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91 Cards in this Set
- Front
- Back
Nasal septum is made of what four bones?
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ethmoid, vomer, maxilla, palatine
and cartilage |
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T/F: The septum helps give the exterior nose its shape.
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False. We can remove most of it and have no effect on external shape.
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Turbinates are located on ____ wall.
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lateral
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The nasal lacrimal duct drains underneat the ____ turbinate.
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inferior
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The ethmoid, maxillary, and frontal sinuses drain underneath the _____ turbinate.
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middle
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Orbit is in close proximity to ____sinuses.
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ethmoid
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Four fxns of paranasal sinuses.
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humidifying and warming air
lightening skull absorbing shock generate mucous |
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ICA leads to _____ artery which leads to ___ and ____ ___ arteries.
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ophthalmic, anterior, posterior, ethmoid
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ECA leads to ____ artery and ____ artery.
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facial, sphenopalatine
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Innervation of nasal cavity is predominately ___ with some ____.
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V2-maxillary nerve, V1-opthalmic nerve
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Viral rhinitis is characterized by ?
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inflammation of mucous membranes of the nose
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Symptoms of viral rhinitis.
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runny nose, congestion, post nasal drip, cough, low grade fever
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Diagnosis of viral rhinitis is usually done w/ ?
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history
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Inflammation and swelling in nose can lead to other problems like?
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blockage of Eustachian tubes or sinuses that can lead to otitis media or sinusitis
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Treatment of viral rhinitis:
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keep swelling and inflammation down to avoid secondary infections like otitis media or sinusitis
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Criteria for diagnosis of sinusitis
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2 major symptoms or 1 major and 2 minor
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Major symptoms of sinusitis
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facial pain or pressure
congestion nasal obstruciton purulent post nasal drip altered smell fever (acute) |
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Minor symptoms of sinusitis
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headache
fever halitosis fatigue dental pain cough ear pain or pressure |
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Acute sinusitis is typically less than ____ and generally follows a ______.
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4 weeks
upper-respiratory infection |
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Typically w/ sinusitis you'll be sick for ____ days then you'll get ____.
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3-5
worse |
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____ coming out of a sinus or in the nose is diagnostic for sinusitis.
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Pus
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Chronic Rhinosinusitis - duration of greater than or equal to ___ .
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12 weeks
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With chronic infection, the tissue in the nose _____.
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undergoes changes
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Distinguishing feature of chronic sinusitis.
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Tissue in nose undergoes changes
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What is often used to diagnose chronic sinusitis
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CT to see mucosa changes
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Typical bugs w/ acute rhinosinusitis and otitis media?
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Pneumococcus, Moraxella, Haemophilus
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Typical bugs w/ chronic Rhinosinusitis
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Staph, pseudomonas
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Management of Sinusitis.
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eliminate infection and restore ventilation
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Recurrent episodes of sinusitis, give?
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nasal steroids to get inflammation down (Nasonex or Flonase)
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NATURAL draining pathways are opened up so that sinuses can drain
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Functional Endoscopic Sinus Surgery
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What are some complications that you would operate on acute sinusitis?
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ethmoid sinusitis where infection spreads to globe
epidural abscesses intracranial sinusitis |
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When do you operate on chronic sinusitis?
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when it is refractory to treatment
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___ is often helpful in patients w/ recurring infections but don't necessarily have changes seen w/ chronic sinusitis. This is called?
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Surgery
Recurrent Acute Rhinosinusitis (RARS) |
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In surgery for RARS the ___ is taken down, and behind it is the opening for the ostium of the maxillary sinus
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uncinate process
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Get CT scan w/ patient wearing a headset and instruments can be tracked INTRAOPERATIVELY.
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Computerized Assisted Surgery (CAS)
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CAS is helpful when?
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when there is a lot of bleeding
anatomy is funky Helpful for avoiding ethmoids and intracranial cavity. |
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Nose bleeds
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epistaxis
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What does the large amount of vascularization in the nose help with?
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humidification of air
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Vasculature of nose is ___ protected.
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poorly
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Vasculature in nose lack ___ therefore they are direct _____. Why is this important in epistaxis?
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capillaries
aterial-venous anastomoses Not typical regulatory mechanism. |
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Majority of bleeds in nose occur in ?
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Kiesselbach's plexus
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Anterior vasculature of nasal cavity on septum. Confluence of ____ and ___ arteries
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Kiesselbach's plexus
ethmoid and facial |
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Posterior vasculature of nasal cavity on septum. Where ___ and ____ arteries are located.
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Woodruff's plexus
sphenopalatine and posterior nasal |
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Bleeds of Woodruff's plexus are usually _____ and seen in ____ patients.
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more serious
older |
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Local factors that lead to epistaxis.
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infections
trauma digital trauma (stop picking Salar) iatrogenic foreign bodies cocaine (uhhhh um...Safa?) |
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Systemic factors that can lead to epistaxis.
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Severe infections
sepsis total body inflammatory responses coagulopathies (von Willebrand) |
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Non surgical treatments of epistaxis.
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control BP
correction of coagulopathy pressure/expulsion of clot topical decongestant/vasoconstrictors cauterize w/ silver nitrate nasal packing greater palatine foramen block |
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Non surgical preventative measures for epistaxis.
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keep things moist (saline, ointment)
avoid trauma avoid straining humidity/emolients |
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Used when bleeding is more severe. Sits in the choana o nasal pharynx. Supposed to block ____ artery.
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Posterior nasal pack
sphenopalatine |
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Indications for surgery/embolization
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continuous bleed despite packing and treatments
Hct<38% |
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Radiologist IDs bleeds w/ contrast and then puts material in to thrombose those vessels.
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Selective Angiography/Embolization
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Selective Angiography/Embolization can only be done for ___ and its branches.
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ECA
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Why is thrombosing ethmoidal arteries dangerous?
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have to go through ophthalmic artery which could cause blindness
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Main problem w/ cancers in nose is? Why?
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delay in diagnosis
Symptoms are not specific |
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Benign Nasal Neoplasms
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Nasal Polyps
Nasal Papillomas |
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Malignant Nasal Neoplasms
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SqCC and salivary gland tumors
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Nasal polyps are caused by ___ of the nose.
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chronic inflammation
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Nasal polyps seen w/ ?
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asthma, allergic rhinitis, CF
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Treatment for nasal polyp?
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systemic of topical steroids then surgery
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Nasal polyps are ___ and arise from ____.
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semitransparent
nasal mucosa |
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____ papillomas refer to those that arise from nasal mucosa.
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Schneiderian
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Two most common papillomas
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fungiform and inverted
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____ papillomas have a 10% chance of progression to malignancy.
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Inverted
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Inverted papillomas are _____.
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removed
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Fungiform papillomas are usually found on ?
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nasal septum
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Inverted papillomas are usually found ?
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lateral wall
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Cylindrical papillomas are found?
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on the lateral wall and the septum
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Inverted papillomas are locally ____
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destructive
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Benign slow growing tumors typically seen in frontal sinuses
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osteomas
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Problems seen w/ osteomas?
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obstruct sinus drainage, producing mucoceles
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Seen in juvenile males, benign but aggressive, originates in post. lateral nasal wall
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Juvenile Nasopharyngeal Angiofibroma
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JNA are usually based off ___ artery.
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sphenopalatine
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Surgery to remove JNA tumors are often ____ pre-op.
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embolized to prevent blood loss
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Malignant lesions are typically seen in?
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older males w/ exposures
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Malignant lesions are associated w/ ____ and ____ use.
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tobacco
alcohol |
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Most malignant lesions are seen in ____.
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maxillary sinus
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Malignant lesions present w/
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pain
trismus - difficulty opening mouth obstruction bleeding runny nose ocular findings - epiphora (exc. tearing), proctosis (bulging eye) facial signs-facial or trigeminal nerve affected |
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Most common carcinoma in sinuses
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SqCC
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Second most common carcinoma in sinuses
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Adenocarcinoma
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Adenocarcinoma has strong association w/?
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occupation (wood workers)
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Common manifestation of Adenoid Cystic Carcinoma
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perineural spread along V2 to skull base
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Melanoma occurs along ____
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septum (bad when it involves mucous membranes)
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Most common malignant sinus tumor in children
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rhabdomyosarcoma
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See rhabdomyosarcoma in ___ ___ and ___
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sinuses, neck, and orbit
SON of a gun, i've got rhabdomyosarcoma |
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Most common metastatic carcinoma to metastasize to sinuses.
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Renal cell carcinoma
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Prognosis for metastatic carcinoma in sinuses.
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bad, palliative treatment
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Unresectable tumors
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it gets to frontal love and involves cavernous sinus
involves optic nerve involves prevetrebral fascia |
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Closure can produce almost no scarring b/c scars are hidden in natural creases of the face.
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lateral rhinotomy
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Go in underneath lip and get into nasal cavity
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midfacial degloving
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Bicoronal incision gives good access to frontal and ethmoid sinuses and the orbits.
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Craniofacial approach
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Most lesions in nose and sinuses present in ____ stages.
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advanced
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