Rhinology and Facial Plastics
Core concepts
Build your framework around sinus drainage pathways and the ostiomeatal complex - the maxillary, anterior ethmoid and frontal sinuses drain into the middle meatus; the posterior ethmoid and sphenoid drain into the superior meatus. Understand the Lund-Mackay scoring for CT staging and the EPOS classification of chronic rhinosinusitis (with/without polyps). For epistaxis, know the Kiesselbach plexus (anterior, young patients) versus sphenopalatine artery (posterior, older hypertensive patients). In facial plastics, be fluent in nasal valve anatomy, the keystone area, and the blood supply of the face (angular artery, danger triangle).
Traps
Question writers exploit the relationship of the frontal recess to the agger nasi and uncinate - a missed frontal recess cell causes failed Draf procedures. Another classic trap is confusing allergic fungal rhinosinusitis (eosinophilic mucin, double-density CT, Bent-Kuhn criteria) with invasive fungal disease (immunocompromised, bone erosion, orbital apex involvement). For rhinoplasty, remember that over-resection of the dorsum causes an inverted-V deformity and internal valve collapse.
Worked example / rule of thumb
A patient with unilateral bloody rhinorrhoea and a positive beta-2-transferrin test: this confirms CSF leak; localise with high-resolution CT and beta-2-transferrin, then consider endoscopic repair. Rule of thumb: "Unilateral polyp or bloody discharge in an adult = image and biopsy to exclude malignancy."