Dr.Ban I.S. head & neck anatomy 2nd y.

Lec.[10]: External nose and nasal cavity:

The nose is pyramidal in form, the root of the nose consists of Frontal, Maxilla
(frontal process) and Nasal bones, the dorsum and apex of the nose consist of: Septal,
lateral nasal and alar cartilages. Because the dorsum and apex are cartilaginous, the nose
is quite mobile.
The cavity of the nose opposite the alar cartilage is called the vestibule and is lined
by many coarse hairs called vibrissae. At the apex are found the 2 nostrils, or anterior
nares, which are separated by the septum.
VASCULAR SUPPLY OF THE NOSE
The blood supply to the nose arises from 3 major arteries: Ophthalmic , Maxillary
and Facial. These arteries anastomose along the nose.
A\Ophthalmic artery : branch from Internal carotid a. Enters the orbit through the optic
foramen, it gives rise to 2 major branches that supply the nose:
1- Dorsal nasal artery: the terminal of ophthalmic artery. Exits the orbit with the
infratrochlear n. Supplies the area along the root of the nose
2- External nasal artery: A terminal branch of anterior ethmoid a., Supplies the area
along the external nose at the junction between the nasal bone and the lateral
nasal cartilage.

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 Dr.Ban I.S. head & neck anatomy 2nd y.

B\Maxillary artery: via nasal branch of the infraorbital a.

C\ Facial artery: it gives rise to 2 branches that supply the nose:
1- lateral nasal a. Supplies the ala and dorsal surface of nose.
2- superior labial a. gives rise to septal branch, Supplies the septum.
VENOUS DRAINAGE: angular v., facial v., Superior ophthalmic and Inferior ophthalmic v.
and communicate with the pterygoid plexus

NERVE SUPPLY OF THE NOSE:

1- The Infratrochlear nerve, a branch of ophthalmic nerve, supplies the skin of root
of the nose.

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 Dr.Ban I.S. head & neck anatomy 2nd y.

2- The external nasal nerve, a branch of the ophthalmic nerve (CN V1), supplies the
skin of the dorsum of nose, nasal alae and nasal vestibule.
3- The infraorbital nerve, a branch of the maxillary nerve (CN v2). Supplies the lateral
aspects of the nose.
4- Motor innervation to the nasal muscles of facial expression is via the facial nerve.

The primary lymphatic drainage of the nose is into the submandibular lymph nodes
Nasal Cavity Anatomy:
The nasal cavity is divided into right and left halves by the nasal septum.
Walls of the Nasal Cavity: Each half of the nasal cavity has a floor, a roof, a lateral wall,
and a medial or septal wall.

Floor: The palatine process of the maxilla and the horizontal plate of the palatine bone
Roof: The roof is narrow and is formed anteriorly by the nasal and frontal bones, in the
middle by the cribriform plate of the ethmoid.
Posteriorly: by the downward sloping body of the sphenoid.

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 Dr.Ban I.S. head & neck anatomy 2nd y.

Lateral Wall: maxilla [frontal process], lacrimal, Ethmoid bone [superior and middle
conchae], inferior concha, perpendicular plate of the palatine bone and the medial plate
of the pterygoid process of the sphenoid bone.
The space below each concha is called a meatus.
Sphenoethmoidal Recess: The sphenoethmoidal recess is a small area above the superior
concha. It receives the opening of the sphenoid air sinus.
Superior Meatus: The superior meatus lies below the superior concha. It receives the
openings of the posterior ethmoid sinuses.

Middle Meatus: The middle meatus lies below the middle concha. It has a rounded
swelling called the bulla ethmoidalis that is formed by the middle ethmoidal air sinuses,
which open on its upper border.
A curved opening, the hiatus semilunaris, lies just below the bulla. The anterior
end of the hiatus leads into a funnel-shaped channel, which is continuous with the frontal
sinus. The maxillary sinus opens into the middle meatus through the hiatus semilunaris.
Inferior Meatus: The inferior meatus lies below the inferior concha and receives the
opening of the lower end of the nasolacrimal duct, which is guarded by a fold of mucous
membrane.

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 Dr.Ban I.S. head & neck anatomy 2nd y.

Medial Wall: The medial wall is formed by the nasal septum. The upper part is formed
by the perpendicular plate of the ethmoid and the lower part by the vomer. The anterior
part is formed by the septal cartilage.
Incisive Canal: This canal is located in the floor of the nasal cavity, posterior to the central
incisor, and lateral to the nasal septum. This structure transmits the nasopalatine nerve
into the oral cavity and the greater palatine artery into the nasal cavity.

Sphenopalatine Foramen: This foramen connects the nasal cavity to the pterygopalatine
fossa and is posterior to the superior meatus.
Nerve Supply of the Nasal Cavity:

1- The olfactory nerves from the olfactory mucous membrane in the superior
portion of the nasal cavity.
Nerve Supply of the Nasal Cavity:

1- The olfactory nerves from the olfactory mucous membrane in the superior
portion of the nasal cavity.

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Dr.Ban I.S. head & neck anatomy 2nd y.

2- Ophthalmic Branches (V1): As the ophthalmic nerve begins to branch, it gives off a
nasociliary branch, which then provides the anterior and posterior ethmoid nerves.
A- The anterior ethmoid gives off:
• an external branch that supplies the nasal tip
• an internal branch that supplies the anterosuperior nasal cavity
• septal branch that supplies the anterior superior nasal septum.
B- The posterior ethmoid supplies the posterosuperior nasal cavity.
3- Maxillary Branches (V2):
• The nasopalatine nerve traverses the nasal septum from posterior to anterior in
a downward projection to enter the incisive canal. It supplies the posterior and
inferior nasal septum as well as mucosa just posterior to the anterior teeth.
• The greater palatine nerve follows the greater palatine artery down the palatine
canal, giving off lateral posterior inferior nasal nerves that supply the posterior
lateral wall of the nasal cavity.

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 Dr.Ban I.S. head & neck anatomy 2nd y.

• The lateral posterior superior nasal nerve and medial posterior superior nasal
nerve, both of which pass through the sphenopalatine foramen to supply the
lateral and medial walls of the nasal cavity, respectively.
• The anterior superior alveolar nerve is the last branch of V2, and it supplies the
anterior septum and the area near the nasal vestibule.
Blood Supply to the Nasal Cavity:

1- Anterior and posterior ethmoidal arteries, branches from ophthalmic artery.

2- Sphenopalatine artery branch from maxillary artery.
3- Greater palatine artery branch from descending palatine artery branch from
maxillary artery.
4- Septal artery from superior labial artery branch from facial artery.

Kiesselbach's Plexus (Little's Area)

Kiesselbach's plexus is a vascular anastomosis between the anterior ethmoid
artery, superior labial artery, greater palatine artery, and the terminal branch of the
sphenopalatine artery. This vascular plexus is located in the anterior nasal septum and is
the most common site of epistaxis.

Venous Drainage:

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 Dr.Ban I.S. head & neck anatomy 2nd y.

The submucous venous plexus is drained by veins that accompany the arteries.

Lymph Drainage of the Nasal Cavity:

The lymph vessels draining the vestibule end in the submandibular nodes. The
remainder of the nasal cavity is drained by vessels that pass to the upper deep cervical
nodes.
The Paranasal Sinuses The paranasal sinuses:
Are cavities found in the interior of the maxilla, frontal, sphenoid, and ethmoid
bones. They are lined with mucoperiosteum and filled with air; they communicate with
the nasal cavity through relatively small apertures. The maxillary and sphenoidal sinuses
are present in a rudimentary form at birth; they enlarge appreciably after the eighth year
and become fully formed in adolescence.
Drainage of Mucus and Function of Paranasal Sinuses:
The mucus produced by the mucous membrane is moved into the nose by ciliary
action of the columnar cells. Drainage of the mucus is also achieved by the siphon action
created during the blowing of the nose. The function of the sinuses is to act as resonators
to the voice; they also reduce the weight of the skull. When the apertures of the sinuses
are blocked or they become filled with fluid, the quality of the voice is markedly changed.

Maxillary Sinus:

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 Dr.Ban I.S. head & neck anatomy 2nd y.

The maxillary sinus is pyramidal in shape and located within the body of the maxilla
behind the skin of the cheek. The roof is formed by the floor of the orbit, and the floor is
related to the roots of the premolars and molar teeth. The maxillary sinus opens into the
middle meatus of the nose through the hiatus semilunaris.

Frontal Sinuses:
The two frontal sinuses are contained within the frontal bone. They are separated
from each other by a bony septum. Each sinus is roughly triangular, extending upward
above the medial end of the eyebrow and backward into the medial part of the roof of
the orbit. Each frontal sinus opens into the middle meatus of the nose through the
infundibulum.

Sphenoidal Sinuses:
The two sphenoidal sinuses lie within the body of the sphenoid bone. Each sinus
opens into the sphenoethmoidal recess above the superior concha.

Ethmoid Sinuses:
The ethmoidal sinuses are anterior, middle, and posterior and they are contained
within the ethmoid bone, between the nose and the orbit. They are separated from the
latter by a thin plate of bone so that infection can readily spread from the sinuses into the
orbit. The anterior sinuses open into the infundibulum; the middle sinuses open into the
middle meatus, on or above the bulla ethmoidalis; and the posterior sinuses open into
the superior meatus.