Anatomy and Physiology of the Nose and Paranasal Sinuses By Dr Ma.
Clarissa Fortuna External Topography: → Bridge → Dorsum → Tip → Columella → Alae → Nostril/vestibule External Nose → Bony Framework → Cartilaginous framework Muscles of the External Nose → Dilators Procerus Dilatos naris Angular head of the quadratus labi superioris → Constrictors Nasalis Depressor septi Depressor aleque nasi Blood supply → External carotid artery facial artery Lateral nasal Angular Alar Septal External nasal → Internal carotid artery opthalmic artery Dorsal nasal Innervation → Trigeminal nerve Opthalmic Division ♣ Nasociliary ♣ External Nasal ♣ Infratrochlear Maxillary Division ♣ Infraorbital Boundaries of Internal Nose → Posterior = Sphenoid → Superior = Cribriform plate of ethmoid → Inferior = Maxillary bone → Medial = septum → Lateral = maxillary bone Nasal septum → Septal cartilage → Vomer → Perpendicular plate of the ethmoid → Maxillary crest → Premaxilla Lateral Nasal Wall → Inferior turbinate → Middle turbinate → Superior turbinate → ???? Supreme turbinate????
Drainage → Superior meatus Posterior ethmoid sinus → Middle meatus Maxillary sinus Anterior ethmoid sinus Frontal sinus → Inferior meatus Nasolacrimal duct Arterial Supply → Internal carotid artery opthalmic artery Anterior ethmoid artery Posterior ethmoid artery → External carotid artery internal maxillary artery Sphenopalatine artery Descending palatine artery Pharyngeal artery Superior labial artery Venous Drainage → Ethmoidal veins opthalmic veins cavernous sinuses
Sphenopalatine vessels Pterygoid Plexus Dural venous sinuses Anterior facial vein dural venous sinuses
Nerve supply → Olfactory nerve → Trigeminal nerve → Facial nerve → Sphenopalatine ganglion Epithelial lining → Pseudostratified columnar ciliated epithelium with goblet cells → Nasal cilia beat 10 – 20 time/sec at room temp Nasal functions → Smelling → Humidification → Filter → Warm Olfaction → Chemical theory Particles of odorous substances are distributed by diffusion throughout the aire and cause chemical reaction when they reach the olfactory epithelium → Undulation theory Waves of energy similar to light impinge upon the olfactory nerve endings Paranasal sinuses → Frontal → Maxillary → Sphenoid → Ethmoid Paranasal sinuses → Pseudostratified ciliated columnar epithelium → Drainage: Gravity Active ciliary transport
Sinus drainage obstruction infection Negative pressure headache Functions Humidification Vocal resonance Mucus production
Increased olfactory area Absorbs shock to the head Regulation of intranasal pressure
Maxillary Sinus → Aka: Antrum of Highmore! → Pyramidal in shape located in the maxillary bone → Largest paranasal sinus → Volume: 15 mL each → Present at birth → Floor is formed by the alveolar process of the maxilla Ethmoid sinus → Bony labyrinth of small air cells → Between the medial wall of the orbit and the middle turbinate → Present at birth → Develop as outpocketings of the medial meatus → Quantity: 7-15 per side, 14 mL volume → Anterior drain into MIDDLE meatus
Osteomeatal complex → Contains the narrow channels that provide for mucociliary clearnace and venulation of the anterior ethmoid, maxillary, and frontal sinuses → Drainage and ventilation of the major paranasal sinuses are dependent on the patency of the osteomeatal complex LESSA
→ → →
Posterior drain into SUPERIOR meatus Lateral wall lamina papyracea Medial wall middle turbinate
Frontal Sinus → Frontal bone → Arise from an expansion of an anterior air cell from the ethmoids → Not present until 6 y/o → Volume: 6-7mL per sinus → Drainage is via the middle meatus Sphenoid sinus → Develop as excavations into the sphenoid bone at around 4 months of age → Volume: 7.5 mL per sinus → Ostium opens into the superior meatus through the sphenoethmoid recess → Borders (please refer to your Netter or Boie’s oke? )
Anteriorly posterior ethmoids Posteriorly pons and basilar artery Superiorly optic chiasma, optic nerves, hypophysis Inferiorly nasal cavity and nasopharynx Lateral? Surrounding? optic nerves, cavernous sinuses, internal carotid artery
Osteomeatal Complex → Uncinate process → Maxillary ostium → Middle turbinate → Bulla ethmoidalis → Ethmoid infundibulum → Hiatus semilunaris