Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, everyone. Thank you for joining us today. My name is Rashik and I'm the chairperson at. So this uh this week we are focusing on Ent and we're very excited to have you all here with us today. Today, I am joined by sa who will guide you through. Ent X is a third year from the University of D to make the session as engaging as possible. We'll be releasing the bulls throughout the session. These are completely anonymous. So we encourage you to participate actively. If you have any questions during the session, please pop them in the chat and we'll do our best to address them at the end of the session. We'll share a feedback form. If you complete this, you will receive a certificate of attendance and exclusive discount codes to teaching surgery and pass the MRC S. Additionally, this session is being recorded, the recording and the slides will be shared on a meal page a couple of hours after the session. So be sure to keep an eye out for that. We're also excited to share that we have an exclusive question bank and other resources on our learning, which is hosted on our website. So be sure to check that out after this session. If you create a free membership account with us, you'll automatically receive a discount code for 10% off the ki medics and lottery flashcards, surgery flashcards, and knowledge control. We also have an exciting opportunity for all our attendees. Two lucky people will win free access to the Kiki medics surgical flashcards and the GKI medics ay station to simply to enter, simply complete the Google form at the end of the session and enter the unique code that we will provide the more sessions you attend, the higher your chances of winning. So be sure to stay for this session until the end and attend as many of our other sessions as well. Finally, before we begin, we would like to thank our partners, the Royal College of Surgeon England, Kiki Medics, the MDU more than skin deep metal T three surgery and P the MRC S without further ado, I'll now hand you over to save you. Hi guys. Um So we'll be talking about epistaxis and the retropharyngeal spaces today. Um So it's quite a short topic, hopefully, relatively straightforward. Um So we'll go through it, hopefully you'll learn a few things and we'll have a, a pull at the end so you guys can uh answer some, some high yield questions. So again, just uh our, our partners here on the screen um and learning objectives as well. Um I'm not gonna go through them. But if you want to go back in your own time, um when we have the recording up, you're welcome to do so. So we'll start with some anatomy. So we have our skull anatomy here. So it's quite important to understand anatomy in order to um understand physiology, um especially in something like ent. Um So first we've got the roof, which is made of your ethmoid bone, specifically your cribiform plate. So remember your cribiform plate is where your olfactory nerve can go through. Um It's also the frontal and the sphenoid on your floor. You've got your maxilla specifically the palatine process and you're thinking like the front of your, the roof of your mouth, uh and your palatine bone. Ok. So that's more at the back. Then your medial wall is that's made of, that's your nasal septum that's made of your um perpendicular plate of the ethmoid. Um And it's also made of your var and your septal cartilage here in the middle. So your vulva below and septal cartilage here. Ok. Then you've got your lateral wall, which is made of your maxilla, uh your palan your ethmoid. It's also got your concha in there, which we'll discuss a little bit later. Um And then of course, your lact more bone and your feeling. Um So, yeah, all the bones of the skull having a good idea of that is the most important. Um And then trying to understand what makes up each wall and each floor. OK. We'll move on from there. Next is your innovation. So, um main things to know is you've got your sensory. So we're thinking you're, you're, you're trigeminal. So you tried to your V 123, ophthalmic maxi maxillary and mandibular. So your ophthalmic V one, that's your anterior ethmoidal nerve. OK. And then you've got your maxillary V two, which is your nasal palatine and greater palatine nerves. Ok. So here's your anterior ethmoidal nerve running here in this image. Then you've got your autonomic. So that's your parasympathetics first. So you've got secretory motor to your mucosal glands in your nose and that's real the pter er pteropine ganglion. Um So there's your parasynthetic in the green there. And then your sympathetic is uh for vasoconstriction and that's via your superior cervical ganglia. OK. So I'll move on to the next slide. Um Also understanding especially um your, your trigeminal um innovation for exams when it's always a, a top question I love to ask in anatomy. Next is your arterial and venous supply. So main thing for this that you need to know is Kalba Plexus, which is also known as little area, little's area. So this is just kind of rich anastomosis of the nasal septum. And is that the anterior nasal septum? Ok. And this is really important cos this is the major site for epistaxis. So we'll talk about that in a little bit. So you've got contributions from several different arteries. You've got sphenopalatine artery, which is a branch of your maxillary artery, great patine artery. Again, maxillary anterior ethmoidal artery, which is a branch from your ophthalmic artery, posterior ethmoidal artery. Again, ophthalmic and finally your superior labial artery, which is about your facial artery, lots of arteries supplying here. Um and all anastomosis here in Koba plexus. Uh then you have woodruff's plexus. I don't have it on this image, but we'll have it a bit later. It's right here at the back in your posterior area. And that's associated with posterior pi flexus, which is about 10% of epistle. And you've got your venous drainage that's via your pterygoid venous plexus, um your facial nerve and your cavernous sinus. So it's thinking your cavernous sinus, you're thinking about um about your brain. OK. I'm not sure how many of you done here already if all of you had already. Um But that is for your drainage. So we'll talk about that later cos that is involving some pathology. Um Again, here I mentioned here creating a potential root for infections, infection spread. So, yes, your cavernous sinus thrombosis, um usually the aseptic spread is from um a lot of pathology involved in. No. So we'll talk about sinusitis and things like that. OK. So next is our division. So it's pretty simple. You've got your olfactory region at the top as you'd expect. Um That's your factory epithelium, um your respiratory region I say for air conditioning and by that, I mean, warming air. Uh and then finally, your vial that's at the very tip of your nose. And that's the hair for like filtration is quite important. Um In terms of some other anatomy, again, this is a side view showing your Ethmoid bone salat Tonier is another big one. For your where your pituitary go sits. Another thing I love to asthma anatomy, your sphenoid sinus here, sitting behind your eyes, your frontal sinus, sitting on top. We'll go through these a little bit later again. Uh And then again, highlighting different bones. So we go the palatine bone uh like the back roof of your mouth and your palatine process, which is at the front, it made up two bones, this this roof of your mouth or floor of your, of your um of your nose. Ok. So, nasal cancer. So there also turbinates and then meatus are the things in between. Ok. So turbinates slash concha, if I'm saying that right? Um Are these fits here, these these kind of bumps inside and then in between them, the ridges, they're called your meatus? OK. So one of the main functions of this um is mainly just increasing surface area. It's pretty simple. Um And it's for warming and humidification. Remember we talked about our, our respiratory division. Um So obviously that is right here. Uh just humidification as it passes into the lungs. Quite simple. Again, knowing some of your note art anatomy here. Um, you know, hard pet, soft pet uvea tonsils. Ok. So, in terms of functions, again, respiration warms, humidifies, filters, olfaction. I think it's pretty simple. Um You've got your olfactory recept receptor for, for smell um in the superior part of your nasal cavity. And then of course, you've got your defense, which is your mucociliary clearance for immune function and voice resonance as well, contributes to, to fulmination to some extent as well. And now we're gonna talk about epistaxis. So, um I think quite a nice picture. It, here we go. It just shows our, our woodruff's plexus. I didn't show on the, the previous picture. Um And we'll go through a about some of these things, we'll talk about the rapid Rhino. So to start pathology and risk factors. So it's to do with rupture of your nasal blood vessels typically in a very richly vascular nasal septum. So again, we're thinking about our Kzla Plexus. So risk factors, anticoagulants, as you'd expect coagulopathies. We're thinking like hemophilias or from Willebrand's disease. Uh trauma, big bang to your nose can easily start causing this. I'm sure if someone's had it before dry air can cause it hypertension, cocaine use is another key exam. One that they love to, to throw in nasal infections, nasal septic perforations, picking again a big one insertion of foreign bodies. You're thinking for pediatrics, juvenile angiofibroma, which is a, it's like a benign tumor that can occur inside your nose and hereditary hemorrhagic tang ectasia, which is this abnormal blood vessel formation. Uh and nose bleeding is actually one of the, the key giveaways that someone has this. It's one of the first signs people notice pathology. Again, I mentioned 90% of epistaxis is involved in your anterior er, in your Kzla plexus. Um usually self limiting as, and it goes around its own. Er, and then you've got your posterior which, um, it's a lot less common, can be more severe and usually you have to, to have some sort of intervention for this. You can't just pinch your nose and hope it goes away. Uh, next we have our management. Um, so time management, quite simple, pinching your nose, the soft air of your nose firmly for 20 minutes. Um, it says keep pa neutral position, you can lean forward. One thing you don't wanna do is lean backwards though, uh, breathe through your mouth.