Disorder of Nasal Septum and Nasal Polyposis MCQs

Recurrences are more common in Ethmoidal polypi after removal as they are allergic in origin. Antrochoanal (AC) polyp is more common in children and its better seen on posterior rhinoscopy. FESS is the treatment of choice for AC polyp. For recurrent AC polyp (second recurrence), Caldwell Luc’s operation is done. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no – 200, 202

Medial maxillectomy is the treatment of choice for Ringertz tumor (Inverted papilloma of nose). These days endoscopic approach is preferred. Option a – Surgical approach is the treatment of choice for angiofibroma. The type of approach depends on the stage of the tumor. Radiotherapy and chemotherapy singly or in combination have also been used. Medial maxillectomy alone is not useful. Option c – Antrochoanal polyps is removed via FESS. Option d – Treatment of maxillary sinus malignancy depends on the stage of tumor. Treatment is usually surgery combined with radiotherapy and chemotherapy as needed. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no - 236

A. i.e. Iliac lymph nodes om 94. Maximum contribution to the floor of orbit is by: a) Maxillary b) Zygomatic c) Sphenoid d) Palatine Correct Answer - A Ans. A. Maxillary The maxillae are the largest of the facial bones, other than the mandible, and jointly form the whole of the upper jaw. Each bone forms the greater part of the floor and lateral wall of the nasal cavity, and of the floor of the orbit "Orbital surface of maxilla is smooth and triangular, and forms most of the floor of the orbit" Also know: Maxilla is also the most commonly fractured bone of orbital floor. The floor (inferior wall) is formed by the orbital surface of maxilla, the orbital surface of Zygomatic bone and the orbital process of palatine bone The seven bones that articulate to the orbit are

Septal abscess is most commonly caused by Staphylococcus aureus. AETIOLOGY- Secondary infection of septal haematoma – most common cause . Furuncle of the nose or upper lip Typhoid or measles - rare TREATMENT- Immediate incision and drainage Systemic antibiotics COMPLICATONS- Saddle nose Meningitis or cavernous sinus thrombosis – rare but serious Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no – 168, 174

This patient with a history of bronchial asthma (episodes of wheezing resolved by inhaler usage) has presented with a nasal polyp now. Aspirin should be avoided in this patient as he may be intolerant to it. Samter’s triad is classically described as - Nasal polypi ( Ethmoidal) Asthma ( Intrinsic) Aspirin intolerance ( NSAIDs) Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8th Edition, pg. no – 201

Nasal polyp means ethmoidal nasal polyp. Allergy is the main aetiology. So the treatment of choice is topical corticosteroid nasal spray (fluticasone, mometasone). They can be commonly associated with bronchial asthma. Early polypoidal changes with oedematous mucosa may revert to normal with antihistaminics. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra , 8 th Edition, pg. no – 203

This is a case of septal hematoma. Bilateral nasal obstruction is the most common presenting symptom. Treatment- Immediate aspiration or incision and drainage. Followed by bilateral nasal packing to prevent reaccumulation. Systemic antibiotics – to prevent formation of septal abscess. Complications - If not drained, may organize into fibrous tissue leading to a permanently thickened septum. Septal abscess Saddle nose deformity Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, pg. no- 173, 174 Scott Brown's Otolaryngology, Head and Neck Surgery, 8 th edition - Volume 1 - Page - 434

A watery nasal discharge that cannot be sniffed back following head trauma is CSF rhinorrhea. Initial management is conservative – bed rest, antibiotics, elevating the head of the bed, stool softeners, and avoidance of nose blowing, sneezing and straining. If it does not resolve in 7- 10 days, surgical repair is planned. Transnasal endoscopic approach is the preferred modality these days. Most of the leaks from the anterior cranial fossa and sphenoid sinus can be managed endoscopically with a success rate of 90%. Cartilage graft - If bony defect is larger than 2 cm, it is repaired with cartilage (from nasal septum or auricular concha) followed by placement of mucosa. Fascial graft - Fascia can be obtained from thigh. Or fat from thigh or abdomen can be used. Reference – Diseases of Ear, Nose and Throat, 8 th edition, page 193