disease
Recurrent epistaxis
Bevacizumab targets a cancer cell protein called vasc:Ular endothelial growth
factor (VEGF)
Surgic I man t1ement:
< • Po ssium·tit nyt.phosphate ( PJ I ser bl tion of I s·ons >
• Injection of b cizumab
• Septodermoplasty
• You s proc dur
Saunder's septodermoplasty.
Denuding of nasal mucosa affected by telangiectasias and coverage of
denuded area with a split-thickness skin grafts
< Walsham Forceps
>

Ash forceps
< >
I
< >

fl(J, 26,2 � ft L.- $1lo\Yof'9! (A)�'I typo.>,

B)CJt,t,1.,��.

Zygoma #TRIPOD
< >
 CSF R�INORR�OEA

< >

...
< >

PAPILLOM MM/CAPILLARY M
� _ .m=::i AM
< >
< Orb!
>
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•

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40.5 Lodonnan'1 clossrtication

< >

HEMOSTASIS UPTO 1.5 MM

< >
 �EAD MIRROR
• CONCAVE MIRROR
• FOCAL LENGTH
25 CMS
< •DIAMETER 89 MM >
•HOLED 19 MM
< >

LARYr GEAL SPACES

 173 Ht
75dB

• I
>

�.., ..., ..
•
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- �C-
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 LARYNX REVIEW: SYNOVIAL JOINTS
THYROID and CRICOID ARYTENOID and CRICOID

.....
SLIDING
< >
,
SYNOVIAL
JOINT
ROTATION BETWEEN
,� ARYTENOID
AND
CRICOID
�HINGE
TILT
JOINT
< >

LARVNGOf#NACI;(
 Grade 1 Grad 2
Stenos 0-50% Stenosls 51-70
< >

Grade 3 Grade 4
S enosis 71-99 Stenosis 100%
Cotton-1\I,Ter classification
 •
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 Which of the following is incorrect statement regarding
Laryngeal histoplasmosis:
a.Commonly seen in eastern india.
b.Laryngeal involvement occurs in chronic disseminated form
of histoplasmosis.
c.Microlarngeal excision is the treatment of choice.
< d.Leishmaniasis is the closest differential diagnosis >
 - .. . . . .

Acute epiglottitis: swan neck

< >
< >
< >
< >
< >

1oma
< >
 CHONDROMA

< Chondromo of Laryngeal cartilage is a rare. benign

neoplasm >
PoS!'erior lamina of the cricoid cartilage > Thyroid >
Arytenoid > Epiglottis
 HPL
PFT MANDATORY
BOTHVOCALCORDSNORMAL
< >
Indications:
 . TI glottic cartt1oau a bo"e-slt e lesion) wbere more
a
m,
thaa 011;:;.-third of the coatrabteral cord is oll'ed
2. Sapndottic cancer with spread to tbe anterior
b commassare
J. fiJTOid cartilage us, ol, emear but 1titboat m,-asioa of

< >
the outer pe.richoadrium

co�tRAINDICATIO Ts
The inttra.I)te_.01d region. the postcnco1d region.
the bilateral pyriform sinuses should be free of
disease.

Supracricoid Partial Laryngectomy

 • • • Vertical Partial Laryngectomy:

Removal of:
< o One vocal fold - from anterior commissure to vocal process
>
o ½ of opposite vocal fold may also be removed if involved

o lpsilateral false vocal cord

o Ventricle

o Paraglottic space (and overlying thyroid cartilage)

 Vertical Partial Laryngectomy:
Contraindications
< o Large T3 or any T4 lesion
>
o lntrarytenoid or cricoa,ytenoid joint involvement

o Bilateral arytenoid cartilage involvement or bilaterally diminished

vocal cord mobility

o Thyroid cartilage penetration

 Ad,·anced la.t)11gopharyngeal
cancers ,,·here the cord is fixed
•
• • Contraindications
•
•
'• Presence of tdematou:s tissue in

< >
•
•' he inter ry1enoid region or the
' l-,,,,-'"\' o tcricoid region
•'
'
11

1IBAR
..I -· r•
-I- ....,
I
I. •
....
TOTAL
I- �- I.
L..�YNGECTO� I\:�
.. 'I

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,..
I

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 Neoadjuvant chemotherapy

- 2 cycles ofCisplatin(80-12omg/rm) + 5- FU(10-

< 1smg/m2) given within 3 weeks interval >
- Only those ,vith > 50% tumour regression will receive
radiation therapy
< >

ELECTRO LARYNX
< >
 Study the given image and
choose most ina.ppropriate
statement:
a.Usually caused by vocal abuse
b.There is collection of oedema
fluid in the subepithelial space
c.There is asymmetrical swelling
< of vocal cords >
d.Vocal cord stripping is the
treatment

ke's eel
-- ..---...
�
-
...
< >

Montgomery i:tube
Bronchial Stenosis ...
 l=indings of
Laungopharyngeal Reflux
I. Subglottic Edema (Pseudosulcus Vocalis) IV. Vocal Fold Edenia

II. Ventricular Obllieration V. Postsrior Cormnissure

Hypertrophy (PCH)
< >

Transnasal endoscopic
Internal maxillary artery
 Nasopharyngeal Cancer

< >
 •

< >
< >
I

What is Moure's sign?

Hold the larynx between index
and thumbfingers of your right
hand and move it from side to
side over the vertebral column

Normally you feel click

In postcricoid carcinoma there is
absence of click

< -- >

ABSE T
ALIG A CY
ABSCESS ....
< >

Tangier Disease
 Tonsillectomy
• Dissection and snare method
• Electrocautery Heat of electrocautery (400 ° __.)
Radiofrequency ablation
Coblation tonsillectomy
Use plasma by combines radi·ofrequency energy and
saline to create a plasma field
< >
• Harmonic Scapel
Ultrasonic energy to vibrate its blade at 55 kHz
• iThermal Welding
rTissue Weld/Painless/ 2-3 °C than body temp.
• Carbon dioxide laser
• Microdebrider
 SUBMU·COUS FIBROSIS
Age� 20 40 years Sex� I=> M
'!'!!!"!!'!'

Is P MAl1IGN T
Steroids
< >