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PARANASAL SINUS
ANATOMY
dr. Khuznita Dasa Novita, Sp. THT-KL
Anatomi-Histologi
Medical Faculty of Brawijaya University
2016
NOSE ANATOMY
NOSE ANATOMY
1. External Nose 2. Internal Nose
1. Bone and Cartilage 1. Vestibulum Nasi
2. Musculature 2. Cavum Nasi
3. Vascularisation 3. Batas
4. Innervation 4. Vascularisation
5. Lymphnode 5. Innervation
6. Lymphnode
7. Mucosa
NOSE
the first part of the upper
respiratory tract
Responsible for :
warming, humidifying
and, to some extent,
filtering inspired air.
Smell : contain
olfactory cells
subdivided into
external nose
internal chamber
1. External Nose
Bony Skeleton of The External Nose
Consist of :
1. Nasal bone / os nasal
(paired)
2. Frontal process of maxilla /
Proc Frontalis Os Maxilla
(paired)
3. Nasal process of frontal /
Proc Nasalis Os Frontal
(paired)
Cartilaginous Skeleton of The External Nose
Consists of :
1. the paired lateral process
septal cartilage
2. The paired major alar
cartilages
3. several minor alar nasal
cartilages
4. Superior margin of septal
cartilage
External Nose
APERTURA PIRIFORMIS
MUSCULATURE VASCULARISATION
LIMFONODULI INERVATION
2. Nasalis muscle
Musculatur of
External Nose 4. Levator labii superioris
alaeque nasi
Internal Nose Nostril Choana
It is divided into right and
left nasal cavities by
nasal septum.
naris or nostril -
choana.
consists of :
Nasal Vestibule :
skin-lined portion
Nasal Cavity :
mucosa-lined portion
Limen nasi
Choana
Nostril
Nasal Vestibule Limen nasi
Anterior and inferior part
of nasal cavity is called
vestibule. Choana
Nostril
lined by skin
contains :
sebaceous glands,
hair follicles (vibrissae)
Its upper limit on the
lateral wall is marked by
limen nasi (nasal valve)
Nasal Cavity
LATERAL NASAL WALL MEDIAL WALL
ROOF FLOOR
SUPERIOR TURBINATE
Dibawahnya ada Meatus Nasi Superior muara Sinus Ethmoid Posterior &
Sphenoid
SUPREMA TURBINATE
Terkecil & biasanya rudimenter
Lateral Nasal Wall
Medial Nasal Wall
The medial wall of
each nasal cavity is
the nasal septum
bone
(posteriorly) and
cartilage
(anteriorly)
Medial Nasal Wall - Bone
1. vomer
2. perpendicular 3
plate of the 2
ethmoid
3. nasal spine of
the frontal
bones
4. nasal crests of
the maxilla and
5. Nasal crests of
palatine bones
1 5 4
Medial Nasal Wall - Cartilage
1. Septal Cartilage
(Lamina
Kuadrangularis)
2. Columella
1
LINING MEMBRANE
OF INTERNAL NOSE 3. RESPIRATORY REGION
Nasal Septum 2/3 inf
1. VESTIBULE :
lined by skin containing hair, hair Cavum nasi floor
follicles and sebaceous glands. Lateral wall of cavum
nasi below Superior
turbinate
2. OLFACTORY REGION
Nasopharyng sup
Nasal Septum 1/3 sup
Cavum nasi roof Paranasal sinus
Superior turbinate Pseudostratified Columnar
Pseudostratified Columnar Non Ciliated Epithel contains
Ciliated Epithel plenty of goblet cells
Contains 3 cells : highly vascular and contains
1.Supporting Cell erectile tissue
2.Basal Cell
3.Olfactory Cell
OLFACTORY REGION
Internal Nose -
Innervation 3. Autonomic nerves
control nasal secretion,
1. Olfactory Nerves : vasoconstriction/vasodilatation
- sense of smell Parasympathetic :
- olfactory cells (1220 greater superficial petrosal
nerves) the cribriform plate
nerve
and end in the olfactory bulb
sphenopalatine ganglion
vidian nerve
2. Sensoric Nerves Sympathetic :
Anterior ethmoidal nerve Ganglion cervicalis superior
(anterior & superior) Ganglion Sphenopalatina
Branches of sphenopalatine
ganglion (2/3 posterior
Excessive rhinorrhoea in cases of
septum & lateral wall)
vasomotor and allergic rhinitis
Branches of infraorbital can be controlled by section of
nerve. the vidian nerve.
Internal Nose - Innervation
A. The lateral wall of the left nasal cavity. B, The medial wall of the left
nasal cavity
Internal Nose - Vascularisation
Nose is richly supplied by both the external and internal
carotid systems, both on the septum and the lateral walls.
LITTLES AREA (Kiesselbachs plexus)
in the anterior inferior part of nasal septum, just above the vestibule.
Plexux of arteries :
anterior ethmoidal,
septal branch of superior labial,
septal branch of sphenopalatine and
the greater palatine,
Epistaxis anterior, usualy in children
WOODRUFFS PLEXUS
It is a plexus of veins (a. sfenopalatina & a. faringeal posterior)
situated inferior to posterior end of inferior turbinate. It is a site of
posterior epistaxis in adults.
Vascularisation of
Nasal Septum
Vascularisation of
Lateral Wall
Functions Of The Nose
Classified as:
1. Respiration.
2. Air-conditioning of inspired air.
3. Protection of lower airway.
4. Vocal resonance.
5. Nasal reflex functions.
6. Olfaction.
Disease Of External Nose
1. CELLULITIS
The nasal skin may be invaded by streptococci or staphylococci
leading to a red, swollen and tender nose.
Treatment : systemic antibacterials, hot fomentation and
analgesics.
2. NASAL DEFORMITIES
Deformities on nasal dorsum
may involve bony,
cartilaginous or both
components of nasal dorsum
3. Benign Tumor
4. Malignant Tumor
Disease of Nasal Vestibule
FURUNCLE
an acute infection of the hair follicle by Staphylococcus aureus.
predisposing factor : trauma from picking of the nose or plucking
the nasal vibrissae
VESTIBULITIS
diffuse dermatitis of nasal vestibule.
predisposing factor : nasal discharge, due to any cause such as
rhinitis, sinusitis or nasal allergy, coupled with trauma of
handkerchief
The causative organism : S. aureus.
FRACTURE of NASAL BONES
The most common
injury to the facial
skeleton
Require reduction to
avoid osmetic deformity.
The terminal branch of
the anterior ethmoidal
nerve and its
accompanying vessels
are at risk when injuries
involve the dorsum of the
nose.
The danger triangle of the face
consists of the area from the corners
of the mouth to the bridge of the
nose, including the nose and
maxilla.
venous communication
(via the ophthalmic veins) between the
facial vein and the cavernous sinus.
The cavernous sinus lies within the
cranial cavity, between layers of the
meninges
Epistaxis
SITES OF EPISTAXIS
1. Littles area : 90% cases of epistaxis
2. Above the level of middle turbinate. Bleeding from above
the middle turbinate and corresponding area on the septum is often
from the anterior and posterior ethmoidal vessels (internal carotid
system).
3. Below the level of middle turbinate : from the branches of
sphenopalatine artery.
4. Posterior part of nasal cavity. Here blood flows directly
into the pharynx.
5. Diffuse. Both from septum and lateral nasal wall. This is
often seen in general systemic disorders and blood dyscrasias.
6. Nasopharynx.
ANATOMI PARANASAL SINUS
PARANASAL SINUS
Cavity in skull around the nose
Divided into 2 groups
E. anterior : 22x22x10 mm
Tumbuh saat usia kehamilan E. posterior : 20x20x10 mm
3-4 bln, berupa evaginasi
dinding lateral nasi Jumlah : 10 - 15 selulae / sisi
ke regio meatus medius Volume : 14 - 15 cc
Etmoid anterior
ke regio meatus superior
Etmoid posterior Berhubungan dengan
Fossa Cranii Anterior
Orbita
Saccus Lacrimalis
Nervus Opticus
...sinus ethmoidalis...
Embriologi
berkembang pertama kali saat usia kehamilan 65 hari
dimulai sbg tunas sepanjang permukaan inferolateral bagian
ethmoid dari kapsul nasalis
Ukuran
Saat lahir : 7 x 4 x 4 mm
Dewasa : 34 x 33 x 23 mm
Volume (Dewasa) : 14,75 cc
...sinus maksilaris...
Sinus terbesar
Berbentuk piramida Dasar : dinding lateral cavum nasi
Ostium terletak di atas antara
dinding medial / dasar piramid
dengan atap ke hiatus semilunaris
Embriologi
Perluasan ke atas dari bagian anterior kapsul
nasalis dalam regio resesus frontalis pada 4
bulan kehamilan.
Ukuran
Dewasa : 28 x 27 x 17 mm
Volume (Dewasa): 6 - 7 cc
Berhubungan dengan
VENA
Fossa Cranii Anterior
Vena Ophthalmica superior Orbita
Sinus Cavernosus Kulit & Periost Dahi
Mulai berkembang pada
usia 8 tahun
SARAF
Embriologi
Berasal dari Evaginasi Mukosa Resesus
Sphenoidalis pada 3 bulan kehamilan.
Ukuran
Dewasa : 14 x 14 x 12 mm
Volume (Dewasa) : 7,5 cc
47
...sinus
sphenoidalis...