Paranasal Sinuses: Anatomy and Function

Glen T. Porter, MD Francis B. Quinn, MD UTMB Department of Otolaryngology Galveston, TX January 2002
1

Case Report—1000B.C. 2

Sinus Anatomy Overview
7 bones 4 paired sinuses 4 turbinates 3 meati Drainage system Nervous supply Vascular supply Related structures

3

Embryology
Maxilloturbinal Ethmoturbinal
Middle turbinate Superior turbinate Supreme turbinate

Agger nasi Uncinate process Ethmoid infundibulum Sinuses 4
Maxillary Ethmoid

Sinus Development 5 .

6 Pediatric Sinuses .

Bony Structure Ethmoid Maxilla Palatine Lacrimal Pterygoid plate of Sphenoid Nasal Inferior Turbinate 7 .

Ethmoid Post. Sphenopalatine Internal Carotid Ophthalmic A.Arterial Supply External Carotid Maxillary A. Ethmoid Supraorbital Supratrochlear 8 . Ant.

Innervation 9 .

Neurovascular Supply 10 .

Sinus Drainage Schema 11 .

Ethmoid Sinus Development Present at birth ! Anterior/Posterior ! Variability ! Structure Volume/shape ! Roof ! Lateral wall ! 12 .

Ethmoid Roof •Anterior 2/3 •Posterior 1/3 Keros I Keros II Keros III 13 .

Onodi Cells . Frontal Bulla. Concha Bullosa.Ethmoid Cells 14 Supraorbital. Haller’s.

Ethmoid Sinus—Related Structures Basal Lamella of the Middle Turbinate ! Three planes Childhood sinus Hiatus Semiluninaris/Superior Hiatus Semilunaris Suprabullar/retrobullar recesses (Sinus Lateralis) Agger nasi cell ! Ethmoid Bulla ! ! Ethmoid Infundibulum/Uncinate Process Anterior/Posterior Ethmoid Arteries Osteomeatal complex 15 .

Basal/Ground Lamella 16 Basal/Ground Lamella Of the Middle Turbinate .

The Agger Nasi Cell 17 .

Ethmoid Bulla Uncinate Process Hiatus Semilunaris 18 .

Ethmoid Infundibulum 19 .

Suprabullar/Retrobullar Recess 20 .

Ethmoid Arteries 21 .

Osteomeatal Complex Middle meatus Maxillary Sinus Ostium Anterior Ethmoid Drainage 22 .

Maxillary Sinus Development Present at birth ! Biphasic growth ! Level of the floor ! Structure Volume & shape ! Walls. floor. roof ! 23 .

Maxillary Sinus 24 .

Maxillary Sinus 25 .

Maxillary Sinus Related Structures Fontanelles ! Natural ostium ! Haller’s Cells &Sinusitis ! Osteomeatal complex ! Accessory Ostium ! Nasolacrimal duct ! 26 .

Fontanelles 27 .

Natural Ostium -Haller’s cells Accessory Ostium 28 .

Nasolacrimal Duct 29 .

Frontal Sinus Development ! ! Frontal bone at birth Age 5 Volume and shape Ostium Walls ! Structure ! ! ! Anterior vs. posterior Related Structures ! Frontal recess 30 .

Frontal Sinus Ostium Frontal recess Boundaries Dumbbell shape Sinus Lateralis Frontal Bulla 31 .

Sphenoidal Sinus Development Arise within the nasal capsule (no pouch) Age 3 begins to pneumatize Structure ! ! ! Volume/variable pneumatization Wall thickness Position within the sphenoid ! ! Relation to sella turcica Sellar and postsellar relationships 32 .

Sphenoid Sinus Pneumatization 33 .

Sphenoid Sinus Sphenoid Sinus 34 .

Sphenoid Sinus 35 .

Sphenoid Sinus Ostium ! ! ! Size (.5-4mm) Location (sinus floor. superior turbinate. anterior sinus wall. cribiform plate) Bony dehiscence Sphenoethmoidal recess Sphenoid rostrum Onodi cell Related Structures ! ! ! 36 . anterior nasal floor.

Sphenoid Ostium Sphenoethmoid Recess Sphenoid Rostrum 37 .

The Onodi Cell 38 .

Microscopic Anatomy Mucosa ! Cilliated columnar epithelial cells Anatomy ! Beat frequency ! Inhibitory effects of contact ! ! Noncilliated columnar cells Distribution ! Function ! ! Basal cells 39 .

Microscopic Anatomy—Cont’d Goblet Cells Glycoproteins—viscosity and elasticity ! Innervation (para=thick. symp=thin) ! Basement membrane ! Submucosal glands ! Distribution 40 .

Microscopic Anatomy 41 .

immune cells ! 42 . ! Enzymes.Mucous Blanket Two layers Superficial layer ! Sol layer ! Function Superficial layer traps bacteria and particulate matter. antibodies.

Mucociliary Transport Directional Flow of Mucous ! Toward the choanae Hilding. MD Ostium drainage—a stubborn beast ! Contact inhibition Haller’s cells ! Surgery ! 43 .

Mucociliary Transport 44 .

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 45 .

New Frontiers Sleep apnea and the sinuses ! ! Humidification contributes up to 6. fungi. viruses Increases cilliary motility Nitric Oxide (NO) ! ! ! 46 .9mm Hg serum pO2 Mouth breathers noted to have decreased end-tital CO2—increased serum CO2—apneas (high baseline) NO produced primarily in sinuses Toxic to bacteria.

Case Report 39 yom with h/o sinus disease c/o headache. Clear rhinorrhea. 47 . rhinorrhea. PMHx of “sinus surgery” years ago ROS reveals h/o two episodes of meningitis in past few years PE: right superior nasal mass. S/p FESS.

48 .

Endoscopic Sinus Surgery: New Horizons. Steven C. et al. Marks.. Nikhil J. Philadelphia. Thomas V. Thorax 1999. New York. c2001.. Watelet. Berlin. Philadelphia. c2000. Lundberg. Weitzberg. 49 .. San Diego.C. Nasal Nitric Oxide in Man. Rhinologic Diagnosis and Treatment.. Allergy 1999. Van. Bhatt.B.B. 54. Head & Neck Surgery -. Theime. Saunders Co. Joao A. The Nasal Cavity and Paranasal Sinuses. 54(10):947-952. Bailey. Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. c1997.. Inc. Singular Publishing Group.. et al. E. Anatomy of the Paranasal Sinuses. c1997. Thieme. J.References Anon. Lippincott Williams & Wilkins. c1996. W. Nasal and Sinus Surgery.. McCaffrey. New York. Jack B. Supp 57:14-25. J. c2001. Navarro.Otolaryngology.. Springer. Cauwenberge P. Byron J..

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