NOSE and

PARANASAL SINUS
ANATOMY
dr. Khuznita Dasa Novita, Sp. THT-KL
Anatomi-Histologi
Medical Faculty of Brawijaya University
2016
NOSE ANATOMY
NOSE ANATOMY
1. External Nose 2. Internal Nose
1. Bone and Cartilage 1. Vestibulum Nasi
2. Musculature 2. Cavum Nasi
3. Vascularisation 3. Batas
4. Innervation 4. Vascularisation
5. Lymphnode 5. Innervation
6. Lymphnode
7. Mucosa
NOSE
the first part of the upper
respiratory tract
Responsible for :
warming, humidifying
and, to some extent,
filtering inspired air.
Smell : contain
olfactory cells
subdivided into
external nose
internal chamber
1. External Nose
Bony Skeleton of The External Nose

Nasal process of frontal

Consist of :
1. Nasal bone / os nasal
(paired)
2. Frontal process of maxilla /
Proc Frontalis Os Maxilla
(paired)
3. Nasal process of frontal /
Proc Nasalis Os Frontal
(paired)
Cartilaginous Skeleton of The External Nose
Consists of :
1. the paired lateral process
septal cartilage
2. The paired major alar
cartilages
3. several minor alar nasal
cartilages
4. Superior margin of septal
cartilage
External Nose
APERTURA PIRIFORMIS

A boney inlet that

forms the anterior
nasal opening
Pear shape
Composed by :
1. Nasal Bone

2. Frontal pocess of maxilla

3. Alveolar process of maxilla

 EXTERNAL NOSE

MUSCULATURE VASCULARISATION

Dilator A. Dorsalis Nasi (branch of A. carotis

M. Procerus interna)
M. Quadratus Labii
Superior caput angulare A. Angularis (branc of A. carotis
Constrictor externa)
M. Nasalis
M. Depressor Nasi V. Angularis Sinus Cavernosus

LIMFONODULI INERVATION

Ln. Submaxillaris Skin : cab. N. Trigeminus

Ln. Parotis Muscle : cab. N. Facialis
1. Procerus muscle

2. Nasalis muscle

3. Depressor nasi muscle

Musculatur of
External Nose 4. Levator labii superioris
alaeque nasi
Internal Nose Nostril Choana
It is divided into right and
left nasal cavities by
nasal septum.
naris or nostril -
choana.
consists of :
Nasal Vestibule :
skin-lined portion
Nasal Cavity :
mucosa-lined portion
 Limen nasi

Choana
Nostril
Nasal Vestibule Limen nasi
Anterior and inferior part
of nasal cavity is called
vestibule. Choana
Nostril
lined by skin
contains :
sebaceous glands,
hair follicles (vibrissae)
Its upper limit on the
lateral wall is marked by
limen nasi (nasal valve)
 Nasal Cavity
LATERAL NASAL WALL MEDIAL WALL

Turbinates or conchae (scrolllike Nasal septum

bony projections) covered by
mucous membrane

ROOF FLOOR

Anterior : nasal bones Anterior three-fourths : palatine

Posterior : sphenoid bone process of the maxilla
Middle : cribriform plate of Posterior one-fourth : horizontal
ethmoid (olfactory nerves enter part of the palatine bone
the nasal cavity)
Lateral Nasal Wall
INFERIOR TURBINATE
Terbesar & terpanjang
Kaya pembuluh darah Plx.
Cavernosus Concharum
Dibawahnya ada Meatus Nasi
Inferior muara Duct.
Nasolacrimalis
( Katub Hasner )
SUPERIOR TURBINATE
Dibawahnya ada Meatus Nasi Superior muara Sinus Ethmoid Posterior &
Sphenoid
SUPREMA TURBINATE
Terkecil & biasanya rudimenter
MEDIAL TURBINATE
Dibawahnya ada Meatus Nasi Medius
muara Sinus Frontalis, Etmoid Anterior
& Maxillaris
Kompleks Ostiomeatal ( KOM )
a. Proc. Unsinatus
b. Infundibulum Ethmoid
c. Hiatus Semilunaris
d. Bula Ethmoid
e. Agger Nasi
f. Recessus Frontal
Lateral Nasal Wall
 Medial Nasal Wall
The medial wall of
each nasal cavity is
the nasal septum
bone
(posteriorly) and
cartilage
(anteriorly)
Medial Nasal Wall - Bone
1. vomer
2. perpendicular 3
plate of the 2
ethmoid
3. nasal spine of
the frontal
bones
4. nasal crests of
the maxilla and
5. Nasal crests of
palatine bones

1 5 4
 Medial Nasal Wall - Cartilage
1. Septal Cartilage
(Lamina
Kuadrangularis)
2. Columella

1
LINING MEMBRANE
OF INTERNAL NOSE 3. RESPIRATORY REGION
Nasal Septum 2/3 inf
1. VESTIBULE :
lined by skin containing hair, hair Cavum nasi floor
follicles and sebaceous glands. Lateral wall of cavum
nasi below Superior
turbinate
2. OLFACTORY REGION
Nasopharyng sup
Nasal Septum 1/3 sup
Cavum nasi roof Paranasal sinus
Superior turbinate Pseudostratified Columnar
Pseudostratified Columnar Non Ciliated Epithel contains
Ciliated Epithel plenty of goblet cells
Contains 3 cells : highly vascular and contains
1.Supporting Cell erectile tissue
2.Basal Cell
3.Olfactory Cell
OLFACTORY REGION
Internal Nose -
Innervation
1. Olfactory Nerves :
- sense of smell
- olfactory cells (1220
nerves) the cribriform plate
and end in the olfactory bulb
2. Sensoric Nerves
Anterior ethmoidal nerve
(anterior & superior)
Branches of sphenopalatine
ganglion (2/3 posterior
septum & lateral wall)
Branches of infraorbital
nerve.
3. Autonomic nerves
control nasal secretion,
vasoconstriction/vasodilatation
Parasympathetic :
greater superficial petrosal
nerve
sphenopalatine ganglion
vidian nerve
Sympathetic :
Ganglion cervicalis superior
Ganglion Sphenopalatina
Excessive rhinorrhoea in cases of
vasomotor and allergic rhinitis
can be controlled by section of
the vidian nerve.
Internal Nose - Innervation

A. The lateral wall of the left nasal cavity. B, The medial wall of the left
nasal cavity
Internal Nose - Vascularisation
Nose is richly supplied by both the external and internal
carotid systems, both on the septum and the lateral walls.
LITTLES AREA (Kiesselbachs plexus)
in the anterior inferior part of nasal septum, just above the vestibule.
Plexux of arteries :
anterior ethmoidal,
septal branch of superior labial,
septal branch of sphenopalatine and
the greater palatine,
Epistaxis anterior, usualy in children
WOODRUFFS PLEXUS
It is a plexus of veins (a. sfenopalatina & a. faringeal posterior)
situated inferior to posterior end of inferior turbinate. It is a site of
posterior epistaxis in adults.
Vascularisation of
Nasal Septum
Vascularisation of
Lateral Wall
Functions Of The Nose
Classified as:
1. Respiration.
2. Air-conditioning of inspired air.
3. Protection of lower airway.
4. Vocal resonance.
5. Nasal reflex functions.
6. Olfaction.
Disease Of External Nose
1. CELLULITIS
The nasal skin may be invaded by streptococci or staphylococci
leading to a red, swollen and tender nose.
Treatment : systemic antibacterials, hot fomentation and
analgesics.

2. NASAL DEFORMITIES
Deformities on nasal dorsum
may involve bony,
cartilaginous or both
components of nasal dorsum

3. Benign Tumor
4. Malignant Tumor
Disease of Nasal Vestibule
FURUNCLE
an acute infection of the hair follicle by Staphylococcus aureus.
predisposing factor : trauma from picking of the nose or plucking
the nasal vibrissae

VESTIBULITIS
diffuse dermatitis of nasal vestibule.
predisposing factor : nasal discharge, due to any cause such as
rhinitis, sinusitis or nasal allergy, coupled with trauma of
handkerchief
The causative organism : S. aureus.
FRACTURE of NASAL BONES
The most common
injury to the facial
skeleton
Require reduction to
avoid osmetic deformity.
The terminal branch of
the anterior ethmoidal
nerve and its
accompanying vessels
are at risk when injuries
involve the dorsum of the
nose.
The danger triangle of the face
consists of the area from the corners
of the mouth to the bridge of the
nose, including the nose and
maxilla.

venous communication
(via the ophthalmic veins) between the
facial vein and the cavernous sinus.
The cavernous sinus lies within the
cranial cavity, between layers of the
meninges
Epistaxis
SITES OF EPISTAXIS
1. Littles area : 90% cases of epistaxis
2. Above the level of middle turbinate. Bleeding from above
the middle turbinate and corresponding area on the septum is often
from the anterior and posterior ethmoidal vessels (internal carotid
system).
3. Below the level of middle turbinate : from the branches of
sphenopalatine artery.
4. Posterior part of nasal cavity. Here blood flows directly
into the pharynx.
5. Diffuse. Both from septum and lateral nasal wall. This is
often seen in general systemic disorders and blood dyscrasias.
6. Nasopharynx.
ANATOMI PARANASAL SINUS
PARANASAL SINUS
Cavity in skull around the nose
Divided into 2 groups

ANTERIOR GROUP POSTERIOR GROUP

Maxilary Sinus, Posterior Etmoidal

etmoidalis anterior Sinus & sfenoidalis
sinus& frontalis sinus sinus

meatus nasi medius meatus nasi superior

 SINUS ETHMOIDALIS

EMBRIOLOGI UKURAN DEWASA

E. anterior : 22x22x10 mm
Tumbuh saat usia kehamilan E. posterior : 20x20x10 mm
3-4 bln, berupa evaginasi
dinding lateral nasi Jumlah : 10 - 15 selulae / sisi
ke regio meatus medius Volume : 14 - 15 cc
Etmoid anterior
ke regio meatus superior
Etmoid posterior Berhubungan dengan
Fossa Cranii Anterior
Orbita
Saccus Lacrimalis
Nervus Opticus
 ...sinus ethmoidalis...

ARTERI VENA SARAF

Cabang nasal Vena Cabang

A. Maxillaris & posterolateral
sphenoplatina Ethmoidalis nasal dari N.
Anterior & sinus Maxillaris (V2)
posterior A. cavernosus. N. Ethmoidalis
ethmoidalis cabang N.
cabang A. Opthalmicus (
ophthalmica V1 )
dari A. Carotis
Interna.
 SINUS MAKSILARIS
ANTRUM OF HIGHMORE

Embriologi
berkembang pertama kali saat usia kehamilan 65 hari
dimulai sbg tunas sepanjang permukaan inferolateral bagian
ethmoid dari kapsul nasalis

Ukuran
Saat lahir : 7 x 4 x 4 mm
Dewasa : 34 x 33 x 23 mm
Volume (Dewasa) : 14,75 cc
 ...sinus maksilaris...

Sinus terbesar
Berbentuk piramida Dasar : dinding lateral cavum nasi
Ostium terletak di atas antara
dinding medial / dasar piramid
dengan atap ke hiatus semilunaris

Lantai : processus alveolaris

maxilla & palatum durum
Akar bbrp gigi menonjol /
Atap : dasar orbita yg tipis menembus lantai sinus ini (P2
M1dan M2)
Apex dpt meluas sampai
processus zygomaticus Lantai sinus maksila 5 10 mm
lebih rendah dp dasar cavum nasi
 ...sinus maksilaris...

ARTERI VENA SARAF

Cabang A. vena Maxillaris Sensasi mukosa

Maxillaris Plexus berasal dari
termasuk, infra Venosus nasal latero
orbital, cabang Pterygoidius posterior dan
lateral nasal dari alveolaris
Sphenopalatina, superior cabang
Palatina major N. Infraorbitalis
dan posterior dari N. Maxillaris
dan antero (V2)
superior A.
Alveolaris
 SINUS FRONTALIS

Embriologi
Perluasan ke atas dari bagian anterior kapsul
nasalis dalam regio resesus frontalis pada 4
bulan kehamilan.

Ukuran
Dewasa : 28 x 27 x 17 mm
Volume (Dewasa): 6 - 7 cc

Sering Asimetri ( 15% populasi )

& tidak berkembang ( 5% populasi)
45
 ...sinus frontalis...
ARTERI

Cabang Supratrochlearis &

Supraorbitalis A.Ophthalmica

Berhubungan dengan
VENA
Fossa Cranii Anterior
Vena Ophthalmica superior Orbita
Sinus Cavernosus Kulit & Periost Dahi
Mulai berkembang pada
usia 8 tahun
SARAF

Sensasi mukosa dari cabang

Supra trochlearis & Supra Orbital
N. Frontalis dari N. Ophthalmica
(V1)
 SINUS SPHENOIDALIS

Embriologi
Berasal dari Evaginasi Mukosa Resesus
Sphenoidalis pada 3 bulan kehamilan.

Ukuran
Dewasa : 14 x 14 x 12 mm
Volume (Dewasa) : 7,5 cc

47
 ...sinus
sphenoidalis...

Terletak di belakang cavum nasi di dalam Corpus

Os. Sphenoid
Batas Superior
Fosa cerebri media & kelenjar hipofisis
Batas Inferior
Atap nasofaring
Batas Lateral
Sinus cavernosus & A. Carotis interna
Batas Posterior
Fosa cerebri posterior daerah Pons
 ...sinus sphenoidalis...

ARTERI VENA SARAF

Cabang dari Vena Maxillaris & Nervus

A.Sphenopalatina Plexus Ethmoidalis
& A.Ethmoidalis Pterygoideus Posterior cabang
Posterior N. Ophthalmica
(V1) & cabang
Sphenopalatina
dari N. Maxillaris
(V2)
 FUNGSI SINUS PARANASAL
Sinus paranasal terbentuk akibat
pertumbuhan tulang wajah
penting untuk proses
pernapasan & mengunyah
Meringankan tengkorak &
membantu keseimbangan kepala
Resonansi Suara
Mengatur kelembaban &
menghangatkan suhu udara
inspirasi (Air Conditioning)
Penahan suhu & peredam
perubahan tekanan udara intranasal
Membantu produksi lendir (Mucous)
Meningkatkan luas permukaan
Olfactory Membrane
Pertahanan imun
Complications of Sinusitis
Sinusitis : infection is
confined only to the
sinus
Complications are said
to arise when infection
spreads into or beyond
the bony wall of the
sinus
 Orbital Complication
Orbit and its contents are closely related to the ethmoid, frontal and maxillary
sinuses, but most of the complications, however, follow infection of ethmoids
as they are separated from the orbit only by a thin lamina of bone - lamina
papyracea.
Infection travels from these sinuses either by osteitis or as thrombophlebitic
process of ethmoidal veins.
 Intracranial Complication

Frontal, ethmoid and sphenoid

sinuses are closely related to
anterior cranial fossa and
infection from these can cause:

1. Meningitis and encephalitis

2. Extradural abscess
3. Subdural abscess
4. Brain abscess
5. Cavernous sinus thrombosis.
TERIMAKASIH