Anatomy of Nose &

Paranasal Sinuses
Dr. Vishal Sharma

Development of
nose

 Face develops from 5 projections: frontonasal

process (ectoderm over forebrain) + 2 maxillary
processes + 2 mandibular processes (1st arch)
An ectodermal olfactory placode divides frontonasal process into medial nasal & lateral nasal
process, which give rise to external nasal skeleton
Olfactory placode deepens into olfactory pit & later
olfactory sac which forms nasal cavities
Nasal septum develops from mesodermal tectoseptal expansion from Rathkes pouch

External Framework

External Framework
Nasal Bone
Frontal Process of Maxilla
Upper Lateral Nasal Cartilage
Lower Lateral Nasal (Alar) Cartilage
Septal Cartilage
Lesser Alar (Sesamoid) Cartilages

Internal Nose
Openings: Anterior nares & posterior
nares (Choanae).
Vestibule of nose: lined by skin
Nasal cavity proper:
Lateral Wall

Medial Wall (Septum)

Roof

Floor

Nasal Septum

Nasal Septum

Nasal Septum
1. Septal cartilage

7. Medial alar crus

2. Ethmoid plate

8. Upper lateral cartilage

3. Vomer

9. Nasal bone crest

4. Palatine crest

10. Frontal spine

5. Maxillary crest

11. Sphenoid rostrum

6. Vomeronasal

12. Membranous septum

cartilage

Lateral Nasal Wall

3 - 4 bony conchae covered with mucosa
to form turbinates. Space below & lateral
to turbinate is called meatus.
Middle meatus contains a round bulla
ethmoidalis separated from uncinate
process by hiatus semilunaris that leads
to a funnel shaped ethmoidal infundibulum.

Meatal Drainage
1. Inferior meatus: Nasolacrimal duct ( guarded at its end
by a mucosal valve called HASNERs valve )
2. Middle meatus:
a. Frontal
b. Anterior ethmoid
c. Maxillary (natural + accessory ostia)
3. Superior meatus: Posterior ethmoid
4. Spheno-ethmoidal recess: Sphenoid

Ostio-meatal Complex

Ostio-meatal Complex
Complex micro-architectural pathway in ethmoid
labyrinth that drains anterior group of paranasal
sinuses. Consists of: frontal recess + ethmoid
infundibulum + hiatus semilunaris + uncinate
process + bulla ethmoidalis + middle meatus.

O.M.C. pathology leads to infection of all anterior

paranasal sinuses (Naumann).

Variants in O.M.C.
1. Concha bullosa (pneumatized M.T.)
2. Paradoxically curved middle turbinate
3. Medially turned uncinate process
4. Large bulla ethmoidalis
5. Hallers cell in orbital floor
6. Agger nasi cell anterior to M.T.
7. Onodi Cell with dehiscent Optic Nerve
8. Mucosal pathology

Concha bullosa

Concha bullosa

Paradoxically curved M.T.

Paradoxically curved M.T.

Medialized Uncinate Process

Large bulla ethmoidalis

Haller cell

Agger nasi cell

Onodi cell with dehiscent optic nv

Mucosal disease

Blood Supply
1. Sphenopalatine artery (main artery)
2. Greater palatine artery
3. Superior labial artery
4. Anterior Ethmoidal artery
5. Posterior Ethmoidal artery
1, 2, 3 & 4 form Kiesselbachs plexus over
Littles area on anterior septum

Venous drainage
Ethmoidal veins: ophthalmic veins
cavernous sinus
Sphenopalatine vein: pterygoid plexus
maxillary vein
Woodruffs venous plexus: present on lateral wall
near posterior end of middle turbinate
Retro-columellar vein: behind columella

Sensory Nerve Supply

Long & short Nasopalatine nerves
Greater palatine nerve
Infra-orbital nerve branches
Anterior ethmoidal nerve
Olfactory nerve

Autonomic Nerve Supply

Deep petrosal nerve (sympathetic) + greater
superficial petrosal nerve (para-sympathetic)
vidian nerve pterygo-palatine ganglion
nasal glands
Sympathetic stimulation vasoconstriction +
ed nasal secretions
Para-sympathetic stimulation vasodilatation
+ ed nasal secretions

Lining Epithelium
Skin: over nasal vestibule
Olfactory epithelium: upper 1/3rd of nasal cavity
above superior turbinate
Respiratory epithelium (pseudo-stratified
ciliated columnar): rest of nasal cavity +
paranasal sinus

Lining Epithelium

Lymphatic Drainage
1. External nose & anterior nasal cavity
submandibular lymph nodes
2. Remaining nasal cavity
upper deep cervical lymph nodes
3. Nasal roof (dangerous area of nose)
subarachnoid space along olfactory nv
4. P.N.S. retropharyngeal & J.D. node

Paranasal Sinuses
Anterior group:
frontal
anterior ethmoidal
maxillary
Posterior group:
posterior ethmoidal
sphenoid

Development of P.N.S.
Appear
first

First X-ray
appearance

Reach adult
size by

Maxillary

At birth

4 mth

15 yr

Ethmoidal

At birth

1yr

12 yr

Sphenoid

2 yr

4 yr

18 yr

Frontal

4 yr

6 yr

15 yr

Sphenoid Sinus Relations

Muco-ciliary blanket
Goblet cells in nasal mucosa secrete a
mucous blanket; moved backwards like a
conveyer belt into nasopharynx.
Consists of:
Superficial mucous or gel layer
Deep serous or sol layer

Muco-ciliary blanket

Muco-ciliary blanket

Thank You