Anatomy Sinonasal Tita

Literatur Reading :
Sinonasal Anatomy and Physiology
dr. Tita Puspitasari
Supervisor :
dr. Sinta Sari Ratunanda, MKes., Sp THT KL (K)
Dept of Otorhinolaryngology Head

and Neck Surgery
Hasan Sadikin General Hospital
Bandung
2017
EMBRIOLOGY
Embryologic development of the nasal cavity
and sinuses can be divided into two ongoing
processes.
- The embryo's head develops into a structure
with two distinct nasal cavities;
- The lateral nasal walls then invaginate to create
complex folds : turbinates, and spaces, known
as sinuses.
Leung M. Randy, Walsh E. Wiliam, Kern. C Roberts. 2014. Baileys Head and Neck Surgery Ottolaryngology.Fifth edition. Baltimore : Lippincott
William & Wilkins: 359-369
Anatomy
Netter F H,. Atlas of Human Anatomy. 6th Edition. Saunders, 2014

Arteries of Nasal Cavity
Cho H J, Kim H Y : Otolaryngology, 1st ed. InTech, 2012

Veins of Nasal Cavity
The venous
drainage is
handled by the
facial vein,
retromandibular
vein, and
internal jugular
vein.

Nerves of Nasal Cavity

Maxillary Sinus
The largest of the
paranasal sinuses
The anterior wall
derives from the facial
surface of the maxilla
The posterior wall
borders the
ptetygopalatine fossa
The medial wall
constitutes the lateral
wall of the nasal cavity
The floor of the sinus
is the alveolar process
The superior wall
serves as the orbital
floor.
30/06/2017 8
Maxillary Sinus
Pneumatized space within the maxillaty bone and is the

largest of the paranasal sinuses.
The anterior wall : Facial surface of the maxilla.
The posterior wall : Borders the ptetygopalatine fossa.
The medial wall : Lateral wall of the nasal cavity,
The floor : The alveolar process,
The superior wall : Orbital floor.
The natural ostium of the maxillary sinus opens into the
superior aspect of the medial wall to drain into the ethmoidal
infundibulum.
Frontal Sinus
10
Youngs R, Evans K, Watson M. The Paranasal Sinuses. Taylor & Francis. 2006
Frontal Sinus
The size of the frontal sinus varies depending on the degree of
pneumatization, may be completely absent (5%).
Divided by an intersinus septum.
The anterior table is twice as thick as the posterior table,
which separates the sinus from the anterior cranial fossa.
The floor of the sinus : Supraorbital roof
The drainage :
Pathway is located in the posteromedial portion of the sinus
floor.
Resembling an hourglassshaped structure in the sagittal plane
The superior portion widens into the frontal sinus and the
inferior portion expands into the frontal recess.
Anatomical Variation in Superior Attachment of Uncinate Process
and Localization of Frontal Sinus Outflow Tract
G. Arun, P. Moiden Sanum, et. al.2017. Anatomical Variation in Superior Attachment of Uncinate Process and Localization of
Frontal Sinus Outflow Tract : 176
SPHENOID
SINUS
The sphenoid sinus
has many important
neurovascular
relationships.
It relates laterally to
the cavernous sinus,
the internal carotid
artery, and cranial
nerves IIVI, and it is
very closely related to
the optic canal.
Leung RM, Walsh WE, Kern RC : Head & Neck Surgery Otolaryngology, 5th ed, . Lippincott Williams & Wilkins, 2014
13
Sphenoid Sinus
The internal carotid artery is lateral to the sphenoid sinus as it courses
through the cavernous sinus producing a prominence in the lateral
sphenoid sinus wall in 65% of individuals.
The visibility of all structures related to the walls of the sphenoid sinus
depends on the degree of pneumatization of the sinus. The degree of
pneumatization is classified into three types: sellar type (86%), presellar
(11 %), and concha] type (3%)
The sphenoid sinus ostium opens into the sphenoethmoidal recess
Identified the posteroinferior end of the superior turbinate as the best
landmark.
The ostium was located medial to the superior turbinate in 83% of cases
and lateral to it in 17%. The sphenoid septum usually deviates posteriorly
from the midline dividing the sinus into two asymmetric parts and can
insert onto thebony prominences overlying the optic nerve or carotid
artery.
Drainage of Paranasal Sinus
Watelet, JB. 2009. Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. Allergy 57, 14 - 25
Osteomeatal Unit
1. Inferior turbinate, 2. Middle turbinate, INF. Infundibulum, M. Maxillary sinus, F.

Frontal sinus, U. Uncinate process, B. Bulla ethmoid, O. Maxillary sinus ostium
Chaitanya Sai Chinala, Raviteja Atkuri. 2015.Computed Tomography Evaluation of Disease of Paranasal Sinuses. International Journal of
Recent Scientific Research. Vol 6
1. Septum, Middle turbinate, 3. Uncinate process, 4. Ethmoid bulla,
5. Inferior turbinate
Dalgorf. M Justin, Harvey. J Richard. 2015. Sinonasal Anatomy and Function. American Journal of Rhinology & Allergy.
Vol 27: 3
1. Right maxillary
procces 2. Maxillary
sinus ostium 3.
Ethmoidal
Infundibulum 4.
Hiatus semilunaris 5.
Bulla ethmoid 6.
Perpendicular plate
of ethmoid bone 7.
crista galli 8. lamina
papyracea 9. left
uncinate process
attaching medially to
the septum;
10. Middle turbinate
11. Haller cell 12.
maxillary sinus
13.Inferior turbinate.
Skull base with uncinate process attaching
superiorly to the skull base 14. Uncinate
process attaching superiorly to the skull
base
Skull base with uncinate procces attaching

laterally to the lamina papyracea 15.
Cribriform plate 16, lateral lamella 17.
Ethmoid roof 18. Left uncinate
process attaching laterally to the lamina
papyrac
Sagital view of the lateral
nasal wall 19. Inferior
turbinate 20. Middle
turbinate 21. Frontal sinus
22. Crista galli 23. Superior
turbinate 24. Sphenoid
sinus
Close up sagittal view of
the lateral nasal wall with
the middle turbinate
removed. 25. Uncinate
process 26. Ager nasi cell
27. Frontal ostium 28.
Bulla ethmoidalis 29.
Middle turbinate
cut edge 30. Superior
turbinate cut edge 31. optic
nerve prominence in the
sphenoid sinus 32. carotid
artery prominence in the
sphenoid sinus 33. sphenoid
sinus ostium 34. Inferior
turbinate cut edge
35.Nasolaaimal duct.
Axial view
36. Septum
37. Ethmoid cell
38. Ondi cell
39. Optic nerve
40. Carotid
artery
41. sphenoid sinus
Prevalence of Various Anatomical Variations
The common anatomical variations found among

the 360 CT scans evaluated were Pneumatized
Agger nasi cells ,
Concha bullosa,
Asymmetry ethmoidal roof,
Haller cells,
Asymmetry of ethmoid fovea,
Anterior ethmoidal artery canal,
Paradoxical bending of middle turbinate,
Suprabullar Cells, Infrabullar Cells, and Onodi
cells
Al-Abri Rashid, Bhargava Deepa, Al-Basam Wameedh, et. al. 2014 Clinically Significant
Anatomy Variant of The Paranasal Sinus. Oman Medical Journal. Vol 29
Frequency of Variations of Middle Turbinate
70 %
60 %
50 %
40 %
30 %
20 %
10 %
PMT Right PMT Left CB Right CB Left CB B/L
Kumar Pradeep, BS. Rakesh, Prasad Rajendra. 2016. Anatomical Variation of Sinonasal Region, a Coronal CT Scan. International Journal
of Contemporary Medical Research . Vol 3: 2601
Ephitelium
The nasal epithelium lies on a basement membrane and a

lamina propria.
Types of epithelium in the nasal cavity:
o A pseudostratified columnar epithelium (respiratory
epithelium), composed of 4 major types of cells: ciliated
(columnar) cells, nonciliated (columnar) cells, goblet cells and
basal cells.
o A squamous and transitional epithelium (stratified epithelium
containing cuboidal cells with microvilli)
o The epithelium of the paranasal sinuses, the simple ciliated
columnar type with a few goblet cells and glands
Watelet, JB. 2009. Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. Allergy 57, 14 - 2 25
Respiration
The extensive vascular and secretory systems of the
nasal cavity and paranasal sinuses serve to warm and
humidify ambient air in preparation for access to the
lower airways.
Can raise the humidity of inspired air to
approximately 85%
This moisture comes from the water content of the
mucus that is directly transudated from nasal blood
vessels and supplied by nasal glands
Olfaction
The olfactory neuroepithelium is scattered through the

superior portions of the nasal cavity, located between the
septum and medial surface of the superior turbinate
bilaterally.
Extend anteriorly onto the middle turbinate. and inferiorly
below the cribriform plate. This area is known as the
olfactory cleft
Olfactory neuron cell bodies reside superficial to the basal
cells.
Dendrites terminate in knobs at the epithelial surface.
Axons extend through the lamina propria and converge with
other axons to form nerve bundles, or fila olfactoria
Protection
Mucous blanket
Mucociliary transport
Ciliary beat
Protection
Normal sinonasal mucosa : Epithelial layer,lamina
propria, submucosa, and periosteum
Epithelial cells are ciliated, pseudo-stratified, columnar
cells with a variable number of goblet cells
Coarse nasal hairs, vibrissae, located at the nasal orifice
filter out large particles entering the nose. Smaller
particles impact the mucosa as a result of turbulent flow
and stick to the nasal mucus
Turbulence increases contact between inspired air and
the nasal mucosa enhancing not only the respiratory
functions but also olfaction and protection
Mucous Blanket
The mucous blanket is composed of two layers.
o Sol layer exists as a thin, periciliary fluid that allows the cilia to
be mobile between strokes produced by microvilli
o Gel layer is a thick sheet of mucus that supplies an insertion point
for the tips of the cilia produced by the goblet cells and
submucosal glands.
Primarily composed of mucoglycoproteins
The mucous blanket contains other components :
o Immunoglobulin A (IgA)
o Immunoglobulin G (IgG) and interferon
o Lysozyme and lactoferrin
Ciliary Movement and Mucous Blanket
Watelet, JB. 2009. Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. Allergy 57, 14 - 25
31
Mucous Blanket
Once the foreign particles or bacteria are trapped, the sinuses can effectively drain
the mucus through the mucociliary clearance system
The cilia propel the mucus at a rate of 3 to 25 mm per minute toward the natural
ostium of the ethmoidal cells and sphenoidal sinus.
The maxillary sinus has a star-shaped drainage pattern from the sinus floor superiorly
to the ostium.
The mucociliary transport of the frontal sinus sweeps in a circular pattern beginning
on the medial wall of the frontal recess, progressing toward the roof, turning
laterally, and finally curving downward and medially toward the sinus ostium.
Once the sinus drainage has taken place, the mucus is swallowed and transported to
the stomach, destroying any acquired bacteria.
Hightlights
Sinonasal embryology can be divided into two ongoing processes:
The embryo's head develops into a structure with two distinct nasal
cavities; The lateral nasal walls then invaginate to create complex
folds, known as turbinates, and spaces, known as sinuses.
The ethmoidal, maxillary; sphenoid, and frontal sinuses make up
the paranasal sinuses.
The complex and variable anatomy of the lateral nasal wall
influences approaches to endoscopic sinus surgery.
The three major functions of the nose : Olfaction,respiration, and
protection

Anatomy Sinonasal Tita

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Anatomy Sinonasal Tita

Uploaded by

Copyright:

Available Formats

Literatur Reading :

Sinonasal Anatomy and Physiology

dr. Tita Puspitasari

Dept of Otorhinolaryngology Head

Netter F H,. Atlas of Human Anatomy. 6th Edition. Saunders, 2014

Cho H J, Kim H Y : Otolaryngology, 1st ed. InTech, 2012

Netter F H,. Atlas of Human Anatomy. 6th Edition. Saunders, 2014

Netter F H,. Atlas of Human Anatomy. 6th Edition. Saunders, 2014

Pneumatized space within the maxillaty bone and is the

1. Inferior turbinate, 2. Middle turbinate, INF. Infundibulum, M. Maxillary sinus, F.

Skull base with uncinate procces attaching

The common anatomical variations found among

PMT Right PMT Left CB Right CB Left CB B/L

The nasal epithelium lies on a basement membrane and a

The olfactory neuroepithelium is scattered through the

You might also like