Prof. Dr .

Mohamed Talaat ELGhonemy

THE EXTERNAL NOSE

Bony upper one third

(Three bones):
a) Nasal bones.
b) Maxillary process of
the frontal bone.
c) Frontal process of the
maxilla.
 Cartilagenous lower two thirds
(Three cartilages):

a) Upper lateral cartilages.

b) Lower lateral (alar) cartilage.
c) Cartilage of the nasal septum
in between.
The nose is divided into two
cavities separated by the nasal
septum.
 The anterior nares (nostrils)
separated by the columella.
 The posterior nares (choanae)
separated by the posterior edge
of the vomer.
Walls of the nasal cavities:
Lateral wall of the nose ≡ medial wall of maxilla
Three bony projections called conchae or turbinates
covering three meatuses and named after them:
1. Superior meatus: drains the posterior ethmoidal
sinuses.

2. Middle meatus: (osteomeatal complex), drains the:

a) Frontal sinus anteriorly.
b) Maxillary sinus posteriorly.
c) Anterior and middle ethmoidal sinuses in the middle.

3.Inferior meatus: drains the naso-lacrimal duct.

Spheno-ethmoidal recess: is a recess above the
superior concha and drains the sphenoidal sinus.
Anatomy of the lateral nasal wall
Lateral wall of the nose after
turbinates dissection
Ostio-meatal complex
 Medial wall:
The septum: It is formed of:
1. Quadrilateral cartilage,
anteroinferiorly.
2. Perpendicular plate of
ethmoid, superiorly.
3. The vomer bone,
postero-inferiorly.
4. Maxillary crest and
spine, inferiorly.
Roof:
Cribriform plate of ethmoid, separates the nasal fossa
from the anterior cranial fossa.
Olfactory nerve fibres pass through it.
Floor:
Hard palate (roof of the mouth).
Lining epithelium:

 The vestibule anteriorly is lined with skin.

 The olfactory area (superior 1/3) is lined
with olfactory epithelium with bipolar
neurons.
 The respiratory area (rest of the nasal
cavity) is lined with pseudostratified
columnar ciliated epithelium.
 Blood supply of the nose:
The nose is supplied by branches from the internal
carotid artery (ICA) above the middle turbinate
and branches from the external carotid artery
(ECA) below the middle turbinate.
1. Anterior and posterior ethmoidal arteries of
ophthalmic artery of ICA.
2. Sphenopalatine and greater palatine arteries of
maxillary artery of ECA.
3. Superior labial artery of facial artery of ECA.
 The Little’s area
It lies in the anterior part of the nasal septum where
branches from ICA & ECA anastomose to form the
KIESSELBACH’S PLEXUS.
-Sphenopalatine artery of ECA.
-Greater palatine artery of ECA.
-Superior labial artery of ECA.
-Anterior ethmoidal artery of ICA.
Blood supply of the medial nasal wall

A : Anterior ethmoid artery / P: Posterior ethmoid artery

S: Sphenopalatine artery/ G: Greater palatine artery/ S: Superior labial artery
Blood supply of the lateral nasal wall
 Venous drainage of the nose:

The nose drains into facial and ophthalmic veins

anteriorly and into pterygoid plexus posteriorly.

The nose is considered a dangerous area because it

communicates with:
 The cavernous sinus via ophthalmic vein.
 The superior sagittal sinus via foramen caecum.
 Veins of the frontal lobe of the brain via cribriform
plate.
Venous drainage of the nose
Nerve supply of the nose:
Olfaction: olfactory nerve to olfactory mucosa.

Sensory: branches from trigeminal nerve: anterior

ethmoidal of ophthalmic nerve, sphenopalatine
and greater palatine of maxillary nerve.

Autonomic: sympathetic from deep petrosal nerve

and parasympathetic from facial nerve
(superficial petrosal) to form the vidian nerve to
sphenopalatine nerve to the nasal mucosa.
Anatomy of the paranasal sinuses
Air filled cavities, 4 on each side,
lined by pseudostratified columnar ciliated epithelium.

Anterior group: frontal, maxillary and anterior ethmoid sinuses.

Posterior group: posterior ethmoid and sphenoid sinuses.
The frontal sinus:

 It lies in the frontal bone

and related posteriorly to
the anterior cranial fossa
and inferiorly to the orbit.
It drains through middle
meatus by the
frontonasal duct.
The maxillary sinus

It lies in the maxilla and is related to

-Superiorly to the orbit.
-Inferiorly to alveolus, mainly second premolar
and first molar teeth and the hard palate.
- Medially: inferior and middle meatus.
- Posteriorly: pterygopalatine fossa and maxillary
artery.
- Anteriorly: cheek, infra-orbital nerve and skin.
The sinus drains through its ostium to the middle
meatus.
The maxillary sinus
The ethmoid bone
It is situated at the anterior part of the base of the
cranium, between the two orbits, at the roof of the
nose, and contributes to each of these cavities.
It consists of four parts:
 a horizontal or cribriform plate, forming part of
the base of the cranium;
 a perpendicular plate, constituting part of the
nasal septum;
 and two lateral masses or labyrinths
Ethmoid bone from above
Perpendicular plate of ethmoid
Ethmoid bone from behind.
Ethmoid bone from the right side
Lateral wall of nasal cavity, showing
ethmoid bone in position
 The ethmoid sinus:
They are 7-15 thin wall air cells between the orbit
and nasal cavity. The anterior and middle
ethmoids (Bulla ethmoidalis) drain into the middle
meatus while the posterior ethmoid drains into the
superior meatus. The posterior ethmoidal sinus is
separated anteriorly from the middle ethmoid by
the ground lamella.
 -Roof: anterior cranial fossa.
 -Floor: maxillary sinus.
 -Medially: middle turbinate.
 -Laterally: orbit, separated from it by thin plate of
bone (lamina papyracea).
The sphenoid sinus
It occupies the body of sphenoid. Its ostium
drains to the spheno-ethmoidal recess.
Relations of sphenoid sinus
-Anteriorly: ethmoid sinus.
-Posteriorly: brainstem.
-Laterally: cavernous sinus, optic nerve and
internal carotid artery.
-Superiorly: pituitary gland.
-Inferiorly: nasopharynx.
FUNCTIONS OF THE NOSE
Respiratory function
1- Respiratory airway.
2- Humidification to the inspired air to protect the lung tissues.

Protective function
1- Purification of air by:
a) Hairs in the vestibule trap particles entering the nose.
b) Mucous layer with its bacteriostatic lysozymes, this layer is
continuously removed by cilia.
2- Reflex sneezing.
3- Lymphoid tissue.
4- Olfaction.
5- Resonance of voice.
6- Drainage of tears and paranasal sinuses.
FUNCTION OF THE PARANASAL SINUSES

1- Increase surface area for heat and humidity.

2- Resonance of voice.
3- Protection of brain in head trauma
4- Reduction of skull weight.
EXAMINATIONS OF THE NOSE

 History of nasal symptoms:

1- Obstruction.
2- Nasal discharge.
3- Headache.
4- Sneezing.
5- Affection of olfaction.

 External examination
For deformity, swelling or tenderness.
Anterior rhinoscopy
Inspection of the septum, middle and inferior turbinates.

Nasal speculum
Posterior rhinoscopy
Posterior choanae, vomer bony septum, inferior turbinates , Eustachian
tube openings.

Posterior nasal mirror

Flexible nasopharyngoscope
Rigid endoscope
 Nasal endoscopy:

Rigid nasal endoscopy and flexible nasopharyngoscopy

help to evaluate inaccessible areas of nasal cavity.
Left nasal cavity
2. Nasal septum. 1. Middle turbinate,
3. Middle meatus , 4. Uncinate process
Radiology:

Plain X- ray: occipitomental views.

Lateral skull
CT scan: for nose and paranasal
sinuses: coronal and axial veiws
for opacities, fluid level, polypi, thickened
mucosa, fracture nasal bone.
CT scan PNS coronal view
 Culture and sensitivity test:
of the nasal discharge.

 Biopsy: from nasal masses.

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