NOSE & PARANASAL

SINUSES
Khristine T. Girado - Pizarro, MD, FPSO-HNS
EMBRYOLOGY
➤ neural crest cells - precursors
of nose
➤ 4th week AOG - caudad
migration toward the midface
➤ Two nasal placodes develop
inferiorly in a symmetrical
fashion.
➤ Nasal pits divide the placodes
into medial and lateral nasal
processes.
medial processes - septum,
philtrum, and premaxilla
of the nose
lateral processes - sides of
the nose.
EXTERNAL NOSE
BONY VAULT
CARTILAGINOUS VAULT & NASAL LOBULE
INTERNAL NOSE
LATERAL NASAL WALL
LATERAL NASAL WALL
➤ Inferior Meatus
nasolacrimal duct
➤ Middle Meatus
frontal sinus
anterior ethmoid
sinus
maxillary sinus
➤ Superior Meatus
posterior ethmoid
sinus
➤ Sphenoethmoidal
recess
sphenoid sinus
SEPTUM
 PARANASAL SINUSES

all sinuses are lined with modified respiratory epithelium capable of producing mucus and having cilia, if emptying secretions into the nasal cavities.

air filled

maxillary sinus - most consistently present at birth

BLOOD SUPPLY - LATERAL NASAL WALL
BLOOD SUPPLY - NASAL SEPTUM
BLOOD SUPPLY
➤ Arterial Supply
➤ ECA - maxillary artery
➤ ICA - ophthalmic artery
➤ Venous Supply
➤ Ophthalmic Vein
➤ Anterior Facial Vein
➤ Sphenopalatine Vein
BLOOD SUPPLY
➤ Internal Maxillary Artery
—> Sphenopalatine Artery
Conchae
Meatus
Septum
—> Superior Labial Artery
—> Infraorbital Artery
—> Alveolar Branch
Maxillary Sinus
—> Pharyngeal Branch
Sphenoid Sinus
BLOOD SUPPLY
➤ Ophthalmic Artery
—> Anterior Ethmoidal Artery
—> Posterior Ethmoidal Artery
Ethmoid sinus
Frontal Sinus
LYMPHATIC SYSTEM
➤ Anterior Lymphatics
Vestibule
Preturbinal area
➤ Posterior Lymphatics
➤ Superior Group —> Retropharyngeal Lymph Nodes
Middle & Superior Turbinates
Nasal Wall
➤ Middle Group —> Jugular Chain Lymph Nodes
Inferior Turbinate
Nasal Floor
➤ Inferior Group —> Internal Jugular Lymph Nodes
Septum
part of Nasal Floor
NERVE SUPPLY
NERVE SUPPLY
➤ Olfactory Nerve (CN1) - olfaction
➤ Trigeminal Nerve (CN V) - sensory afferent impulses
—> Ophthalmic Division (Anterior ethmoidal Nerve)
—> Maxillary Division (Nasal, Nasopalatine & Palatine
Branches)
➤ Facial Nerve (CN VII) - respiratory muscles of the external nose &
Autonomic Nervous System
➤ Sphenopalatine Ganglion - control vein & artery diameters in the
nose; & mucus production
OLFACTION
➤ Chemical Theory - particle of odorous substances are distributed by
diffusion throughout the air and cause chemical reaction when they
reach the olfactory epithelium
➤ Undulation Theory - waves of energy similar to light impinge upon
the olfactory nerve endings

➤ Anosmia - absence of smell sensation

➤ Hyposmia - reduced smell sensation
➤ Normal Olfaction
➤ Parosmia - distorted smell perception
 AIRWAY RESISTANCE
➤ optimal conditions for oxygen uptake, and in the reverse
process optimal elimination of CO2 brought to alveoli by the
blood stream
➤ normal nasal cycle - 1 to 6 hours, average of 2.5 hours
➤ measured using Rhinomanometry
➤ “Valves”
1. anterior narrowing - posterior aspect of the upper lateral
cartilage and nasal septum
2. Bony piriform aperture

breathing conveys air through URT and LRT to the alveoli of the lung in sufficient volume, with sufficient pressure, moisture, warmth, and cleanliness
AIR CONDITIONING
➤ inspired air is warmed or cooled to near body temperature
and its relative humidity is brought to near 100%
 AIR PURIFICATION
➤ vibrissae - deposition of particulate matter
➤ expectorated or carried by mucociliary transport to the
stomach for sterilisation by gastric secretions
➤ soluble gases are removed from the air as it passes through
the nose ( >water solubility of gas, >removed from nasal
mucosa)

foreign matter, bacteria and viruses

Ammonia, HCl, Sulfur dioxide - highly water soluble

Ca Monoxide & hydrocarbons - low water solubility —> pass straight to the lungs
MUCOCILIARY FUNCTION
➤ transport of foreign
particles deposited from
inspired air posteriorly to
the pharynx
➤ Mucus blanket renewed
every 2 to 3 times per hour
➤ humidifies inspired air
with > 1 later of moisture
per day
MUCOCILIARY CLEARANCE
 SPEECH MODIFICATIONS
➤ nose & sinuses - articulation, nasal resonance
➤ “m”, “n” and “ing”
➤ hypernasality - cleft palates
➤ hyponasality - URI, adenoid hypertrophy, nasal tumors

lungs - power source

larynx - sound generator

lips, tongue, teeth - articulators

hypernasal - velopharyngeal insufficiency allows too many sounds to resonate

hyponasal - sounds that normally resonate in nasal spaces are prevented from doing so

DIAGNOSTICS

WATER’S VIEW