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A NATOMY

OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES



Course Objectives:
Familiarize with the basic anatomy of the nose and the Muscles of the Nose
paranasal sinus
Application in clinical practice

External Nose and Vestibule


Nasal bone
Upper and lower lateral cartilages
Vestibule and skin
Muscles
Blood supply
Nerve supply
Lymphatic drainage

Nasal Bone
Form nasal bridge
Grooved by neurovascular bundles Blood Supply
Ossifies at 3rd intrauterine month Branches of the facial artery
Dorsal nasal branch of the ophthalmic artery
Infraorbital branch of the maxillary artery
Venous drainage to facial and ophthalmic veins
Dangerous area of the face

Nasal Framework
nasal bones
upper lateral cartilages
lower lateral cartilages
greater alar cartilage
lesser alar cartilage

Upper and Lower Lateral Cartilage Nerve Supply


Composed of hyaline cartilage Facial nerve for muscles of facial expression
Prevent collapse of the vestibule Ophthalmic nerve for sensation
Form the mid and lower third of the nose
Lymphatic Drainage
Anterior face to the submental and submandibular
nodes
Drainage may be bilateral

Vestibule and Skin


Dilated passageway
Lined with skin and vibrissae
Skin of dorsum/sides loosely connected
Adherent at apex and alar cartilages

NASAL SEPTUM
Osteology
Histology
Blood supply
Nerve supply
Lymphatic drainage

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DR. KAREN ADIEL RANCES | JANUARY 30, 2017


A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Osteology
Bony
Perpendicular plate of the ethmoid
Vomer
Bony crest of maxilla and palatine

Cartilagenous
Quadrilateral cartilage
Contribution from the lower and upper lateral alar
cartilages

Histology (Nasal Septum)


Hyaline cartilage
Represents the unossified portion of the perpendicular
plate of the ethmoid
Mucous membrane is principally respiratory

Nerve Supply
Maxillary division of the
trigeminal nerve

Respiratory Epithelium
Basal cells

Goblet cells

Columnar cells either


ciliated or non-
ciliated

Lymphatic Drainage
Anterior septum to the submandibular nodes
Blood Supply Posteriorly, to the retropharyngeal and anterior deep
cervical nodes
External carotid

Internal carotid Lateral Wall


Inferior meatus
Inferior turbinate
Middle meatus
Middle turbinate
Superior meatus
Superior turbinate
Histology
Blood supply
Nerve supply
Lymphatic drainage

Inferior meatus
Kiesselbachs Plexus Lateral to the inferior turbinate
Sphenopalatine br of the maxillary artery Largest meatus
Greater palatine artery Nasolacrimal duct
Superior labial branch of facial artery Compact to lamellar bone
Anterior and posterior ethmoidal branches of the Thicker posteriorly, anteriorly, inferiorly
internal carotid a.

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A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Inferior turbinate Superior meatus and turbinate


Conchal bone Receives ostia from the posterior ethmoidal cells
Mucoperiosteum On occasion a supreme turbinate can be seen
Submucosal cavernous plexus
Respiratory mucus membrane

Histology
Majority of the lateral wall is covered by respiratory
columnar epithelium

Blood Supply
Middle meatus
External and internal carotid systems
-Most important area Venous drainage is via the sphenopalatine system

-Osteomeatal
complex

-Bulla ethmoidalis

-Ostium

-Uncinate process

-Hiatus semilunaris

-Middle turbinate

-Ethmoid
infundibulum

Middle turbinate Nerve Supply


Integral part of the ethmoid bone Similar to the septum
Sometimes pneumatized Anterior ethmoidal nerve
Cavernous plexus less developed Branches of the pterygopalatine and the anterior
Goblet cells fewer palatine nerves

Lymphatic Drainage
Drains anteriorly to the submandibular nodes
Posteriorly to the retropharyngeal and upper deep
cervical nodes

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A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Nasopharynx Maxillary Sinus
Continous with the choana (anterior limit) Osteology
Roof is skull base Histology
Continous with the posterior pharyngeal wall Relations
Lateral wall consists of torus tubarius, eustachian tube Blood nerves and lymphatic drainage
orifice and the fossa of Rosenmuller
Inferior limit is the level of the hard palate Maxillary Bone and Sinus
Largest facial bone
after the mandible

Form most of the


roof of the mouth,
floor and lateral
wall of the nasal
cavity and floor of
the orbit

Body is
quadrilateral
pyramid

Paranasal Sinus
Maxillary Bone and Sinus
Maxillary
Canine depression is relatively thin
Ethmoid
Roof of sinus forms the floor of the orbit
Sphenoid
Floor of the sinus is thick and encroached by dental
Frontal
roots of the 2nd and 3rd molars

Maxillary Bone and Sinus


Level of the
floor of the sinus
relative to the
nasal floor

Birth several
mm higher

8-9yrs level

Continued
development
sinus lower than
nasal floor
Functions:
Impart resonance to voice
Humidify and warm the inspired air
Increase the area of the olfactory membrane
Absorb shock applied to the head
Secrete mucus for keeping the nasal chambers moist
Provide thermal insulation for the brain
Contribute to facial growth
Lighten the bones of the skull
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A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Maxillary Bone and Sinus Blood supply
Lacrimal canal Branches of the maxillary artery
created between o Infraorbital artery
the maxilla, lacrimal o Greater palatine artery
bone and inferior o Posterosuperior alveolar artery
cocha o Anterosuperior alveolar artery
o Lateral nasal branches of sphenopalatine
Nasolacrimal duct artery
passes to the Venous drainage
anterior inferior o Anteriorly: anterior facial vein
meatus o Posteriorly: tributaries of the maxillary vein

Innervation
Maxillary nerve
o Greater palatine nerve
o Posterolateral nasal nerve
o Superior alveolar branches of infraorbital
nerve

Average volume of 14.25 ml Ethmoid Bone and Sinuses


Average dimensions Osteology
Height 36-45mm Histology
Width 25-35mm Ethmoidal arteries and veins
Length 38-45mm Relations
Blood supply, nerve supply, and lymphatic drainage

Histology
Ciliated columnar respiratory epithelium containing
goblet cells and glands
Density of goblet cells and seromucinous glands highest
in the maxillary sinus

Relations
Superior orbit
Inferior - upper dentition and palate
Posterior infratemporal fossa
Anterior cheek with fat and facial musculature

Maxillary Sinus

Osteology (Ethmoid Sinus)


- Extremely complex
bone

- Five parts:
perpendicular plate,
cribriform plate,
crista galli,
two lateral labyrinths

Development
3rd month of fetal life - Develops as a bud from the
lateral wall of ethmoid portion of nasal capsule
4th to 5th month after birth readily seen
radiographically
3 years of age - grows continues rapidly
7 years of age- slowly progresses until 12 years old

Volume: Approximately 15ml


Dimensions: 34mm x 25mm x 33mm

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A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Relations Osteology
Divides the anterior cranial fossa and the nasal cavity Largest single bone in the skull base
Orbital cavity Composed of body, two wings, two inferior plates
Sphenoid sinus (lateral and medial pterygoid)
Variable in size and often assymetric

Ethmoid sinuses Histology


Respiratory epithelium with goblet cells and glands
Glands are least numerous in these sinuses (0.06/mm2)

Relations
Form posterior wall of ethmoid sinus
Intimately related to the optic canal
Posteriorly, the body articulates with the occipital bone
Laterally lie the cavernous sinuses

Development
3rd fetal month anterior & middle ethmoid cells begins
as evaginations of the lateral nasal wall in the region of
the middle meatus. Later posterior ethmoid cells
evaginate the nasal mucosa in the superior meatus
1-year-old visualized radiographically
12 years old attains adult sized sinuses

Dimensions:
Anteromiddle group (2 to 8 cells) 24mm x
21mm x 11mm
Posterior group (1 to 8 cells) 21mm x 21mm x
12mm

Blood supply
Nasal branches of sphenopalatine artery
Anterior & posterior ethmoidal arteries Forms the roof of the nasopharynx
Venous drainage Superiorly, the jugum supports the olfactory tracts
o Nasal veins from maxillary vein
o Ethmoidal veins from ophthalmic veins

Innervation Sphenoid sinus


Ophthalmic and maxillary division of the trigeminal
nerve

Sphenoid Bone and Sinuses


Osteology
Histology
Relations
Blood, nerves and lymphatic drainage

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A NATOMY OF THE NOSE, NASOPHARYNX, AND PARANASAL SINUSES

Development Close relationship with the orbit
4th fetal month identifiable
4 months after birth evagination of the
sphenoethmoid recess
5 year old invasion of the sphenoid bone is
more rapid
7 years old sinus has extended posteriorly to
the sella turcica
Late teens aerated to the dorsum sellae

Dimensions: 20mm x 23mm x 17mm

Blood Supply
Internal & external carotid arteries
Roof: posterior ethmoidal branch of
the ophthalmic artery
Floor: sphenopalatine branches of
the maxillary artery
Venous drainage:
Maxillary vein Frontal sinus
Pterygoid venous plexus

Innervation
Mucosa - 1st & 2nd divisions of the trigeminal
nerve
Superior portion posterior ethmoid nerve
Floor sphenopalatine branches of the
maxillary division

Frontal Bone and Sinuses


Osteology Development
Histology Begins in the ethmoid portion of the nasal capsule in
Relations the region of the frontal recess
Blood, nerves and lymphatic drainage At birth indistinguisable from anterior ethmoid cells
4 year old frontal sinus invades vertical portion of
Osteology frontal bone
Forms the forehead and the orbital roof 6 years old visualized radiographically
Varying thickness 2 years old until late teens size still increases
Thinnest at the orbital roof
Usually L shaped Dimensions: 28mm x 24mm x 20mm
1% have no frontal sinus
Blood supply
Supraorbital and supratrochlear arteries
Venous drainage:
o Superior opthalmic vein

Innervation
Supraorbital & supratrochlear branches of the
frontal nerve

Post-Quiz
1-2. Give 2 paranasal sinuses that are present at birth
3-4. What is the mucosal lining of the paranasal sinuses?
5-6. Give 2 functions of paranasal sinuses?

Histology
Respiratory epithelium with the fewest number of
goblet cells (5900/mm2)
Very few glands (0.08/mm2)

Relations
Articulates with the cribriform plate
Intimately related with the ethmoidal labyrinth

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