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By: D. Elber, M.A., M.D., M.P.H.
Vice Chair, Eastern Virginia Medical School
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Anterosuperior part of the nasal cavity (lateral wall and septum) is supplied by anterior ethmoidal nerve, which can be blocked by placing the cotton pledget impregnated in 4% xylocaine high up inside of nasal bones. The greater superfcial petrosal nerve, which carry preganglionic fbers from the parasympathetic nucleus situated in brain stem, joins deep petrosal nerve (postganglionic vasomotor sympathetic fibers) and forms nerve to pterygoid canal (vidian nerve), which reaches to the sphenopalatine ganglion where only parasympathetic fbers relay. Sympathetic: the preganglionic sympathetic nerve fbers come from upper two thoracic segments of spinal cord (origin from hypothalamus) and relay in superior cervical ganglion. The postganglionic fbers form a plexus around internal carotid artery, from which deep petrosal nerve arises that joins the preganglionic parasympathetic fbers of greater petrosal nerve to form the nerve to pterygoid canal (vidian nerve). These postganglionic sympathetic vasomotor fbers reach the nasal cavity without relaying in the sphenopalatine ganglion and cause vasoconstriction of nasal vessels (decongestion of nasal cavity). Lymphatic Drainage Floor: It is situated about 1 cm below the level of foor of 37 fi Submandibular Lymph Nodes: the external nose and anterior nose in adults. The roots of all the molars, second premolar Retropharyngeal Nodes: Posterior part of nasal cavity drains and sometimes frst premolar (depending on the extent into upper jugular nodes and retropharyngeal nodes, which of pneumatization and age of the person), are situated drain to upper jugular nodes. These teeth roots are Perineural Intracranial Spread: the perineural intracranial separated from the sinus mucosa by a thin lamina of spread of cancer is possible through the lymphatics of the bone, which may be dehiscent. The chances of oroantral upper nasal cavity, which communicate with subarachnoid fstulae are high after the extraction of these teeth, the space along the olfactory nerves. They are divided fi Accessory Ostium: In 30% of population, an accessory ostium, into two groups: which may be quite large, is seen behind and in front of the 1. The maxillary sinus does not drain lamella of middle turbinate in the middle meatus, form through accessory ostium and is bypassed by the mucus anterior group of paranasal sinuses. Posterior Group: the sinuses, which open posterior and During endoscopic sinus surgery, accessory maxillary ostium is superior to basal lamella of middle turbinate, form posterior joined with the natural maxillary ostium to prevent recirculation group of paranasal sinuses. The posterior ethmoidal sinuses open in the superior meatus and sphenoid sinuses open in spheFrontal Sinus noethmoidal recess. It lies between the inner and outer tables of the lower Maxillary Sinus (Antrum of Highmore) (Fig. The shape and size of this loculated sinus It is the frst to develop in human fetus. The base faces towards lateral wall of and often obliquely placed, may be defcient in some cases. Posterior wall: It is in relation with the infratemporal and Posterior wall relations are meninges and frontal lobe pterygopalatine fossa. Medial wall: It is thin and membranous at places and fi Ostium of frontal sinus is situated in its foor and opens into faces middle and inferior meatuses.
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Treatment should include an antiviral such as acyclovir, valacyclovir, or famciclovir. Specific glaucoma therapy may be retinitis pigmentosa may mimic uveitis and be mistaken required to prevent optic nerve damage while the inflamfor an inflammatory process. Three forms of these somation resolves and may be necessary long term, called masquerade syndromes are commonly associated depending on the extent of the damage to the aqueous with glaucoma. Permanent, extensive damage occasionally necessitates surgical trabeculectomy, ideally only Schwartz-Matsuo Syndrome (Retinal Detachment) after inflammation is fully controlled. Corticosteroids are the mainstay for treatment of ocuAlthough the majority of patients with a retinal detachlar inflammation. Although triamcimarked pressure elevation occurs in some patients, it nolone hexacetonide (40 mg>mL) is probably the most resolves following successful retinal detachment surgery. Fortunately, Pigment dispersion results from the mechanical rubbing glaucoma is a very rare complication of corticosteroid of lens zonules against the iris, releasing posterior piginjection if the patient has not developed glaucoma on ment throughout the anterior and posterior chambers. Circulating pigment in the tion of action than triamcinolone, whereas dexamethaanterior chamber can be mistaken for leukocytes. The typical patient is older and has evidence of vascular disease in other cated in patients with anterior scleritis. Although the latter formed in the presence of active inflammation, a patent may diminish total, chronic corticosteroid therapy, the iridotomy can be difficult to achieve and maintain, requirpotential for serious, life-threatening side effects dictates ing intense topical corticosteroid therapy and close monthat they be used in conjunction with a physician familiar itoring postoperatively. Implanhumor formation following effective suppression of the tation of a valve, or seton, may be necessary in eyes where inflammation. Because the extent of pressubstituting it with a weaker agent, can reverse a steroid sure lowering from these devices is generally less than response, the ongoing need to treat the inflammation with trabeculectomy, valves should be reserved for eyes may limit this approach. The Side effects of corticosteroids, including steroidsource of protein in the aqueous humor of the norinduced glaucoma and cataracts, can be minimized by mal monkey eye. Invest Ophthalmol Vis Sci 1992; selecting alternative, steroid-sparing strategies in spe33:581. Selection and interpreagents for scleritis, and immunosuppressive therapy for tation of laboratory tests for patients with uveitis. Chest computed tomography and medibarrier, improve patient comfort by relaxing ciliary spasm, astinoscopy in the diagnosis of sarcoidosis-associated and prevent posterior synechiae by encouraging pupillary uveitis. Arch Ophthalmol pupillary mobility, further preventing permanent poste1955;54:179.
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Membraneous Conjunctivitis (Diphtheritic Conjunctivitis) the conjunctival surface is covered by a fibrinous membrane. Other organisms such as gonococcus, pneumococcus, Streptococcus can also produce a membrane specially in sick, malnourished children. It often occurs in weak children after measles, scarlet fever or in cases of impetigo. Symptoms In mild cases there is swelling of the lids along with serous or mucopurulent discharge. On everting the lids, a white membrane is seen covering the palpebral conjunctiva which peels off rapidly without much bleeding in mild cases. In severe cases, the membrane does not peel off easily and underlying surface bleeds. Diagnosis It is confirmed by bacteriological examination and culture of the conjunctival swab. Symblepharon may occur due to adhesions forming in between the palpebral and bulbar conjunctiva. Every case having membrane is treated as diphtherial unless conjunctival and throat swabs and culture are negative. Intensive local and general administration of penicillin or other suitable antibiotic. Prompt injection of antidiphtheritic serum (4-6-10000 units repeated in 12 hours) and topical application. Simple Chronic Conjunctivitis Simple chronic conjunctivitis often occurs as a continuation of acute conjunctivitis. Seborrhoea, chronic intranasal infection and dandruff of scalp are common associated conditions. Bacteriological examination is done and a short course of suitable local antibiotic drops and ointment is given. Angular Conjunctivitis (Diplobacillary Conjunctivitis) the reddening of the conjunctiva is confined exclusively to the intermarginal strip of the bulbar conjunctiva. It is often found in the nasal cavity and nasal discharge in case of angular conjunctivitis. Reddening of the bulbar conjunctiva is seen limited to the intermarginal strip specially at the inner and outer canthi. Zinc sulphate lotion though less effective acts by inhibiting the proteolytic enzymes produced by Morax-Axenfeld bacillus. Follicular Conjunctivitis In this condition, conjunctivitis is associated with the development of follicles. Follicular conjunctivitis the Conjunctiva 81 Signs Multiple follicles are mainly present in the lower fornix.
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Ananthnarayan 7/e, p 209, 210] b) Classification by dancefiled based on carbohy4. True statement about streptococcus faecalis: a) Scarlet fever [Bihar 04] a) Growns in 6. Glanders disease is due to: [Bihar 06] d) Bile insoluble and optochin sensitive a) Burkholderia mallae [Ref. Nasopharyngeal acquistation and colonization vvvvv Spread to lung Blood stream invasion vvvvv vvvvv Pneumonia Slow multiplication Rapid multiplication vvvvv vvvvv Results meningitis Results Fulminant meningococcemia Thus, meningitis is result of blood borne dissemination and not direct invasion. In 2nd and 3rd trim, relative impermeability of cervical mucous prevent ascending infection. After few days a) It is the most common cause of meningitis in chilYogender develops infection due to Group C dren meningococcus. Mass chemoprophylaxis is restricted to closed and medically supervised communities. However cervical specimen are not recommended in prepubertial girls unless necessary.