ANATOMY

Nose and Paranasal Sinuses Block 3

Marissa P. Roxas, MD | October 17, 2022 Trans 3.02

OVERVIEW Figure 2. Bony and Cartilaginous Parts of External Nose

I. Nose and Nasal Cavity B. Frontal Sinuses Table 1. Parts of the nose and their functions [2026 trans]
A. Nose C. Ethmoidal Sinuses Part Function
B. Nasal Cavity D. Sphenoid Sinuses
C. Blood Supply E. Maxillary Sinuses [1] Nasal Bones Pair of oblong bones
D. Venous Drainage III. Common Complications [2] Frontal Bone
E. Nerve Supply A. Sinusitis Between brow ridges
Bony Part (Nasal process)
II. Paranasal Sinuses B. Other Common
A. Anatomical Relations of the Complications (Appendix I) [3] Maxilla Projects upward, medially.
Sinuses (Frontal process) Lateral boundary of the nose
LEGEND Divide left & right airways of the
⭐: Important information [4] Nasal Septum
nasal cavity and nostrils
Dark Gray 2: Book information [7] Septal (1) Hyaline cartilage
💬: Good-to-know info from lecturer
Paired; below the inferior margin
of the nasal bones
I. LEARNING OBJECTIVES Cartilaginous Part
[6] Lateral (2)
Extend from dorsal aspect of
● Describe the external nose and the nasal cavity (5 main cartilages) septal cartilage
● Describe the nasal conchae (nasal turbinates) and the passages Paired; U-shaped, free, and
associated with them [5] Alar (2) movable = can dilate and
● Discuss the clinical significance of the venous drainage constrict nares
● Describe the blood supply of the nose
● Discuss the significance of Kiesselbach area Nasal Septum
● Describe the nerve supply of the nose
● Describe the paranasal sinuses with regard to their: location, site of
drainage, and anatomical relationships
● Discuss the clinical significance of the anatomical relationships of
the sinuses

II. NOSE AND NASAL CAVITY

A. Nose
● Superior to the hard palate
● Contains the peripheral organ of smell
● Includes the external nose (Fig. 1) and the nasal cavity, which is
divided into right and left cavities (kudos Nasal septum)
● Functions:
○ Olfaction (smelling) (Olfactory area superior 1/3 of nasal cavity)
○ Respiration (breathing), humidification of inspired air, and
Filtration of dust (Respiratory zone: Inferior 2/3 of nasal cavity)
○ Reception and elimination of secretions from paranasal sinuses
and nasolacrimal ducts
External Nose
● Consists of bony and cartilaginous portions
○ Skeleton is mainly cartilaginous
● Visible portion that projects from the face
Figure 3. Sagittal section of the head and the neck, with
nasal cavity intact (star on left: nasal septum)
● Septal cartilage - anterior, tongue-and-groove articulation with
edges of the bony septum
● Perpendicular plate of the ethmoid - bone; forms superior part
of the nasal septum and descends from cribriform plate and is
continued superior to this plate as the Crista Galli
● Vomer - bone; inferior, thin flat bone
● Other contributors: Maxilla and Palatine bone
B. Nasal Cavity
● Entire cavity or right or left half of the internal nose
● Anterior opening: Nares (nostrils)
● Posterior opening: Nasopharynx through the choanae (internal
nares)
● Lined by mucosa except at the vestibule (lined with skin)

Vestibule
● Area in the anterior external opening to the nasal cavity
● Lined by skin containing nasal hair called vibrissae
Figure 1. Parts of External Nose ○ Vibrissae are usually moist, they filter dust particles
● Parts (Figure 1)
1. Root: Superior, continuous with the forehead, between the Nasal Mucosa
eyebrows
● Firmly bound to the periosteum and perichondrium of the
2. Dorsum: extends from the root  apex (tip) of the nose
3. Ala/Wing (pl. Alae) - lateral boundary of nares supporting bones and cartilages of the nose
4. Nares/Nostrils (Anterior nasal apertures) - pair of piriform (pear- ● Continuous with the lining of all the chambers with which nasal
shaped) openings that pierces the inferior surface of the nose cavities communicate:
○ Posterior: Nasopharynx
○ Superior and lateral: Paranasal sinuses
○ Superior: Lacrimal sac and conjunctiva
● Consists of two areas: Respiratory area and Olfactory area
Table 2. Areas of the nasal cavity
Respiratory Area Olfactory Area
● Inferior 2/3 of nasal mucosa ● Superior 1/3 of nasal mucosa
● Air is warmed & moistened ● Contains the peripheral organ
here before passing through the of smell, sniffing draws air to

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 Anatomy 3.02

rest of Respiratory tract the area Figure 5. Sagittal View focusing on the Nasal Conchae (Turbinates)

Rhinitis ● Bony structure on the lateral wall of the nasal cavity

● Nasal Mucosa Infection, leads to swelling  rapidly, blocking the ● 3 Pairs
nasal passages on that side ⭐ ○ Superior: Smallest, usually missed; Middle
● Occurs during severe URTI and allergic reactions (e.g., hay fever). ○ Inferior: Largest among the three
Swelling occurs readily because of its vascularity. ● Superior and Middle: parts of the ethmoid bone
● May spread to the anterior cranial fossa, nasopharynx and retropharyngeal soft ○ Inferior is formed by its own separate bones
tissues, middle ear, paranasal sinuses, and lacrimal apparatus and conjunctiva ● The mucosa lining the nasal turbinates can also become inflamed
Nasal Conchae (Turbinates) leading to the obstruction of the nasal passages

Nasal Meatus
● Passages beneath nasal turbinates, thus having a Superior,
Middle, and Inferior Nasal Meatus

Fig 6. Sagittal View of the Head focusing on the Nasal Meatus. Fig 7. Middle and Inferior Nasal Meatus Fig 2. Sphenoid sinus .

Meatus Description Drains the Passes through May infect/Extra info

Provides surgical access to the pituitary
Sphenoethmoidal Superoposterior to superior gland (located at the roof of the
Sphenoid sinus
recess nasal turbinate
sphenoidal sinus ★)
Ethmoidal cells form most of the medial
Superior Beneath Superior Posterior Ethmoidal
wall of orbit. Severe inf. may cause
Nasal Meatus nasal turbinate sinus/cells
blindness & optic neuritis
Frontonasal duct  Roof of orbital cavity
Frontal Sinus Ethmoidal infundibulum Infections when left untreated can
 Semilunar hiatus spread to orbital or cranial cavities
Near maxillary molar teeth = Dental
Middle Beneath Middle
Maxillary Sinus Semilunar hiatus infections can spread from the oral
Nasal Meatus nasal turbinate
cavity  maxillary sinus
Ethmoidal bulla: round elevation on
Anterior and Middle Anterior: Ethmoidal infundibulum
middle nasal meatus formed by the
Ethmoidal sinus/cells Middle: Ethmoidal bulla
middle ethmoidal cells
Produces lacrimal fluid/tears.
Inferior Beneath Inferior Lacrimal Gland
Nasolacrimal duct Reason why we get a runny nose when
Nasal Meatus nasal turbinate (Superolateral to orbit)
we cry

Fig 18. Sphenoidal Sinus Fig 17. Ethmoidal Sinus (left) and Bulla (right) Fig 17.Maxillary sinus Figure 16. Nasolacrimal Gland
C. Blood Supply
External Nose & Nasal Cavity
● EN: Supplied by branches of Ophthalmic and Facial A.
● NC: Supplied by branches of Facial, Ophthalmic, & Maxillary A.

Table 3. Branches supplying External Nose

Ophthalmic Artery Facial Artery
Supratrochlear A. Angular A.
Dorsal nasal A. Lateral nasal A.

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 Anatomy 3.02

External nasal A. Superior labial A.

*Maxillary artery → infraorbital artery
Table 4. Branches of the ophthalmic, facial, and maxillary artery
Facial A. Ophthalmic A. Maxillary A.
Superior labial A. Anterior ethmoidal A. Sphenopalatine A.
Lateral nasal A. Posterior ethmoidal A. Greater palatine A.

Kiesselbach Area (Little’s area)

● Most common site of epistaxis (nosebleed)
● Located in the anterior 1/3 of nasal septum
● Anastomotic network of arteries supplying the Nasal Cavity
Figure 14. Nerve Supply of the Nose

Trigeminal Nerve (CN V)

Ophthalmic Nerve (CN V1) Maxillary Nerve (CN V2)
Divisions of the Trigeminal nerve (CN V)
Supplies the anterior-superior Supplies the posterior-inferior
portion of the nasal mucosa: portion of the nasal mucosa:
● Anterior ethmoidal N. ● Greater Palatine N. -
● Posterior ethmoidal N. Lateral wall
● Nasopalatine N. -Nasal
septum
Also innervates the dorsum & Also innervates the ala of the
D. Venous Drainage apex of the external nose external nose
Submucosal Venous Plexus
● Located deep to the nasal mucosa III. PARANASAL SINUSES
● Participates in the thermoregulatory system of the body ● Air filled chambers
○ Warms the air before it enters the lungs ● Lined with mucus-producing membrane (mucus secretions)
● Provides drainage of the nose via the following veins: ● Named according to the bones where they are found:
Vein Drains Drains into Frontal Sinus | Ethmoidal Sinus | Sphenoidal Sinus | Maxillary Sinus
Facial Facial A. Internal jugular vein ● Cranial cavity: Part of the cerebral hemisphere’s frontal lobe
Ophthalmic Ophthalmic A. Cavernous sinus
Sphenopalatine Maxillary A. Pterygoid plexus B. Frontal Sinus
**The Facial vein Anastomoses posteriorly w/ Pterygoid plexus (connects  Roof of the orbit, Near the orbital and cranial cavity
to the cavernous sinus) through the deep facial V.

Figure 12. Facial and Scalp Veins
External Nose
● Empties into the facial vein
○ Via angular and lateral nasal veins
● Danger triangle of the face - Nose lies within this area
○ Facial vein communicates with cavernous sinus
➢ Venous channel within the cranial cavity
○ A wound  Infection within danger triangle can travel
intracranially from the facial vein to the cavernous sinus
C. Ethmoidal Sinus
● Made of several cells thus have different drainage patterns:
○ Anterior & Middle ethmoidal cells  Middle nasal meatus
○ Posterior ethmoidal cells  Superior nasal meatus
● Ethmoid bone
○ Forms most of the medial wall of the orbit
○ Lamina papyracea (Paper-thin due to ethmoidal air cells)
➢ Orbital lamina of the ethmoid bone
➢ Paper-thin especially in children  easily penetrated by
infection
D. Sphenoidal Sinus
● Provides surgical access to the pituitary gland (located at the roof
of the sphenoidal sinus ★)
○ Optic chiasm
○ Cranial Nerves: Oculomotor, trochlear, and abducens N.
➢ Branches of Trigeminal N.: Maxillary & Ophthalmic M.
○ Blood vessels: Internal carotid A, and cavernous sinuses
● Supplied by the posterior ethmoidal arteries and the nerves that
accompany them [Moore’s]

E. Nerve Supply
Olfactory Nerve (CN I)
● Nerves that arise from the olfactory epithelium  pass through
the cribriform plate of the ethmoid bone  end at the olfactory
bulb
○ Central processes of these nerve cells form CN I
● Responsible for sensation of smell (olfaction)

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 Anatomy 3.02

E. Maxillary Sinus
A. Roof
B. Medial Wall
C. Lateral Wall
D. Floor

_____3. True regarding the Kiesselbach Area

A. Formed by the anastomosis of nasal cavity blood vessels
B. Site that receives the paranasal sinuses found beneath the nasal
turbinates
C. Common site of epistaxis
D. A and B
E. A and C

Table 5. Parts of the maxillary sinus
Part Details
Apex Zygomatic bone
Base Inferior part of the lateral wall of nasal cavity
Roof Floor of the orbit
Alveolar part of the maxilla
Floor Near the maxillary molar teeth = Dental infections can
spread from the oral cavity to the maxillary sinus
● Innervated by the anterior, middle, and posterior superior
alveolar nerves (branch of maxillary nerve) [Moore’s]s?
IV. COMMON COMPLICATIONS
A. Sinusitis
● Inflammation and swelling of the mucosal lining of sinuses
○ Exposure to dust, pollens, and microorganisms causes
blockage of ostium of sinuses  Retention of secretions
● Since paranasal sinuses are continuous with nasal cavities,
infection in the nasal cavity may spread into the sinuses
B. Other Complications [Moore’s]
COMPLICATION DESCRIPTION
S _____7. Drains to the middle nasal meatus; anatomically related to the
Nasal bones are commonly fractured in motor / car
Nasal Fractures
accidents and sports  Nose deformation
Deviation of the May result from a birth or during adolescence &
Nasal Septum adulthood from trauma (e.g., Fist fight)
Most commonly infected
Infection of Maxillary ostia are located near the roof of the sinuses
Maxillary Cells = Difficult drainage (lying on one’s side drains only
the other side of the sinus )
OTHER INFORMATION
Extraction of maxillary molar tooth can fracture a root
 Piece of root may be driven superiorly into the
Relationship of the maxillary sinus so infection may occur
Teeth to Maxillary
Sinus Inflammation in this sinus is usually accompanied by
a toothache sensation in the molar teeth since the
superior alveolar N. supplies both areas
1. Bright light is placed in patient’s mouth on one side of
hard palate or firmly against the cheek
Transillumination of 2. Light passes through maxillary sinus & appears
Sinuses crescent-shaped, dull glow inferior to the orbit
(Performed in a 3. If sinus has excess fluid, a mass, or a thickened mucosa,
darkened room) glow is decreased
Can also be done in frontal sinuses by directly light
superiorly under medial aspect of the eyebrow
4. Pattern and illumination differs from person to p
_____4. Concerned with the sensation of smell
A. Olfactory Nerve (CN V1)
B. Olfactory Nerve (CN I)
C. Maxillary Nerve (CN V2)
D. Ophthalmic Nerve (CN V1)
E. Ophthalmic Nerve (CN I)
Paranasal Sinuses
_____5. Largest among the paranasal sinuses
A. Ethmoidal Sinuses
B. Maxillary Sinuses
C. Frontal Sinuses
D. Sphenoid Sinuses
_____6. Can be a pathway for the spread of infection or inflammation to
the orbital and cranial cavities because due to its proximity; Provides
surgical access to the pituitary gland
A. Ethmoidal Sinuses; Maxillary Sinuses
B. Maxillary Sinuses; Frontal Sinuses
C. Frontal Sinuses; Sphenoid Sinuses
D. Sphenoid Sinuses; Ethmoidal Sinuses
optic chiasm
A. Ethmoidal Sinuses; Frontal Sinuses
B. Maxillary Sinuses; Sphenoid Sinuses
C. Frontal Sinuses; Ethmoidal Sinuses
D. Sphenoid Sinuses; Maxillary Sinuses
_____8. Supplied by the anterior and posterior ethmoidal branches of the
nasociliary nerves
A. Ethmoidal Sinuses
B. Maxillary Sinuses
C. Frontal Sinuses
D. Sphenoid Sinuses
Common Complications
_____9. Infection of ethmoidal cells
A. Occurs due to swollen and inflamed mucosa of the sinuses
B. Occurs due to swollen and inflamed nasal mucosa
C. Occurs due to blockage of nasal drainage
_____10. Rhinitis
A. Occurs due to swollen and inflamed mucosa of the sinuses
B. Occurs due to swollen and inflamed nasal mucosa
C. Occurs due to blockage of nasal drainage
***End of Short Quiz***

V. REVIEW QUESTIONS ANSWERS

1: B
Nose and Nasal Cavity 2: D
3: E; B describes the Nasal Meatus
_____1. Which of the following statements correctly describes the lateral 4: B. Recall: Ophthalmic Nerve: CN V1 & Olfactory Nerve: CN I
cartilaginous part of the nose? 5: B
A. Paired, U-shaped, and movable 6. C
B. Paired and found below the inferior margin of the nasal bones 7. B
C. Paired, Oblong 8. A
9. C
10. B
_____2. This nasal cavity boundary is formed by the palatine process of
the maxilla and horizontal plates of the palatine bone

Page 4 of 6 | TH: OBAOB, L. | TRANS GROUP 31 & 32 | ROMERO, RONQUILLO, SACDALAN, SAMPANG, SAN JOSE, SANTOS, SEDERICA, TIDOSO
 Anatomy 3.02

VI. REFERENCES ● Dr. Marissa P. Roxas, MD. (2022). “Nose and Paranasal Sinuses”
● Moore, K.L., Dailey, A. F., & Agur, A.M. (2018). Clinically PPT
oriented anatomy (8th ed). Philadelphia: Wolters Kluwer ● Batch 2026 Trans on Nose and Paranasal

APPENDIX

Appendix I. Lateral and medial/septal walls of the right side of the nasal cavity (left) and External nose (right).

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