aranasal Sinuses

The paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity into the
following cranial bones: frontal, ethmoid, sphenoid, and maxilla (Fig. 7.40). They are named according to
the bones in which they are located.
The frontal sinuses are between the outer and the inner tables of the frontal bone, posterior to the
superciliary arches and the root of the nose. Each sinus drains through a frontonasal duct into the
ethmoidal infundibulum, which opens into the semilunar hiatus of the middle meatus. The frontal
sinuses are innervated by branches of the supraorbital nerves (CN V
1
).
The ethmoidal cells (sinuses) include several cavities that are located in the lateral mass of the ethmoid
between the nasal cavity and the orbit. The anterior ethmoidal cells drain directly or indirectly into the
middle meatus through the infundibulum. The middle ethmoidal cells open directly into the middle
meatus. The posterior ethmoidal cells, which form the ethmoidal bulla, open directly into the superior
meatus. The ethmoidal sinuses are supplied by the anterior and posterior ethmoidal branches of the
nasociliary nerves (CN V
1
) (Fig. 7.39C).
Epistaxis
Epistaxis (nose bleeding) is relatively common because of the rich blood supply to the nasal mucosa. In
most cases, the cause is trauma, and the bleeding is from an area in the anterior third of the nose
(Kiesselbach area). Recall that this area is supplied by the anastomosing of branches from five different
arterial sources (Fig. 7.39B). Spurting of blood from the nose results from rupture of these arteries. Mild
epistaxis may also result from nose picking, which tears veins in the vestibule of the nose.
CSF Rhinorrhea
Although nasal discharges are commonly associated with upper respiratory tract infections, a nasal
discharge after a head injury may be cerebrospinal fluid. CSF rhinorrhea results from fracture of the
cribriform plate, tearing of the cranial meninges, and leakage of CSF from the nose.
Rhinitis
The nasal mucosa becomes swollen and inflamed (rhinitis) during upper respiratory infections and
allergic reactions (e.g., hayfever). Swelling of this mucous membrane occurs readily because of its
vascularity and abundant mucosal glands. Infections of the nasal cavities may spread to the:
Anterior cranial fossa through the cribriform plate.
Nasopharynx and retropharyngeal soft tissues.
Middle ear through the pharyngotympanic (auditory) tube.
Paranasal sinuses.
Lacrimal apparatus and conjunctiva.
The sphenoidal sinuses, unevenly divided and separated by a bony septum, occupy the body of the
sphenoid bone; they may extend into the wings of this bone in the elderly. Because of these sinuses, the
body of the sphenoid is fragile. Only thin plates of bone separate the sinuses from several important
structures: the optic nerves and optic chiasm, the pituitary gland, the internal carotid arteries, and the
cavernous sinuses. The posterior ethmoidal artery and nerve supply the sphenoidal sinuses (Fig. 7.40).
The maxillary sinuses are the largest of the paranasal sinuses (Fig. 7.40B & C). These large pyramidal
cavities occupy the bodies of the maxillae. The apex of the maxillary sinus extends toward and often into
the zygomatic bone. The base of the maxillary sinus forms the inferior part of the lateral wall of the
nasal cavity. The roof of the maxillary sinus is formed by the floor of the orbit. The floor of the maxillary
sinus is formed by the alveolar part of the maxilla. The roots of the maxillary teeth, particularly the first
two molars, often produce conical elevations in the floor of the maxillary sinus. Each sinus drains by an
opening, the maxillary ostium (Fig. 7.40A), into the middle meatus of the nasal cavity by way of the
semilunar hiatus. Because of the superior location of this opening, it is impossible for the sinus to drain
when the head is erect until the sinus is full. The arterial supply of the maxillary sinus is mainly
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from superior alveolar branches of the maxillary artery; however, branches of the greater palatine
artery supply the floor of the sinus (Fig. 7.39B). Innervation of the maxillary sinus is from the anterior,
middle, and posterior superior alveolar nerves (Fig. 7.29A), branches of CN V
2
.
Infection of Ethmoidal Cells
If nasal drainage is blocked, infections of the ethmoidal cells of the ethmoidal sinuses may break
through the fragile medial wall of the orbit. Severe infections from this source may cause blindness
because some posterior ethmoidal cells lie close to the optic canal, which gives passage to the optic
nerve and ophthalmic artery. Spread of infection from these cells could also affect the dural sheath of
the optic nerve, causing optic neuritis.
Infection of Maxillary Sinuses
The maxillary sinuses are the most commonly infected, probably because their ostia are small and
located high on their superomedial walls (Fig. 7.40A and B), a poor location for natural drainage of the
sinus. When the mucous membrane of the sinus is congested, the maxillary ostia often are obstructed.
The maxillary sinus can be cannulated and drained by passing a cannula from the nares through the
maxillary ostium into the sinus.
The proximity of the molar teeth to the floor of the maxillary sinus poses potentially serious problems.
During removal of a maxillary molar tooth, a fracture of a root may occur. If proper retrieval methods
are not used, a piece of the root may be driven superiorly into the maxillary sinus. As a result a
communication may be created between the oral cavity and the maxillary sinus