Anatomy of the Nose

and Paranasal
sinuses
PREPARED BY:
DR. ZAID ALI AL-MARRANY
OTO R H I N O L A RY N G O LO G I S T M D
Embryology:
- Nose develop at the end of 4 th week
gestation fusion of five prominences -
frontonasal prominence, nasal placodes
form nasal pits- lateral ( the alae)and
medial nasal prominence.(nasal tip)
The maxillary prominence continue to
expand medially and contact with
intramaxillary segments ( upper lip and
anterior palate) .the frontal
prominences.( nasal bridge)
-Paranasal sinuses development is
heralded by the appearance of series of
folds on the lateral nasal wall at 8 week
of gestation known as ethmoturbinals.
 The nose:
The nose consists of the
external nose and the
nasal cavity.
Both are divided by a
nasal septum into right
and left halves.
 External nose:
The framework of the external nose is
made up above by nasal bones THE
FRONTAL PROCESSES OF THE
MAXILLAE , AND NASAL PART OF THE
FRONTAL BONE .

BELOW, THE FRAMWORK IS FORMED

OF PLATES OF HYALINE CARTILAGE .
 BLOOD SUPPLY OF THE External nose
The skin of the external nose is
supplied by the branches of
the ophthalmic and maxillary
arteries.
The skin of the ala and lower
part of the septum are
supplied by branches from the
facial artery
Nerve supply of external nose:
The infratrochlear and
external nasal branches of
the ophthalmic nerve and
the infraorbital branch of
the maxillary nerve.
Nasal cavity
The nasal cavity has :
a floor .
A roof .
a lateral wall .
a medial or septal wall.
The floor of nasal cavity
Palatine process of maxilla .
The horizontal plate of palatine bone .
 The roof of nasal cavity

Narrow .
It is formed BY:

- anteriorly beneath the bridge of the nose by

the nasal bone and frontal bones.
- in the middle by the cribriform plate of the
ethmoid ,
- Located beneath the anterior cranial fossa,

- Posteriorly by the downward slopping of the

sphenoid .
Medial wall of nasal cavity
The nasal septum divides the nasal cavity
into tow halves.
It has an osseous and cartilaginous part.

The nasal septum consist of the

perpendicular plate of ethmoid bone
superior ,
The vomer inferior . And the septal cartilage
anterior .
Nasal septum
The lateral walls of
nasal cavity

Markrd by 3 projections:
- superior turbinate .
- middle turbinate .
- inferior turbinate .
The space between each is called a
meatus.
 Lateral wall of nasal cavity
Inferior meatus:
Nasolacrimal duct.
Middle meatus :
Maxillary sinus
Frontal sinus
Anterior ethmoid sinus
Superior meatus :
posterior ethmoid sinuses
Sphenoethmoidal recess.
Sphenoid sinus .
Osteomeatal complex:
It is a common channel that links
frontal ,anterior ethmoids and
maxillary sinuses to the middle meatus;
allowing air flow and mucocilary
drainage.
it compose of five structures;
Maxillary ostium, infundibulum,
ethmoid bulla, uncinate process and
hiatus semilunaris.
Blood supply of the nasal cavity
Little’s area or Kiesselbach’s plexus in
the anteroinferior part
of nasal septum just above the vestibule
is the vascular area,
where anterior ethmoidal,
sphenopalatine, greater palatine and
septal branch of superior labial arteries
and their corresponding
veins form an anastomosis. This is the
most common site for
epistaxis .
Nerve supply of the nasal
cavity
The olfactory nerves from the olfactory mucous membrane ascend through the cribriform plate of
the ethmoid bone to the olfactory bulb.
The nerves of ordinary sensation are branches of the ophthalmic division and maxillary division of
the trigeminal nerve.
Autonomic nerves: nerves of pterygoid canal (vidian ) formed by;
sympathetic (deep petrosal nerve ) vasoconstriction .
Parasympathetic ( greater superficial petrosal nerve) secretomotor
Medial wall and septum
Lateral wall
 Lymphatic drainage of the nasal cavity
The lymph vessels draining the vestibule end in the
submandibular nodes.
The reminder of the nasal cavity is drained to upper
deep cervical lymph nodes.
N.B: Dangerous Area of Face :
This triangular area, venous drainage of which goes
intracranially, extends from nasion to angles of
mouth and includes external nose and upper lip. The
inferior ophthalmic vein, which receives angular
vein, drains into cavernous sinus.
The infection of this area has the potential to cause
cavernous sinus thrombosis.
Histology of the nose and paranasal
sinuses:
Skin of Nasal Vestibule: Vestibule is lined by skin (stratified
squamous epithelium), which contains hair, hair follicles
and sebaceous glands.
Olfactory Epithelium: The olfactory epithelium that is paler
in color lines the olfactory region, which includes roof of
nasal cavity and area above superior concha.
Respiratory Mucosa: The respiratory mucous membrane,
which covers the lower two-third of the nasal cavity, shows
variable thickness. It is thickest over nasal conchae especially at their ends. It is thick over the
nasal septum and
thin in the meatuses and floor of the nose. This respiratory
mucous membrane is pseudostratified ciliated columnar
epithelium and contain plenty of goblet cells.
PHYSIOLOGY OF NOSE
The functions of the nose include:
(1) respiration,
(2) air conditioning of inspired air,
(3) protection of lower airway,
(4) vocal resonance,
(5) nasal reflex and (6) olfaction.
The para nasal
sinuses
 ANATOMY OF PARANASAL SINUSES

They are divided

into two groups:
1. Anterior Group: The sinuses, which open anterior to basal
lamella of middle turbinate in the middle meatus, form
anterior group of paranasal sinuses. They are maxillary,
frontal and anterior ethmoid sinuses.
2. Posterior Group: The sinuses, which open posterior and
superior to basal lamella of middle turbinate, form posterior
group of paranasal sinuses. They are posterior ethmoid and
sphenoid sinuses. The posterior ethmoidal sinuses open in
the superior meatus and sphenoid sinuses open in sphenoethmoidal recess.
PHYSIOLOGY OF PARANASAL SINUSES

FUNCTIONS : not well known but;

„Air-conditioning of the inspired air (humidification and
warming)
„ Keep the nasal chambers moist
„ Resonance to voice
„ Protect the delicate structures in the orbit (eye) and the
cranium (brain).
„ Lighten the skull bones.
„ Rapid growth of face.
„ Absorption of shock to the face and skull.
„ Increasing the area of olfactory membrane.
„ Regulation of intranasal pressure .
Viral rhinosinusitis( common cold):
The average attacks of VRS in a
year in an adult can be two to four.
Approximately 20–30% cases of
acute rhinosinusitis are viral.
Caused mainly by Rhinoviruses,
influenza and parainfluenza
 PA
OF THO
C
CO OM Y
PH
LD S
MO IOL
N O GY
 Clinical picture:
1. Sore throat, which lasts for 1 or 2
days and then followed by cough and
nasal discharge.
2. In beginning there may be burning
sensation at the back of nose, nasal
stuffiness, rhinorrhea and sneezing.
3. Patient has chill and low-grade fever.
4. Nasal watery discharge is profuse.
Treatment:
•usually is symptomatic:
– topical nasal decongestants.
– antihistamines.
– Analgesics.
– Vit. C
– No need for Antibiotics .
• Complications are occasional and include sinusitis,
pharyngitis, tonsillitis, bronchitis, pneumonia and otitis media.
THANK YOU NEXT LECTURE
RHINOSINUSITS