EN4.{27,31-34} | Sinonasal Inflammation and Tumours — Glossary

Inflammation of the nasal mucosa and one or more paranasal sinus mucosae lasting up to 4 weeks; viral in >90% of cases; classified as mild, moderate, or severe by symptom score.

An IgE-mediated allergic reaction to environmental moulds in immunocompetent hosts producing thick eosinophilic mucin ('peanut-butter' mucin) within expanded sinuses; distinct from invasive fungal sinusitis.

Testosterone and androgen receptors expressed within the fibroblasts of JNA stroma; the molecular basis of the tumour's exclusive occurrence in males and its growth peak during puberty; historically motivated oestrogen therapy (now abandoned).

An enzyme elevated in serum in ~60% of patients with active sarcoidosis, produced by epithelioid macrophages in the granulomas; used as a supportive diagnostic and monitoring marker for sarcoidosis.

Complete absence of the sense of smell; in nasal polyps may be conductive (physical obstruction of olfactory cleft) or sensorineural (inflammatory damage to olfactory neuroepithelium); may not fully recover even after surgery.

Irrigation of the maxillary sinus via a trocar through the inferior meatus under the inferior turbinate; used diagnostically (culture) and therapeutically (drainage) in refractory maxillary ARS.

A unilateral, single polyp arising from the maxillary antrum and extending posteriorly through the choana into the nasopharynx; commoner in children and young adults; requires root avulsion from the antrum at surgery.

Cytoplasmic antineutrophil cytoplasmic antibody directed against proteinase 3; present in >90% of generalised active GPA; the key serological diagnostic marker; cytoplasmic immunofluorescence pattern on ANCA testing.

Septic thrombosis of the cavernous sinus from sinusitis spread; presents with bilateral proptosis, ophthalmoplegia (CN III, IV, VI), high fever, and altered consciousness; Chandler Class V; high mortality.

Five-class staging system for orbital complications of sinusitis: Class I = preseptal cellulitis; Class II = orbital cellulitis; Class III = subperiosteal abscess; Class IV = orbital abscess; Class V = cavernous sinus thrombosis.

Persistent rhinosinusitis symptoms for >12 weeks with objective evidence of mucosal disease on endoscopy or CT; subclassified into CRSwNP (with nasal polyps) and CRSsNP (without polyps).

Autosomal recessive mutation in the CFTR gene causing thick viscid mucus in airways, pancreas, and sinuses; associated with nasal polyps in up to 40% of affected children — should be excluded by sweat chloride test in any child with nasal polyps.

Fluoroscopic imaging technique that subtracts background bone and soft-tissue density to clearly visualise blood vessels; used to map JNA feeding vessels before embolisation and surgery.

Clinical pattern in bacterial ARS: initial improvement after 5–7 days of viral URTI followed by secondary worsening with return of fever, purulent discharge, and facial pain; indicates bacterial superinfection.

A monoclonal antibody targeting the IL-4Rα receptor, blocking both IL-4 and IL-13 signalling; approved for severe uncontrolled chronic rhinosinusitis with nasal polyps in adults after inadequate response to corticosteroids.

The primary aetiological agent for NPC Types II and III; VCA-IgA (viral capsid antigen IgA) in serum is used as a diagnostic and surveillance marker; EBV latent membrane proteins LMP1 and LMP2A are expressed in NPC cells.

A granulocyte mediating type 2 immune responses; central to the pathogenesis of ethmoidal nasal polyps through IL-5-driven degranulation and release of major basic protein, causing mucosal oedema and epithelial damage.

A malignant tumour of the ethmoid sinuses strongly associated with occupational wood-dust exposure (hardwood: oak, beech, teak; IARC Group 1 carcinogen); an occupational history is essential in all patients with this diagnosis.

Bilateral, multiple nasal polyps arising from the ethmoid mucosa, strongly associated with eosinophilic inflammation and allergy; the commonest type of nasal polyp in adults.

Endoscopic procedure to open the OMC, remove polyp tissue, and restore sinus ventilation and drainage; the standard surgical treatment for medically refractory CRS.

Staging system for JNA: Stage I = nasal cavity/nasopharynx; Stage II = pterygomaxillary fossa/paranasal sinuses; Stage III = infratemporal fossa/orbit/parasellar; Stage IV = intracranial extension.

The lateral recess of the nasopharynx posterior to the Eustachian tube opening; the most common site of origin of nasopharyngeal carcinoma.

The thin bony roof of the ethmoid sinuses forming the floor of the anterior cranial fossa; breach during FESS causes CSF leak and risk of meningitis.

Endoscopic surgical technique for nasal polyps and chronic sinusitis; removes polyp tissue and opens the OMC and sinus ostia under endoscopic visualisation to restore ventilation and drainage.

Autosomal dominant (APC gene) syndrome of familial adenomatous polyposis + multiple craniofacial osteomas + epidermoid cysts + desmoid tumours; discovery of a craniofacial osteoma should prompt evaluation for Gardner's syndrome and colorectal polyp surveillance.

A focal collection of activated epithelioid macrophages (sometimes with multinucleate Langhans or foreign body giant cells) representing a chronic immunological response to indigestible antigens; may be caseating (TB — central eosinophilic necrosis) or non-caseating (sarcoidosis, GPA).

ANCA-associated vasculitis (c-ANCA/anti-PR3 positive) affecting small and medium vessels; classic triad = upper airway (nasal crusting, septal perforation, saddle nose) + lower airway (pulmonary nodules/haemoptysis) + renal (pauci-immune crescentic GN); treated with cyclophosphamide/rituximab + corticosteroids.

Destruction of the nasal septum and cartilage by tuberculosis producing an upward tilting of the nasal tip resembling a parrot beak or tapir nose; a result of advanced destructive nasal tuberculosis.

Anterior bowing of the posterior wall of the maxillary sinus seen on CT, caused by JNA filling the pterygomaxillary fossa and displacing the posterior maxillary wall anteriorly; pathognomonic for JNA.

Landmark randomised controlled trial establishing concurrent cisplatin-based chemoradiotherapy as the standard of care for Stage II–IVB NPC, demonstrating significantly improved progression-free and overall survival vs radiotherapy alone.

A terminal branch of the external carotid artery that enters the pterygopalatine fossa and gives rise to the sphenopalatine artery; the dominant blood supply to JNA in early-stage disease; the primary target for pre-operative embolisation.

Rapidly progressive, life-threatening fungal infection (mucormycosis, invasive aspergillosis) in immunocompromised patients; characterised by vascular invasion, ischaemic necrosis (black eschar), and bone/orbital/intracranial spread.

A locally aggressive benign epithelial tumour of the lateral nasal wall or sinuses; unilateral, irregular surface, ~10% risk of malignant transformation; requires complete surgical excision and biopsy.

A highly vascular benign fibrovascular tumour of the nasopharynx occurring almost exclusively in adolescent males; presents with recurrent severe epistaxis and nasal obstruction; biopsy contraindicated due to catastrophic haemorrhage risk.

A form of primary ciliary dyskinesia comprising the triad of bronchiectasis, situs inversus, and chronic sinusitis; caused by mutations in genes encoding axonemal dynein arms, resulting in immotile cilia.

The thin medial bony wall separating the ethmoid sinuses from the orbital cavity; breach during FESS risks orbital haematoma and blindness.

A validated CT-based scoring system for chronic rhinosinusitis; grades each sinus 0–2 (normal/partial/total opacification) and OMC 0 or 2; maximum 24; score ≥12 indicates severe disease.

A violaceous, indurated cutaneous plaque over the nose, cheeks, and lips in sarcoidosis; one of the characteristic skin manifestations of systemic sarcoidosis; its presence should prompt investigation for nasal sarcoidosis and systemic involvement.

The most common form of cutaneous tuberculosis; apple-jelly coloured nodules on skin (particularly nose tip and face) that demonstrate the characteristic colour on diascopy (glass slide compression); may cause destructive nasal TB with Hebra nose deformity.

The anti-inflammatory (non-antibiotic) property of macrolides (azithromycin, clarithromycin) that reduces neutrophilic mucosal inflammation; effective in CRSsNP but not in CRSwNP which has eosinophilic (type 2) inflammation.

Large vacuolated macrophages containing Klebsiella rhinoscleromatis bacilli; pathognomonic histological finding in the granulomatous stage of rhinoscleroma; seen on H&E staining as pale foamy cells.

A selective cysteinyl leukotriene receptor 1 antagonist; useful adjunct in Samter's triad by blocking the leukotriene-mediated inflammatory component exacerbated by aspirin/NSAIDs.

An oedematous, pedunculated outgrowth of chronically inflamed nasal or sinus mucosa, typically arising from the ethmoid mucosa in the middle meatus; the gross result of chronic eosinophilic mucosal inflammation.

Carcinoma of the nasopharyngeal epithelium classified by WHO into Type I (keratinising SCC), Type II (non-keratinising), and Type III (undifferentiated/lymphoepithelioma, EBV-associated); endemic in East/Southeast Asia and North Africa; treated with concurrent chemoradiotherapy.

Unilateral maxillary sinusitis arising from periapical infection of the upper molars/premolars, whose roots lie in proximity to the maxillary sinus floor; characterised by foul-smelling purulent discharge.

An imaginary line from the medial canthus to the angle of the mandible dividing the maxillary sinus into anteroinferior (infrastructure — better prognosis) and superoposterior (suprastructure — worse prognosis, adjacent to orbit and skull base) compartments.

A rare neuroectodermal tumour arising from olfactory epithelium at the cribriform plate; presents with anosmia and epistaxis; bimodal age distribution; treated with craniofacial resection plus radiotherapy.

The functional drainage unit of the anterior paranasal sinuses located in the middle meatus, comprising the uncinate process, hiatus semilunaris, ethmoid bulla, and infundibulum; obstruction here drives chronic sinusitis.

Osteomyelitis of the frontal bone secondary to frontal sinusitis, with subperiosteal abscess producing a characteristic doughy forehead swelling; a complication of frontal sinusitis spread via diploic veins.

Selective angiographic occlusion of the dominant feeding vessels of JNA (primarily the internal maxillary artery) 24–48 hours before surgical excision; reduces intraoperative blood loss by 50–75% and makes surgery feasible.

Anatomical distinction crucial for orbital complication staging: preseptal = anterior to the orbital septum (periorbital cellulitis, no vision threat); postseptal = posterior to the septum (orbital cellulitis, abscess — vision threatened).

A small pyramidal space behind the maxillary sinus communicating with the nasal cavity (via sphenopalatine foramen), orbit (inferior orbital fissure), infratemporal fossa (pterygomaxillary fissure), and cranial fossa (foramen rotundum); key route of JNA spread.

Hyponasal voice quality caused by obstruction of the nasopharynx preventing normal nasal resonance; a feature of advanced JNA filling the nasopharyngeal airway.

A chronic granulomatous disease caused by Klebsiella rhinoscleromatis (Frisch bacillus), progressing through catarrhal → granulomatous → sclerotic stages; pathognomonic histology = Mikulicz cells + Russell bodies; treated with prolonged ciprofloxacin or tetracyclines.

A granulomatous infection caused by Rhinosporidium seeberi (a mesomycetozoean); endemic in South India and Sri Lanka; presents as a strawberry polyp with sporangia visible on surface; treatment is complete surgical excision.

An anti-CD20 monoclonal antibody depleting B lymphocytes; approved for induction treatment of GPA (equivalent to cyclophosphamide per RAVE trial); used as both induction and maintenance therapy in severe or relapsing GPA.

Eosinophilic hyaline globules within plasma cells representing accumulated immunoglobulin; found alongside Mikulicz cells in rhinoscleroma biopsy; together these two features are pathognomonic.

Collapse of the nasal bridge due to loss of cartilaginous septal support; caused by GPA, syphilis, leprosy, TB, cocaine inhalation, and trauma; the broad differential requires a systematic diagnostic approach.

The association of nasal polyps, asthma, and aspirin/NSAID sensitivity (aspirin-exacerbated respiratory disease); caused by preferential leukotriene synthesis when COX-1 is inhibited.

An opening in the lateral nasal wall at the posterior end of the superior meatus, communicating the nasal cavity with the pterygopalatine fossa; transmits the sphenopalatine artery (terminal branch of internal maxillary artery) and nasopalatine nerve; the site of origin of JNA.

Large (up to 300–400 μm) spherical structures containing mature endospores, produced by Rhinosporidium seeberi; visible as white dots on the surface of a rhinosporidiosis polyp (pathognomonic); on biopsy, sporangia at various stages of maturation are seen within the mucosa.

The commonest malignant tumour of the nasal cavity and paranasal sinuses (~80%); most often arises in the maxillary sinus; risk factors include tobacco, nickel, woodworking, and leather-tanning dust exposure.

Surgical resection of the entire maxillary bone including the hard palate, floor and walls of the maxillary sinus; standard surgical treatment for resectable maxillary sinus SCC; followed by post-operative radiotherapy.

The classic clinical triad of advanced NPC: unilateral conductive deafness (Eustachian tube obstruction), unilateral palatal paraesthesia (CN V2/V3), and immobility of the ipsilateral soft palate (CN X or palatal muscle invasion).

Surgical incision used for total maxillectomy giving wide access to the maxilla: vertical component through the upper lip philtrum, horizontal along the infraorbital rim, and along the nasolabial fold; also called the lateral rhinotomy with infraorbital extension.