WINDSOR

UNIVERSITY
SCHOOL OF MEDICINE

 THE NOSE
 REGION.
Dr.Vishal 


Surender .MD.
THE NOSE part of the respiratory
tract superior to the
hard palate and contains
the peripheral organ of
smell.

COMPONENTS
External Nose
Nasal Cavity- divided in
to right and lf by nasal
septum and each
nasal cavity further
divided in to olfactory and
respiratory area>

FUNCTIONS
Warm and moisten the
inspired air
Clean the inspired air by
trapping dust particles
through the vibrissae and
lining respiratory
epithelium
 varies considerably in size and shape,
mainly because of differences in the
EXTERNAL NOSE nasal cartilages.
The dorsum of the nose extends from
its superior angle, the root , to the
apex (tip) of the nose.
The inferior surface of the nose is
pierced by two piriform openings, the
nares (nostrils, anterior nasal
apertures), which are bound laterally
by the alae (wings) of the nose and
separated from each other by the nasal
septum. The external nose consists of
bony and cartilaginous parts
Superiorly – bone
nasal bones
frontal processes of the
Maxilla
nasal part of the frontal
Bone
Inferiorly - hyaline
Cartilage
septal cartilages
major and minor alar
cartilages
NASAL CAVITY
extends from the
nostrils anteriorly to
the choanae
Posteriorly

divided into right

and left halves by
the nasal septum
 Subdivisions of
nasal cavity
Vestibule
Dilatation inside nostril lined by
skin with hairs to filter
incoming Air

Olfactory region
Upper third of nasal cavity
lined
with olfactory mucosa

Respiratory region
Lower two thirds of nasal
cavity
lined with highly vascular,
glandular
respiratory mucosa to warm and
humidify air
nasal mucosa
Alternate breathing .
elationships of nasal cavity
Roof
Related anteriorly to
anterior
cranial fossa and
posteriorly
to body of sphenoid with
sphenoidal sinuses
Floor
Hard palate separating
nasal
cavity from oral cavity
Medial wall
Formed by nasal septum of
septal cartilage ,
perpendicular
plate of ethmoid , and
vomer , and the nasal crests of
the maxillary and palatine
bones.
Lateral wall
Complicated structure formed by
parts of lacrimal, ethmoid,
maxillary, palatine, sphenoid,
and inferior nasal concha bones
 Deviation of the
nasal septum
Deviation of the nasal
septum
may obstruct the nasal airway
and block the openings of the
paranasal sinuses .
Ashley Tisdale
Nasal trauma and
developmental defects are the
most common causes.

Cocaine abuse can be

diagnosed by looking at the nasal
septum which is usually
perforated.
 Lateral wall
of nasal cavity
Uneven because of nasal conchae,

Superior and middle

nasal conchae
Processes of ethmoid bone

Inferior nasal concha

Separate bone
Lateral wall
of nasal cavity
The nasal conchae divide the nasal
cavity into four passages
Sphenoethmoidal recess
receives the opening of the
sphenoidal air sinus
Superior meatus
Receives opening of posterior
ethmoidal air cells
Middle meatus
Infundibulum, ethmoidal bulla*
and
semilunar hiatus
Receives openings of frontal
and
maxillary sinuses and
anterior
and * middle ethmoidal air
cells
Inferior meatus
Receives opening of
nasolacrimal duct
BLOOD SUPPLY OF THE
NASAL CAVITY
Arterial - mainly from
branches
of the maxillary artery
 sphenopalatine artery -
branch of
the maxillary artery ; enters the
nasal cavity through the
sphenopalatine foramen
 anterior and posterior
ethmoidal
arteries - from ophthalmic artery
 alar and septal branches of
the
superior labial branch of the facial
Artery
Veins - form a rich
plexus in
the submucosa; accompany the
corresponding arteries
LYMPH DRAINAGE OF THE
NASAL CAVITY
Vestibule -
submandibular nodes

Rest of nasal cavity -

deep cervical nodes
Epistaxis
( nosebleed )
most often occurs from
the anterior nasal septum
( Kiesselbach's area ),
where branches of the
sphenopalatine ,
anterior ethmoidal ,
greater palatine , and
superior labial ( from
facial) arteries converge.
Foreign bodies in
the nasal cavity
Foreign bodies in the
nasal cavity are common in
children.

Folded, shelf-like conchae

make impaction and
retention of balloons, peas,
small toys relatively easy
Symptoms
Thick yellow nasal discharge, foul
odor from the nose, noisy breathing,
itching, nasal pain, recurrent
nosebleeds, headaches.
NERVE SUPPLY OF THE
NASAL CAVITY
1 . Special sensation :
olfactory nerves ( CN I )

2 . General sensation :
anterior part
anterior ethmoidal nerve
(from nasociliary branch of
ophthalmic nerve CN V1 )
-
-Posterior part
nasal, nasopalatine, and
palatine branches of the
pterygopalatine
ganglion and internal
nasal branch of infraorbital
nerve (from maxillary
nerve CN V2 )
NERVE SUPPLY OF THE NASAL
CAVITY
3 . Autonomic :
Preganglionic
parasympathetic
innervation to glands derived
from
facial nerve ( CN VII ) with
postganglionic fibers from
cell
bodies in pterygopalatine
ganglion distributed through
branches of ganglion and
maxillary
nerve
Postganglionic sympathetic
innervation to blood vessels
from
cell bodies in superior
cervical
ganglion distributed through
branches of maxillary nerve and
pterygopalatine ganglion and also
through perivascular plexuses
PARANASAL
SINUSES
 Develop as outgrowths of
nasal mucosa into bones
surrounding nasal cavity
 Innervated by maxillary and
ophthalmic divisions of CN V
 Reduce weight of skull, serve
as resonating chambers for
sound production, and
increase surface area for
warming and humidifying
inspired air
 Communicate with the
nasal
cavity through small
apertures or openings
Maxillary sinus
Largest of paranasal sinuses
and already present at
birth
Located within body of
maxilla
lateral to nasal cavity and
inferior to orbit
Drains into middle meatus
through semilunar hiatus
Variably related to roots
of
maxillary molars
Maxillary sinusitis
In maxillary sinusitis , the
sinus
accumulates mucus. Because the ostium
of the maxillary sinus is well above
the
level of its floor, its drainage is
inefficient,
particularly when inflamed.
To facilitate drainage, an accessory
opening may be created surgically ,
often
into the inferior meatus .
Only a thin layer of bone and just
mucous
membrane may separate the roots of
the
maxillary teeth from the sinus
cavity , and
sinusitis frequently produces a
toothache .
If only a thin layer of bone covers
the
roots of the molars, extraction may
create a fistula between the sinus
 Sphenoidal sinus
Lies within body of
sphenoid and is divided into
left and right sinuses by
oblique bony septum , each
draining into
sphenoethmoidal recess
Supplied by maxillary and
ophthalmic nerves and
sphenopalatine
and ophthalmic arteries

Important relationships :
Superiorly : pituitary gland in
hypophyseal fossa and optic
chiasma and
nerves
Inferiorly : nasal cavity and
nasopharynx
Laterally : cavernous sinus and
internal carotid artery
Posteriorly : brainstem in
posterior cranial fossa
Sphenoiditis
Relationships of the
sphenoidal sinus are
clinically
important ; because of potential
injury during pituitary
surgery and the possible
spread of infection .
Infection can reach the sinuses
through their ostia from the
nasal cavity or through their
floor from the nasopharynx .
Infection may erode the walls to
reach the cavernous sinuses,
pituitary gland , optic nerves ,
or optic chiasma
Ethmoidal sinus
Related :
Medially - to nasal cavity ,
Laterally - to orbit ,
Superiorly - to anterior cranial fossa
Consists of anterior , middle , and
posterior ethmoidal air cells
Anterior ethmoidal cells : open into
middle meatus ( anterior ethmoidal
nerve and artery)
Middle ethmoidal cells : open into
middle meatus ( anterior ethmoidal
nerve and artery)
Posterior ethmoidal cells : open into
superior meatus and share nerve
and blood supply with sphenoidal
sinus

Ethmoiditis
Infection in the ethmoidal
sinuses can erode the
medial wall of the orbit,
resulting in orbital
cellulitis that can spread to
the cranial cavity.
 Frontitis
Frontal sinus Frontal sinusitis is usually
Paired sinus of highly accompanied by maxillary
variable size in sinusitis because of the close
squamous and orbital relationship of the ostia in the
parts of frontal bone middle meatus.
that Frontal sinusitis may erode
drains by infundibulum the thin bone of the anterior
into middle meatus cranial fossa, producing
Related posteriorly to meningitis and / or brain
anterior cranial fossa abscess.
and interiorly to orbit Despite antibiotic therapy,
Supplied by sinusitis with intracranial spread
supratrochlear and is a significant source of
supraorbital nerves and morbidity and mortality.
arteries