Anatomy & Physiology of PNS

Dr. B. Arvind. Sangavi.

M. S. ( E. N. T.)

Associate Professor
Dept Of ENT & HNS RIMS

Paranasal sinuses

PNS are air containing cavities in the skull bones & are lined by mucosa, which drains into the nasal cavity.

Development

The PNS arise as localized epithelial invaginations or recesses of the nasal mucosa, after 2nd month. These recesses become ostia of various sinuses

PNS Groups
Anterior group : 1. Frontal Sinus 2. Maxillary sinus 3. Anterior Ethmoidal sinus 4. Middle Ethmoidal sinus Posterior Group : 1. Posterior Ethmoidal sinus 2. Sphenoid sinus

Sinus Anatomy Overview

Bony Structure

Sinus Drainage Schema

Osteomeatal Complex

Micro architectural pathway of drainage & anterior group of PNS, consists of narrow passage between uncinate process & bulla ethmoidalis. This cleft comprises of ostium & frontal recess Anatomical & pathological abnormalities in this region lead to persistent of infection & disease

Osteomeatal Complex

Middle meatus , Ethmoidal infundibulum Maxillary Sinus Ostium Frontal recess Drainage

Osteomeatal Complex

Maxillary Sinus ( Antrum of Highmore)

Present at birth Pyramidal in shape 15 ml capacity Walls : Anterior, posterior, roof & floor. Floor is 1 cm below the level of floor of nose.

Maxillary Sinus

Ostia opens into posterior part of infundibulum middle meatus Related Structures
Fontanelles Natural ostium

Hallers Cells &Sinusitis Osteomeatal complex

Accessory Ostium- 30% Nasolacrimal duct

Fontanelles

Nasolacrimal Duct

Frontal Sinus

Not present at birth, develops at age 5 Between outer & inner table of frontal bone Varies in size/shape Average 7 ml capacity Ostia floor Opens into middle meatus frontal recess, infundibulum

Frontal Sinus
Ostium Frontal recess
Boundaries Dumbbell shape

Sinus Lateralis Frontal Bulla

Ethmoid Sinus

Present at birth Occupies the med wall of orbit & upper third of lat wall of nose Anterior/Posterior group 3-18 air cells Antr - middle meatus Postr superior meatus

Ethmoid Roof

Anterior 2/3 Posterior 1/3 Keros I Keros II Keros III

Ethmoid Cells

Supraorbital, Frontal Bulla, Concha Bullosa, Hallers, Onodi Cells

Onodi cell Onodi cell : posterior ethmoidal cells may extend lateral to sphenoid sinus where it is related to optic nerve.

Ethmoid SinusRelated Structures

Basal Lamella of the Middle Turbinate

Three planes
Childhood sinus Suprabullar/retrobullar Hiatus Semiluninaris/Superior recesses (Sinus Lateralis)

Agger nasi cell

Ethmoid BullaHiatus Semilunaris

Ethmoid Infundibulum/Uncinate Process Anterior/Posterior Ethmoid Arteries Osteomeatal complex

Ethmoid Bulla Uncinate Process Hiatus Semilunaris

Sphenoidal Sinus

Situated in body of sphenoid Two halves, separated by septa-asymmetric Drains into sphenoethmoidal recess Superior- pituitary, optic chiasma, olfactory tract, frontal lobe Inferior- nasopharynx Anterior- nasal cavity Lateral- cavernous sinus, int. carotid artery, C. N. III, IV, VI, V

Sphenoid Sinus

Sphenoid Sinus

Sphenoid Ostium Sphenoethmoidal Recess Sphenoid Rostrum

Blood Supply : Infraorbital & supr dental art- Int max artery Br of antr & postr ethmoidal artery Pharyngeal br of Int max artery Lymphatic drainage Lateral retropharyngeal & JD nodes

Physiology of PNS

Ventilation is paradoxical- air empties during inspiration & is filled with air during expiration Mucosa - ciliated columnar epithelium Goblet Cells

Glycoproteinsviscosity and elasticity Innervation (para=thick, symp=thin)

Basement membrane Sub mucosal glands.

Microscopic Anatomy

Mucous Blanket

Two layers
Superficial layer Sol layer

Function
Superficial layer traps bacteria and particulate matter. Enzymes, antibodies, immune cells

Mucociliary Transport

Directional Flow of Mucous

Toward the choanae

Ostium drainage Contact inhibition

Hallers cells Surgery

Mucociliary Transport

Function of Paranasal Sinuses

Humidifying and warming inspired air Regulation of intranasal pressure Increasing surface area for olfaction Lightening the skull Resonance Absorbing shock Contribute to facial growth

Thank you..