Anatomy and Physiology of the Nose and Paranasal Sinuses

By Dr Ma. Clarissa Fortuna Drainage

→ Superior meatus
External Topography:  Posterior ethmoid sinus
→ Bridge → Middle meatus
→ Dorsum  Maxillary sinus
→ Tip  Anterior ethmoid sinus
→ Columella  Frontal sinus
→ Alae → Inferior meatus
→ Nostril/vestibule  Nasolacrimal duct
External Nose Arterial Supply
→ Bony Framework
→ Cartilaginous framework → Internal carotid artery  opthalmic artery
 Anterior ethmoid artery
Muscles of the External Nose  Posterior ethmoid artery
→ Dilators → External carotid artery  internal maxillary artery
 Procerus  Sphenopalatine artery
 Dilatos naris  Descending palatine artery
 Angular head of the quadratus labi superioris  Pharyngeal artery
→ Constrictors  Superior labial artery
 Nasalis
 Depressor septi Venous Drainage
 Depressor aleque nasi → Ethmoidal veins  opthalmic veins  cavernous sinuses
Blood supply
→ Sphenopalatine vessels  Pterygoid Plexus  Dural
venous sinuses
→ External carotid artery  facial artery
 Lateral nasal
→ Anterior facial vein  dural venous sinuses
 Angular
Nerve supply
 Alar → Olfactory nerve
 Septal → Trigeminal nerve
 External nasal → Facial nerve
→ Internal carotid artery  opthalmic artery → Sphenopalatine ganglion
 Dorsal nasal
Epithelial lining
Innervation → Pseudostratified columnar ciliated epithelium with goblet
→ Trigeminal nerve cells
 Opthalmic Division → Nasal cilia beat 10 – 20 time/sec at room temp
♣ Nasociliary
♣ External Nasal Nasal functions
→ Smelling
♣ Infratrochlear
→ Humidification
 Maxillary Division → Filter
♣ Infraorbital → Warm
Boundaries of Internal Nose Olfaction
→ Posterior = Sphenoid → Chemical theory
→ Superior = Cribriform plate of ethmoid  Particles of odorous substances are distributed by
→ Inferior = Maxillary bone diffusion throughout the aire and cause chemical
→ Medial = septum reaction when they reach the olfactory epithelium
→ Lateral = maxillary bone → Undulation theory
 Waves of energy similar to light impinge upon the
Nasal septum olfactory nerve endings
→ Septal cartilage
→ Vomer Paranasal sinuses
→ Perpendicular plate of the ethmoid → Frontal
→ Maxillary crest → Maxillary
→ Premaxilla → Sphenoid
→ Ethmoid
Lateral Nasal Wall
→ Inferior turbinate Paranasal sinuses
→ Middle turbinate → Pseudostratified ciliated columnar epithelium
→ Superior turbinate → Drainage:
→ ???? Supreme turbinate????
 Gravity
 Active ciliary transport
1
→ Sinus drainage obstruction  infection → Basal lamella
→ Negative pressure  headache

→ Functions
 Humidification
 Vocal resonance Osteomeatal complex
 Mucus production → Contains the narrow channels that provide for
 Increased olfactory area mucociliary clearnace and venulation of the anterior
 Absorbs shock to the head ethmoid, maxillary, and frontal sinuses
→ Drainage and ventilation of the major paranasal sinuses
 Regulation of intranasal pressure
are dependent on the patency of the osteomeatal
complex
Maxillary Sinus
→ Aka: Antrum of Highmore!
→ Pyramidal in shape located in the maxillary bone
→ Largest paranasal sinus LESSA
→ Volume: 15 mL each
→ Present at birth
→ Floor is formed by the alveolar process of the maxilla

Ethmoid sinus
→ Bony labyrinth of small air cells
→ Between the medial wall of the orbit and the middle
turbinate
→ Present at birth
→ Develop as outpocketings of the medial meatus
→ Quantity: 7-15 per side, 14 mL volume
→ Anterior  drain into MIDDLE meatus
→ Posterior  drain into SUPERIOR meatus
→ Lateral wall  lamina papyracea
→ Medial wall  middle turbinate

Frontal Sinus
→ Frontal bone
→ Arise from an expansion of an anterior air cell from the
ethmoids
→ Not present until 6 y/o
→ Volume: 6-7mL per sinus
→ Drainage is via the middle meatus

Sphenoid sinus
→ Develop as excavations into the sphenoid bone at
around 4 months of age
→ Volume: 7.5 mL per sinus
→ Ostium opens into the superior meatus through the
sphenoethmoid recess
→ Borders (please refer to your Netter or Boie’s oke? )
 Anteriorly  posterior ethmoids
 Posteriorly  pons and basilar artery
 Superiorly  optic chiasma, optic nerves,
hypophysis
 Inferiorly  nasal cavity and nasopharynx
 Lateral? Surrounding?  optic nerves, cavernous
sinuses, internal carotid artery

Osteomeatal Complex
→ Uncinate process
→ Maxillary ostium
→ Middle turbinate
→ Bulla ethmoidalis
→ Ethmoid infundibulum
→ Hiatus semilunaris