1

Dr.Juan Herrera Salazar

05/01/17

de
NEW Apuntes
!

Fisiologia Nasal, Sistema

olfativo

Seminarios
Clnica de Asma y
Alergia
Favor leer

Dr.Juan Herrera Salazar

notas al pie
05/01/17

Anatomy of the Nose

The external nose consists of paired nasal bones and upper
and lower lateral cartilages. Internally, the nasal septum
divides the nasal cavity into a right and left side.
The lateral nasal wall consists of inferior and middle
turbinates and occasionally a superior or supreme
turbinate bone. The opening of the sinuses also is found
under the middle turbinates on the lateral nasal wall.
The lacrimal system drains into the nasal cavity below the
anterior inferior aspect of the inferior turbinates.
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Dr.Juan Herrera Salazar

05/01/17

Overview Fisiologa Nasal

To understand the physiology of the nose, its functions must be
understood. The nose serves as the only means of bringing
warm humidified air into the lungs. It is the primary organ for
filtering out particles in inspired air, and it also serves to
provide first-line immunologic defense by bringing inspired air
in contact with mucous-coated membranes that contain
immunoglobulin A (IgA). Inspired air is brought high into the
nasal cavity to come in contact with the olfactory nerves,
thereby providing the sense of smell, which is intimately
associated with the taste sensation. Dysfunction of any of these
systems can lead to symptoms of nasal dysfunction (eg,
congestion, postnasal drainage, facial pressure, headaches,
sinus infections).
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Dr.Juan Herrera Salazar

05/01/17

Nasal Airflow
Air flows superiorly into the nares, determined by its position
and the anterior nasal valve. The airstream then turns
posteriorly approximately 90 and flows into the
nasopharynx. The airstream then turns inferiorly 90 through
the pharynx and larynx and flows into the trachea toward the
lungs. The anterior nasal valve is located 1.5-2 cm posterior
to the anterior nares and is the narrowest portion of the upper
airway. The narrow portion of the upper airway allows close
contact between the airstream and mucosal surfaces.
Humidification occurs by evaporation of moisture from the
mucosal blanket. Air is humidified to 75-80%.

Dr.Juan Herrera Salazar

05/01/17

 Lo ms dificil es ver lo que esta delante de tus

ojos W. Goethe

6 Dr.Juan Herrera Salazar

05/01/17

Vista endoscpica ,fosa nasal derecha. El turbinato

esta inflamado levemente, mucosa palida,el turbinato
viene a ponerse en contacto con el septo
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Dr.Juan Herrera Salazar

05/01/17

Abnormal
Nasal Physiology
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Dr.Juan Herrera Salazar

05/01/17

To understand the physiology of the nose, its functions must

be understood. The nose serves as the only means of
bringing warm humidified air into the lungs. It is the
primary organ for filtering out particles in inspired air, and it
also serves to provide first-line immunologic defense by
bringing inspired air in contact with mucous-coated
membranes that contain immunoglobulin A (IgA).
Inspired air is brought high into the nasal cavity to come in
contact with the olfactory nerves, thereby providing the
sense of smell, which is intimately associated with the taste
sensation. Dysfunction of any of these systems can lead to
symptoms of nasal dysfunction (eg, congestion, postnasal
drainage, facial pressure, headaches, sinus infections).

Dr.Juan Herrera Salazar

05/01/17

10

Dr.Juan Herrera Salazar

05/01/17

Tests of
Nasal Physiology
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Dr.Juan Herrera Salazar

05/01/17

Bibliografa Emedecine
Nasal Physiology Author: Sanford M Archer, MD;

Chief Editor: Arlen D Meyers, MD, MBA more...

Olfactory System Anatomy Author: Amir

Vokshoor, MD; Chief Editor: Arlen D Meyers, MD,

MBA more...
Nasal Aerodynamics Author: Samuel J Lin, MD;
Chief Editor: Arlen D Meyers, MD, MBA more...
Nasal Reconstruction

Author: Ali Sajjadian, MD,

FACS; Chief Editor: Arlen D Meyers, MD, MBA
more...

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Dr.Juan Herrera Salazar

05/01/17

Aparato Olfativo Anatoma

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Dr.Juan Herrera Salazar

05/01/17

Anatoma del aparato

olfativo

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Dr.Juan Herrera Salazar

05/01/17

Olfactory Epithelium
Olfactory Nerve and the Cribriform Plate
Olfactory Bulb
Olfactory Tract and Central Pathways
Central Projections
Clinical Correlation
Clinical Evaluation

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Dr.Juan Herrera Salazar

05/01/17

Olfactory Nerve and the Cribriform Plate

The small, unmyelinated axons of the olfactory receptor cells
form the fine fibers of the first cranial nerve and travel centrally
toward the ipsilateral olfactory bulb to make contact with the
second-order neurons.
Conduction velocities are extremely slow, and support is
provided in bundles by a single Schwann cell. As previously
mentioned, the trigeminal nerve (cranial nerve V) sends fibers to
the olfactory epithelium to detect caustic chemicals, such as
ammonia.
The cribriform plate of the ethmoid bone, separated at the
midline by the crista galli, contains multiple small foramina
through which the olfactory nerve fibers, or fila olfactoria,
traverse. Fracture of the cribriform plate in traumatic settings can
disrupt these fine fibers and lead to olfactory dysfunction .
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Dr.Juan Herrera Salazar

05/01/17

Olfactory Bulb

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Dr.Juan Herrera Salazar

05/01/17

Olfactory Tract and Central Pathways

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Dr.Juan Herrera Salazar

05/01/17

NIH pathways flashcard

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Dr.Juan Herrera Salazar

05/01/17

Fisiologa Nasal
Tests of Nasal Physiology
Estos

exmenes incluyen estudios :

Flujo nasal
Funcin ciliar
Olfato.

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Dr.Juan Herrera Salazar

05/01/17

Rinomanometria
Rhinomanometra cuantifica el flujo areo

nasal durante respiracin nasal exclusiva.

( Nasal resistance measurement)
Acoustic rhinometry.
Rhinomanometry and acoustic rhinometry can
be used clinically to evaluate nasal patency in a
number of situations. Either test may be used
for a general evaluation of nasal airflow and to
compare premorbid conditions with changes
that may occur after medical or surgical
therapy. Additionally, these tests can compare
nasal passages for medical or surgical planning.
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Dr.Juan Herrera Salazar

05/01/17

Otros examenes
Radiologic imaging with CT or MRI also can

assess the cross-sectional area of nasal

passages (see the eMedicine articleCT
Scan, Nasal Cavity).
The saccharin test evaluates ciliary
function by measuring the time it takes for
a drop of saccharin to be tasted in the back
of the throat when applied to the anterior
tip of the inferior turbinate.

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Dr.Juan Herrera Salazar

05/01/17

Otros examenes olfato

University of Pennsylvania Smell

Identification Test (UPSIT)es el test del

olfato ms conocido.
.The UPSIT is a 40-item scratch-and-sniff
test and is highly validated by age and sex.
Recent research into exhaled nitric oxide
suggests that in the future, these
measurements may prove valuable as noninvasive objective tools for the assessment
and management of normal nasal
physiology and nasal and sinus disorders.[3]
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Dr.Juan Herrera Salazar

05/01/17

Anomalas de la fisiologa
nasal
Nitric oxide

Low NO concentrations were reported in certain

diseases, such as primary ciliary dyskinesia, cystic

fibrosis, and acute and chronic maxillary sinusitis,
whereas high concentrations were detected in
upper airway infection, allergic rhinitis, and nasal
polyposis.

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Dr.Juan Herrera Salazar

05/01/17

El septo nasal
Desviacin del

Septo

Fisiologa de las desviaciones del Septo

Nasal
Factor predisponente. Sinusitis
Ver el papel de las alergias

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Dr.Juan Herrera Salazar

05/01/17

Septo Nasal
Estructura Osea y
Cartilaginea.

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Dr.Juan Herrera Salazar

05/01/17

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Dr.Juan Herrera Salazar

05/01/17

Nervios de la Cavidad
Nasal Septum

Nervio Palatino Mayor .. jhs

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Dr.Juan Herrera Salazar

05/01/17

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Dr.Juan Herrera Salazar

05/01/17

Distribucin de la mucosa
olfativa

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Dr.Juan Herrera Salazar

05/01/17

Correlaciones Clnicas
Anosmia - Absence of smell sensation
Hyposmia - Decreased sensation
Dysosmia - Distortion of smell sensation
Cacosmia - Sensation of a bad or foul smell
Parosmia - Sensation of smell in the

absence of appropriate stimulus

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Dr.Juan Herrera Salazar

05/01/17

Sndromes Clnicas
Kallmann syndrome (ie, hypogonadism with

anosmia)
Foster Kennedy syndrome (ie, papilledema,
unilateral anosmia, and optic atrophy
usually associated with an olfactory groove
meningioma).
Partial complex epilepsy with a mesial
temporal focus includes an aura of foulsmelling odors (termed uncinate fits) that
occur before seizure onset, emphasizing
presumed origination at the uncus.
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Dr.Juan Herrera Salazar

05/01/17

Sindromes clnicas
Olfactory dysfunction is

associated with early

Parkinson disease and
with other
neurodegenerative
disorders, such as
Alzheimer disease and
Huntington chorea.[3]An
association also exists
between abnormal
olfactory identification
and obsessivecompulsive disorder.[4]
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Dr.Juan Herrera Salazar

Head trauma leading to

fracture of the cribriform plate

may cause cerebrospinal fluid
(CSF) rhinorrhea and a
potential for meningitis.
Paranasal sinus endoscopy
may lead to violation of the
cribriform plate and potential
infectious complications.
Olfactory structures also can
be injured during
craniotomies involving the
anterior cranial base or from
subarachnoid hemorrhage,
which may disrupt the fine
fibers of the olfactory nerve.

05/01/17

Liquidos Cerebro Espinal

Rinorrea liquido claro

Promptly complete evaluation and treatment of

clearrhinorrheain the patient in whom leakage of

CSF is suspected. Initial testing of fluid for glucose
suggests CSF but is not confirmatory. Presence of
beta transferrin is a more sensitive indicator of CSF
rhinorrhea. Computed tomography (CT) scanning
with cisternography or radionuclide scans can be
used to detect the site of CSF leakage from the
anterior cranial fossa. Repair of leaks at the level
of the cribriform plate may be achieved from the
intracranial approach, intranasal (endoscopic)
approach, or both, depending on the nature of the
defect.
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Dr.Juan Herrera Salazar

05/01/17

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Dr.Juan Herrera Salazar

05/01/17

Ramas oftlmica y maxilares,

V1, V2
The
trigemina
l nerve
innervate
s the
posterior
nasal
cavity to
detect
noxious
stimuli.
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Dr.Juan Herrera Salazar

05/01/17

Gracias
!

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Dr.Juan Herrera Salazar

05/01/17

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Dr.Juan Herrera Salazar

05/01/17

39

Dr.Juan Herrera Salazar

05/01/17

Gracias por la oportunidad

Desde la Clnica de Asma y Alergia

Managua , Nicaragua. Tel 22781169,

22703359, 88825513
Dr. Juan Herrera Salazar
Favor ver la II Parte
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Dr.Juan Herrera Salazar

05/01/17