Anatomy and physiology of the nose

ANATOMY ANDANATOMY AND
PHYSIOLOGY OF THEPHYSIOLOGY OF THE
NOSENOSE..
DISEASES OF THE NOSE.DISEASES OF THE NOSE.

NoseNose
 The nose is an important organ.The nose is an important organ.
 The nose performs a number ofThe nose performs a number of
functions: it subserves the sense of smell,functions: it subserves the sense of smell,
prerpares inhaled air for use in the lungs,prerpares inhaled air for use in the lungs,
furnishes the air resistance necessary forfurnishes the air resistance necessary for
normal functioning of the lungs, exertsnormal functioning of the lungs, exerts
certain reflex effects upon the lungs, andcertain reflex effects upon the lungs, and
modifies speech.modifies speech.

ANATOMYANATOMY
External NoseExternal Nose
The midline structure projecting outwardThe midline structure projecting outward
from the plane of the cheeks and upper lip,from the plane of the cheeks and upper lip,
the external nose may be dividedthe external nose may be divided
structurally into three divisions: the bonystructurally into three divisions: the bony
vault, the most superior, is immobile; belowvault, the most superior, is immobile; below
it comes the slightly movable cartilaginousit comes the slightly movable cartilaginous
vault; and lowest is the movable nasalvault; and lowest is the movable nasal
lobule.lobule.

Skeletal structures include:Skeletal structures include:
 the ascending processesthe ascending processes
of the maxillaeof the maxillae
 the two nasal bones,the two nasal bones,
 all supported by the nasalall supported by the nasal
process of the frontalprocess of the frontal
bonebone
 a portion of thea portion of the
perpendicular plate of theperpendicular plate of the
ethmoid bone.ethmoid bone.

The next division:The next division:
 the slightly movablethe slightly movable
cartilaginous vault, iscartilaginous vault, is
made up of the uppermade up of the upper
lateral cartilageslateral cartilages
 The lowest third of theThe lowest third of the
external nose, the nasalexternal nose, the nasal
lobule, has its shapelobule, has its shape
maintained by the lowermaintained by the lower
lateral cartilages.lateral cartilages.

Internal NoseInternal Nose
 This structure extends from the osThis structure extends from the os
internum anteriorly to the posteriorinternum anteriorly to the posterior
choana, which divides the nasal cavitychoana, which divides the nasal cavity
from the nasopharynx.from the nasopharynx.
 The nasal septum, a bony midlineThe nasal septum, a bony midline
structure, anatomically divides the organstructure, anatomically divides the organ
into two nosesinto two noses

 The internal lateralThe internal lateral
nasal walls are furthernasal walls are further
structured by thestructured by the
turbinates and theturbinates and the
irregular air spacesirregular air spaces
between them - thebetween them - the
inferior, middle, andinferior, middle, and
superior meatisuperior meati

 The nasolacrimalThe nasolacrimal
duct empties intoduct empties into
the inferior meatusthe inferior meatus
anteriorly.anteriorly.

 The hiatusThe hiatus
semilunaris of thesemilunaris of the
middle meatusmiddle meatus
provides sinus ostiaprovides sinus ostia
for the :for the :
 frontal,frontal,
 anterior ethmoid,anterior ethmoid,
 maxillary sinuses.maxillary sinuses.

 The posteriorThe posterior
ethmoid sinus cellsethmoid sinus cells
drain into thedrain into the
superior meatus, andsuperior meatus, and
the sphenoid sinusthe sphenoid sinus
drains into thedrains into the
sphenoethmoidsphenoethmoid
recessrecess

SeptumSeptum
The skeletal portion of theThe skeletal portion of the
septum is composed of:septum is composed of:
 the septal cartilagethe septal cartilage
(quadrangular)(quadrangular)
anteriorly,anteriorly,
 the perpendicular platethe perpendicular plate
of the ethmoidof the ethmoid
 vomervomer
 crest of the maxillascrest of the maxillas
 crest of the palatinescrest of the palatines

SeptumSeptum
 Warping of the septum, which may be due toWarping of the septum, which may be due to
growth factors or trauma, may be so great thatgrowth factors or trauma, may be so great that
it interferes with the air flow and must beit interferes with the air flow and must be
corrected surgically.corrected surgically.

Paranasal SinusesParanasal Sinuses
Sinuses namedSinuses named::
 maxillarymaxillary
 sphenoidsphenoid
 frontalfrontal
 ethmoidethmoid

Paranasal SinusesParanasal Sinuses
In health, the sinuses are essentially air-filled.In health, the sinuses are essentially air-filled.

Blood SupplyBlood Supply
 The sphenopalatine branch of the internalThe sphenopalatine branch of the internal
maxillary artery supplies the conchae, meatus,maxillary artery supplies the conchae, meatus,
and septumand septum
 The anterior and posterior ethmoidal branchesThe anterior and posterior ethmoidal branches
of the ophthalmic artery supply the ethmoidalof the ophthalmic artery supply the ethmoidal
and frontal sinuses and the roof of the noseand frontal sinuses and the roof of the nose

Blood SupplyBlood Supply
 The veins form a close cavernous plexus underThe veins form a close cavernous plexus under
the mucous membrane. This plexus isthe mucous membrane. This plexus is
especially well marked over the noddle andespecially well marked over the noddle and
inferior conchae and the lower portion of theinferior conchae and the lower portion of the
septum, where it forms the erectile tissue.septum, where it forms the erectile tissue.
 Venous drainage is accomplished principallyVenous drainage is accomplished principally
through the ophthalmic, anterior facial, andthrough the ophthalmic, anterior facial, and
sphenopalatine veins.sphenopalatine veins.

Nerve SupplyNerve Supply
 Directly involved are the first cranial nerve forDirectly involved are the first cranial nerve for
olfactionolfaction
 The ophthalmic and maxillary divisions of theThe ophthalmic and maxillary divisions of the
trigeminal nerve for all other sensory afferenttrigeminal nerve for all other sensory afferent
impulsesimpulses
 The facial nerve for movement of theThe facial nerve for movement of the
respiratory muscles of the external noserespiratory muscles of the external nose

Functions of the noseFunctions of the nose
 OlfactionOlfaction
 Airway ResistanceAirway Resistance
 Air ConditioningAir Conditioning
 Air PurificationAir Purification
 Mucociliary FunctionMucociliary Function

Airway ResistanceAirway Resistance
 The human breath begins at the rim of theThe human breath begins at the rim of the
nostril. The act of breathing conveys airnostril. The act of breathing conveys air
through the upper and lower respiratory tractthrough the upper and lower respiratory tract
to the alveoli of the lung in sufficient volume,to the alveoli of the lung in sufficient volume,
with sufficient pressure, moisture, warmth, andwith sufficient pressure, moisture, warmth, and
cleanliness, to assure optimal conditions forcleanliness, to assure optimal conditions for
oxygen uptake, and in the reverse processoxygen uptake, and in the reverse process
optimal elimination of carbon dioxide broughtoptimal elimination of carbon dioxide brought
to the alveoli by the blood streamto the alveoli by the blood stream

Air ConditioningAir Conditioning
 During the brief time that air traverses theDuring the brief time that air traverses the
horizontal portion of the nasal passage, 16 tohorizontal portion of the nasal passage, 16 to
20 times a minute in normal respiration, the20 times a minute in normal respiration, the
inspired air is warmed (or cooled) to near bodyinspired air is warmed (or cooled) to near body
temperature and its relative humidity istemperature and its relative humidity is
brought to near 100 per cent.brought to near 100 per cent.

Air PurificationAir Purification
 The hairs of the skin-lined nasal vestibule play a roleThe hairs of the skin-lined nasal vestibule play a role
in air filtrationin air filtration
 The irregular internal anatomy of the nasal passagesThe irregular internal anatomy of the nasal passages
causes eddies in the inspired air, resulting in acauses eddies in the inspired air, resulting in a
deposition of particulate matter in the nose anddeposition of particulate matter in the nose and
nasopharynx. This foreign material, includingnasopharynx. This foreign material, including
bacteria and viruses, is either expectorated or carriedbacteria and viruses, is either expectorated or carried
by mucociliary transport to the stomach forby mucociliary transport to the stomach for
sterilization by gastric secretionssterilization by gastric secretions

Mucociliary FunctionMucociliary Function
 The transport of foreign particles depositedThe transport of foreign particles deposited
from inspired air posteriorly to the pharynx,from inspired air posteriorly to the pharynx,
where they are either swallowed orwhere they are either swallowed or
expectorated, is carried out through action ofexpectorated, is carried out through action of
cilia moving the mucous blanket with itscilia moving the mucous blanket with its
entrapped particlesentrapped particles

ExaminationExamination
 Patient HistoryPatient History
 Palpation and percussion over the frontal andPalpation and percussion over the frontal and
maxillary sinuses or the teethmaxillary sinuses or the teeth
 Direct rhinoscopyDirect rhinoscopy
 Mirror (indirect) rhinoscopyMirror (indirect) rhinoscopy
 Flexible rhinoscopyFlexible rhinoscopy
 Rigid rhinoscopyRigid rhinoscopy
 Chest X-RayChest X-Ray
 CT scansCT scans

Patient HistoryPatient History
 DischargeDischarge
 ObstructionObstruction
 BleedingBleeding
 Loss or Change of Smell (Anosmia)Loss or Change of Smell (Anosmia)
 Sneezing attacksSneezing attacks
 Headache or other painHeadache or other pain

DischargeDischarge
 Is one side or are both sides involved?Is one side or are both sides involved?
 Duration? Continual or intermittent, and howDuration? Continual or intermittent, and how
so? Age at onset?so? Age at onset?
 Is the discharge watery or thick? Purulent orIs the discharge watery or thick? Purulent or
bloody?bloody?
 Does it occur with environmental or seasonalDoes it occur with environmental or seasonal
changes?changes?

ObstructionObstruction
 Is one side or are both sides involved?Is one side or are both sides involved?
 Duration? Continual or intermittent, and how so?Duration? Continual or intermittent, and how so?
Age at onset?Age at onset?
 Is there a history of injury?Is there a history of injury?
 Is there a history of nasal or other otolaryngologicIs there a history of nasal or other otolaryngologic
surgery?surgery?
 Is there a history of allergic disorders, especiallyIs there a history of allergic disorders, especially
those associated with seasonal variation? Ifthose associated with seasonal variation? If
suggestive, a complete allergic history is indicated.suggestive, a complete allergic history is indicated.
 Does the patient use nasal sprays or medications?Does the patient use nasal sprays or medications?

BleedingBleeding
 What is the duration? Frequency? How long agoWhat is the duration? Frequency? How long ago
was the last episode?was the last episode?
 Is the bleeding unilateral or bilateral?Is the bleeding unilateral or bilateral?
 Does bleeding originate from the anterior orDoes bleeding originate from the anterior or
posterior nares or both?posterior nares or both?
 Does it occur only in winter?Does it occur only in winter?
 Is there a history of trauma?Is there a history of trauma?
 Does the patient have a bleeding tendency?Does the patient have a bleeding tendency?
 Does the patient use any medications?Does the patient use any medications?
 Is hypertension present?Is hypertension present?

Loss or Change of Smell (Anosmia)Loss or Change of Smell (Anosmia)
 Is the loss associated with trauma, upperIs the loss associated with trauma, upper
respiratory infection, systemicrespiratory infection, systemic
illness?illness?
 Is the loss or change of smell partial orIs the loss or change of smell partial or
complete?complete?
 Is there any history of sinus or nasal disease?Is there any history of sinus or nasal disease?
 Are there other systemic symptoms?Are there other systemic symptoms?

SYMPTOMS AND PHYSICALSYMPTOMS AND PHYSICAL
FINDINGSFINDINGS
 Symptoms of nasal disease include local as well asSymptoms of nasal disease include local as well as
distant manifestationsdistant manifestations
Local symptoms includeLocal symptoms include::
 nasal congestion or obstruction,nasal congestion or obstruction,
 rhinorrhea,rhinorrhea,
 bleeding,bleeding,
 pain,pain,
 anosmia or other alterations of smell,anosmia or other alterations of smell,
 postnasal dischargepostnasal discharge

Direct rhinoscopyDirect rhinoscopy
 Nasal speculum which make it possible to visualizeNasal speculum which make it possible to visualize

Examination of the noseExamination of the nose
 Examination of the nose may reveal mucosalExamination of the nose may reveal mucosal
edemaedema

Mirror (indirect) rhinoscopyMirror (indirect) rhinoscopy

Rigid rhinoscopyRigid rhinoscopy

Sinus diseaseSinus disease
 Acute SinusitisAcute Sinusitis
 Chronic SinusitisChronic Sinusitis

Acute SinusitisAcute Sinusitis
Maxillary SinusitisMaxillary Sinusitis
 Acute maxillary sinusitis usually follows a mildAcute maxillary sinusitis usually follows a mild
upper respiratory tract infection.upper respiratory tract infection.
 Chronic nasal allergies, foreign bodies, andChronic nasal allergies, foreign bodies, and
deviated nasal septum are among the most commondeviated nasal septum are among the most common
predisposing local factors.predisposing local factors.
 Dental conditions account for approximately 10 perDental conditions account for approximately 10 per
cent of all acute maxillary sinus infections.cent of all acute maxillary sinus infections.

Symptoms of acute maxillarySymptoms of acute maxillary
The symptoms of acute maxillary sinus infection consistThe symptoms of acute maxillary sinus infection consist
of:of:
 Fever, malaise, and headacheFever, malaise, and headache
 There is a feeling of fullness in the face, and pain in theThere is a feeling of fullness in the face, and pain in the
teethteeth
 Often there is some degree of characteristic dull,Often there is some degree of characteristic dull,
throbbing cheek painthrobbing cheek pain
 Runny noseRunny nose
 Loss or Change of SmellLoss or Change of Smell

Physical examinationPhysical examination
 During acute maxillary sinusitis, physicalDuring acute maxillary sinusitis, physical
examination may reveal pus in the nose,examination may reveal pus in the nose,
usually from the middle meatus, or pus orusually from the middle meatus, or pus or
mucopurulent secretions in the nasopharynx.mucopurulent secretions in the nasopharynx.
 Finally, the characteristic air-fluid level due toFinally, the characteristic air-fluid level due to
accumulation of pus is in the upright viewsaccumulation of pus is in the upright views
(sinus radiographs) of the maxillary sinus(sinus radiographs) of the maxillary sinus

Upright views of the maxillary sinusUpright views of the maxillary sinus

CulturesCultures
 A culture from the posterior aspect of the nose or theA culture from the posterior aspect of the nose or the
nasopharynx would be much more accurate but,nasopharynx would be much more accurate but,
technically, this is extremely difficult to obtain.technically, this is extremely difficult to obtain.
 Specific cultures of the bacteria concerned withSpecific cultures of the bacteria concerned with
sinusitis are obtained using maxillary irrigation. Mostsinusitis are obtained using maxillary irrigation. Most
frequently, an appropriate antibiotic is given to coverfrequently, an appropriate antibiotic is given to cover
the more common organisms involved in this diseasethe more common organisms involved in this disease
{Streptococcus pneumoniae, Haemophilus{Streptococcus pneumoniae, Haemophilus
influenzae, anaerobes, Branhamella catarrhalis).influenzae, anaerobes, Branhamella catarrhalis).

TreatmentTreatment
 Acute maxillary sinusitis is generally treated with aAcute maxillary sinusitis is generally treated with a
broad-spectrum antibiotic such as amoxicillin,broad-spectrum antibiotic such as amoxicillin,
ampicillin or erythromycin plus sulfonimide, withampicillin or erythromycin plus sulfonimide, with
other alternatives being amoxicillin/clavulanate,other alternatives being amoxicillin/clavulanate,
cefuroximecefuroxime
 Decongestants such as pseudoephedrine are usefulDecongestants such as pseudoephedrine are useful
 The route of insertion of the troacar for maxillaryThe route of insertion of the troacar for maxillary
antral irrigation is usually beneath the inferiorantral irrigation is usually beneath the inferior
turbinate after initial cocainization of the mucousturbinate after initial cocainization of the mucous
membranemembrane

Antral irrigationAntral irrigation
 Purulent secretions inPurulent secretions in
the maxillary sinus canthe maxillary sinus can
be irrigated by passing abe irrigated by passing a
needle through theneedle through the
inferior meatusinferior meatus
 Warm saline is irrigatedWarm saline is irrigated
into the maxillaryinto the maxillary
antrum via this route,antrum via this route,
and the pus is flushedand the pus is flushed
out through the naturalout through the natural
ostium.ostium.

Antral irrigationAntral irrigation
 needleneedle

Maxillary Sinusitis of Dental OriginMaxillary Sinusitis of Dental Origin
 This particular form of maxillary dentalThis particular form of maxillary dental
disease is responsible for 10% of cases ofdisease is responsible for 10% of cases of
sinusitis occurs following dental problems.sinusitis occurs following dental problems.
The most common cause is the extraction of aThe most common cause is the extraction of a
molar tooth, usually the first molar, duringmolar tooth, usually the first molar, during
which a small piece of bone lying between thewhich a small piece of bone lying between the
apex of the tooth and the maxilfary sinus isapex of the tooth and the maxilfary sinus is
removedremoved

 Other dental infections such as apical abscessOther dental infections such as apical abscess
or periodontal disease may cause a similaror periodontal disease may cause a similar
condition.condition.
 The bacteriologic picture of sinusitis of dentalThe bacteriologic picture of sinusitis of dental
origin is predominantly that of the gram-origin is predominantly that of the gram-
negative infectionnegative infection

 This leads to a particularly foul-smelling pusThis leads to a particularly foul-smelling pus
and, consequently, foul odor from the nose.and, consequently, foul odor from the nose.
 Antibiotics, irrigation of the sinus, andAntibiotics, irrigation of the sinus, and
correction of the dental problem are thecorrection of the dental problem are the
mainstays of therapy.mainstays of therapy.

Ethmoid SinusitisEthmoid Sinusitis
 Isolated acute ethmoid sinusitis is moreIsolated acute ethmoid sinusitis is more
common in childrencommon in children
 In adults it often accompanies maxillaryIn adults it often accompanies maxillary
sinusitis and must be regarded as an inevitablesinusitis and must be regarded as an inevitable
accompaniment of frontal sinusitis.accompaniment of frontal sinusitis.

Ethmoid SinusitisEthmoid Sinusitis
 Symptoms include pain and tendernessSymptoms include pain and tenderness
between the eyes and over the bridge of thebetween the eyes and over the bridge of the
nose, nasal drainage, and nasal obstruction.nose, nasal drainage, and nasal obstruction.
 Treatment of ethmoid sinusitis involves theTreatment of ethmoid sinusitis involves the
use of systemic antibiotics, nasaluse of systemic antibiotics, nasal
decongestants, and topical vasoconstrictordecongestants, and topical vasoconstrictor
sprays and dropssprays and drops
 Development of impending complications andDevelopment of impending complications and
inadequate improvement andinadequate improvement and indications for anindications for an
ethmoidectomyethmoidectomy

Frontal SinusitisFrontal Sinusitis
 Acute frontal sinusitis is almost alwaysAcute frontal sinusitis is almost always
associated with anterior ethmoid infectionassociated with anterior ethmoid infection
 The predisposing factors of acute frontal sinusThe predisposing factors of acute frontal sinus
infection are similar to those for other sinusinfection are similar to those for other sinus
infectionsinfections
 The disease is seen predominantly in adultsThe disease is seen predominantly in adults

Frontal SinusitisFrontal Sinusitis
 Frontal sinusitis is associated with aFrontal sinusitis is associated with a
characteristic head paincharacteristic head pain
 The pain is situated above the eyebrows, isThe pain is situated above the eyebrows, is
present usually in the morningpresent usually in the morning
 Fever, malaiseFever, malaise
 Runny noseRunny nose
 Loss or Change of SmellLoss or Change of Smell

TreatmentTreatment
 The treatment consists of appropriateThe treatment consists of appropriate
antibiotics as described previously,antibiotics as described previously,
decongestants, and vasoconstrictor nasaldecongestants, and vasoconstrictor nasal
drops.drops.
 Failure to resolve quickly or the onset ofFailure to resolve quickly or the onset of
complication would require drainage bycomplication would require drainage by
frontal sinus trephine techniquefrontal sinus trephine technique

Sphenoid SinusitisSphenoid Sinusitis
 Acute isolated sphenoid sinusitis isAcute isolated sphenoid sinusitis is
exceptionally rare.exceptionally rare.
 It is supposed to be characterized by headacheIt is supposed to be characterized by headache
directed to the vertex of the skulldirected to the vertex of the skull

Chronic SinusitisChronic Sinusitis
 Failure to adequately treat acute or recurrentFailure to adequately treat acute or recurrent
sinusitis will lead to an incompletesinusitis will lead to an incomplete
regeneration of the surface ciliated epithelium,regeneration of the surface ciliated epithelium,
resulting in a failure to remove sinusresulting in a failure to remove sinus
secretions and, therefore, predisposing tosecretions and, therefore, predisposing to
further infectionfurther infection

Chronic SinusitisChronic Sinusitis
 The symptoms of chronic sinusitis are vague.The symptoms of chronic sinusitis are vague.
During an acute exacerbation of chronicDuring an acute exacerbation of chronic
sinusitis the symptoms are similar to those ofsinusitis the symptoms are similar to those of
acute sinusitisacute sinusitis

TreatmentTreatment
 Treatment must consist of simultaneouslyTreatment must consist of simultaneously
treating the infection and the factors that led totreating the infection and the factors that led to
the infectionthe infection
 For chronic maxillary sinusitis the simplestFor chronic maxillary sinusitis the simplest
surgical intervention consists of creating ansurgical intervention consists of creating an
adequate drainage opening.adequate drainage opening.

TreatmentTreatment
 Endoscopic sinusEndoscopic sinus
surgery, a technique thatsurgery, a technique that
allows the surgeonallows the surgeon
excellent visualizationexcellent visualization
and magnification of theand magnification of the
nasal anatomy andnasal anatomy and
normal sinus ostia, hasnormal sinus ostia, has
been popularized in thebeen popularized in the
recent pastrecent past

TreatmentTreatment
 Chronic ethmoiditis is almost alwaysChronic ethmoiditis is almost always
associated with chronic maxillary or chronicassociated with chronic maxillary or chronic
frontal disease and may require surgicalfrontal disease and may require surgical
treatment along with these other diseases.treatment along with these other diseases.
Chronic ethmoiditis can accompany chronicChronic ethmoiditis can accompany chronic
nasal polyposis, and, of course, the treatmentnasal polyposis, and, of course, the treatment
will include removal of the nasal polyps.will include removal of the nasal polyps.
Removal of the tissues from which the polypsRemoval of the tissues from which the polyps
originate reduces the rate of recurrent diseases.originate reduces the rate of recurrent diseases.

Complications of sinusitisComplications of sinusitis
 Intracranial ComplicationsIntracranial Complications
 Orbital ComplicationsOrbital Complications

Orbital ComplicationsOrbital Complications
 A. Mild inflammatoryA. Mild inflammatory
or reactionary edemaor reactionary edema
 B. Orbital cellulitisB. Orbital cellulitis
 C. Subperiosteal abscessC. Subperiosteal abscess
 D. Orbital abscessD. Orbital abscess
 E. Cavernous sinusE. Cavernous sinus
thrombosisthrombosis

Subperiosteal abscessSubperiosteal abscess
 Pus collected between periorbital and bonyPus collected between periorbital and bony
orbital wall causes proptosis and chemosisorbital wall causes proptosis and chemosis

Orbital abscessOrbital abscess
 At this stage pus has broken through theAt this stage pus has broken through the
periostem and has intermingled with theperiostem and has intermingled with the
orbital contentsorbital contents
 This stage is associated with the more seriousThis stage is associated with the more serious
unilateral sequelae of optic neuritis andunilateral sequelae of optic neuritis and
blindness.blindness.
 ChemosisChemosis
 Increased proptosisIncreased proptosis

Cavernous sinus thrombosisCavernous sinus thrombosis
 This complication is due to the spread ofThis complication is due to the spread of
bacteria through the venous channels to thebacteria through the venous channels to the
cavernous sinus, where a septiccavernous sinus, where a septic
thrombophlebitis develops.thrombophlebitis develops.
 Pathognomonical cavernous sinus thrombosisPathognomonical cavernous sinus thrombosis
consists of total ophthalmoplegia, chemosis ofconsists of total ophthalmoplegia, chemosis of
the conjunctiva, severe impairment of vision,the conjunctiva, severe impairment of vision,
patient prostration and signs of meningitispatient prostration and signs of meningitis

Intracranial ComplicationsIntracranial Complications
 Acute MeningitisAcute Meningitis
 Dural AbscessDural Abscess (An extradural abscess is a(An extradural abscess is a
collection of pus between the dura and internalcollection of pus between the dura and internal
table of the skull)table of the skull)
 Brain AbscessBrain Abscess

TreatmentTreatment
 Treatment of a severe intracranial suppurativeTreatment of a severe intracranial suppurative
infection is, again, intensive antibiotic therapy,infection is, again, intensive antibiotic therapy,
surgical drainage of abscessed cavities, andsurgical drainage of abscessed cavities, and
prevention of spread of the infection.prevention of spread of the infection.

Anatomy and physiology of the nose

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