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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
NASAL SEPTUM
Osteology
Histology
Blood supply
Nerve supply
Lymphatic drainage
1
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
Nerve Supply
Maxillary division of the
trigeminal nerve
Respiratory Epithelium
Basal cells
Goblet cells
Lymphatic Drainage
Anterior septum to the submandibular nodes
Blood Supply Posteriorly, to the retropharyngeal and anterior deep
cervical nodes
External carotid
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.
2
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017
A NATOMY
OF
THE
NOSE,
NASOPHARYNX,
AND
PARANASAL
SINUSES
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
Lymphatic Drainage
Drains anteriorly to the submandibular nodes
Posteriorly to the retropharyngeal and upper deep
cervical nodes
3
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017
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
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
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
4
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017
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
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
- 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
5
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017
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
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
6
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017
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
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
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
7
DR.
KAREN
ADIEL
RANCES
|
JANUARY
30,
2017