Second Year Dental Student

• Anatomy
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the head and neck of Major compartments ‫اﻟﺜﻼﺛﺎء‬

Lecture: 6 Date: 28/3/2017
Dr’s name: Mohammad alsalem

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Asnan
 Major compartments of the head and neck

NASAL CAVITIES
z Uppermost parts of the
respiratory tract and
contain the olfactory
receptors.
z Elongated wedge-
shaped spaces with a
large inferior base and a
narrow superior apex
z Skeletal framework:
bone and cartilage.
z Regions:
- Anterior: enclosed by
the external nose
- Posterior: central within
the skull.
 NASAL CAVITIES
z Nares: The anterior
apertures of the nasal
cavities, open into the
inferior surface of the
nose.
z Choanae: The posterior
apertures, open into the
nasopharynx.
z The nasal cavities are
separated:
- From each other by a
midline (nasal septum)
- From the oral cavity below
by the hard palate
- From the cranial cavity
above by parts of the
frontal, ethmoid, and
sphenoid bones.

The ethmoid bone

z Cuboidal in shape
- Composed of:
z Ethmoidal
labyrinths: two
rectangular box-
shaped
z Cribriform plate:
perforated sheet of
bone, superiorly unite
the labyrinths
z Perpendicular plate:
sheet of bone:
descends vertically in
the median sagittal
plane
 Ethmoidal labyrinth
z Two delicate
sheets of
bone +
ethmoidal
cells in
between
z Lateral sheet
: (the orbital
plate) flat,
forms part of
the medial
wall of the
orbit;
- Two processes:
z Medial sheet:
z Superior and Middle nasal conchae: curved shelves of
of bone forms
the upper part bone, which project across the nasal cavity and curve
of the lateral downward ending in free medial margins
wall of the - Ethmoidal bulla: prominent bulge of middle ethmoidal
nasal cavity cells, inferior to the origin of the middle concha, on the
medial wall of the labyrinth.

Ethmoidal labyrinth
z Ethmoidal
infundibulum: Extending
anterosuperiorly from just
under the bulla is a
groove which continues
upward, and narrows to
form a channel that
penetrates the ethmoidal
labyrinth and opens into
the frontal sinus.
(frontonasal duct).
z Uncinate process: A
delicate irregularly
shaped projection on the
anterior aspect of the
inferior surface of the
ethmoidal labyrinth
extends posteroinferiorly
to articulate with the
inferior concha.
 The perpendicular plate
z Quadrangular in shape,
descends in the midline
from the cribriform plate,
and forms the upper part
of the median nasal
septum
- Articulation:
z Posteriorly: sphenoidal
crest on the body of the
sphenoid bone
z Anteriorly: nasal spine on
the frontal bone and with
the site of articulation at
the midline between the
two nasal bones
z Inferiorly: anteriorly with
the septal cartilage and
posteriorly with the vomer

External nose
z Extends the
nasal cavities
Into the front of
the face and
positions the
nares so that
they point
downward
z Pyramidal in
shape with its
apex anterior in
position.
z The upper
angle of the z Posteriorly, (Bony parts): nasal bones and parts of the
nose between maxillae
the openings of z Anteriorly, (cartilaginous):
the orbits is z on each side, lateral processes of the septal cartilage,
continuous with major alar and three or four minor alar cartilages
the forehead
z In the midline: single septal cartilage that forms the
anterior part of the nasal septum.
The medial wall
z Mucosa-covered surface
of the thin nasal septum
z Oriented vertically in the
median sagittal plane and
separates the right and left
nasal cavities
z Consists of:
z Anteriorly: Septal nasal
cartilage
z Posteriorly: mainly the
vomer and the
perpendicular plate of the
ethmoid bone
z small contributions by
nasal spine of the frontal
bone, nasal crests of the
maxillary and palatine
bones, incisor crest of the
maxilla

Floor
z Smooth, concave, and
much wider than the roof
- Consists of:
z Soft tissues of the external
nose
z The upper surface of the
palatine process of the
maxilla
z horizontal plate of the
palatine bone
z Openings:

- The naris: anteriorly

- Superior aperture of the
incisive canal is deep to
the mucosa immediately
lateral to the nasal septum
near the front of the hard
palate
 Roof
z Narrow and is highest in
central regions where it
is formed by the
cribriform plate of the
ethmoid bone
z Anterior to the cribriform
plate the roof slopes
inferiorly to the nares
and is formed by:
- The nasal spine of the
frontal bone
- The nasal bones
- The lateral processes of
the septal cartilage and
major alar cartilages of
the external nose.

Lateral wall
z Characterized by three curved shelves of bone (conchae):
- Superior, middle and inferior nasal conchae
z Project medially and inferiorly across the nasal cavity

z The medial, anterior, and posterior margins of the conchae are free
 z The conchae divide each
nasal cavity into four air
channels
1- Inferior nasal meatus:
between the inferior concha
and the nasal floor
2- Middle nasal meatus:
between the inferior and
middle concha
3- Superior nasal meatus:
between the middle and
superior concha
4- Spheno-ethmoidal recess:
between the superior concha
and the nasal roof

z Each nasal cavity consists

of three general regions:
z Nasal vestibule: small
dilated space just internal to
the naris that is lined by skin
and contains hair follicles
z Respiratory region: largest
part of the nasal cavity, has
a rich neurovascular supply,
and is lined by respiratory
epithelium composed mainly
of ciliated and mucous cells
z Olfactory region: small, at
the apex of each nasal
cavity, lined by olfactory
epithelium, and contains the
olfactory receptors.
Lateral
wall
z Ethmoidal labyrinth and uncinate process
z Perpendicular plate of the palatine bone
z Medial plate of the pterygoid process of the sphenoid bone;
z Medial surfaces of the lacrimal bones and maxillae
z The inferior concha.

Lateral wall
z Semilunar
hiatus: Inferior
to the
ethmoidal
bulla is a
curved gutter
which is
formed by the
mucosa
covering the
lateral wall as
it spans a
defect in the
bony wall
between the
ethmoidal z Nasolacrimal duct: opens onto the lateral wall of the
bulla above inferior nasal meatus under the anterior lip of the inferior
and the concha-it drains tears from the conjunctival sac of the eye
uncinate into the nasal cavity and originates at the inferior end of
process below the lacrimal sac on the anteromedial wall of the orbit
 Choanae
z Oval-shaped openings
between the nasal cavities
and the nasopharynx
- Margins are formed by:
z Inferiorly: posterior border of
the horizontal plate of the
palatine bone
z Laterally: posterior margin of
the medial plate of the
pterygoid process
z Medially: posterior border of
the vomer
z Superiorly: ala of the vomer,
the vaginal process of the
medial plate of the pterygoid
process; and body of the
sphenoid bone

Gateways

z Cribriform plate
z Sphenopalatine
foramen
z The incisive canal
z Small foramina in
the lateral wall
z Foramen cecum?
Foramen cecum
z Connection
between
nasal veins
and the
superior
sagittal sinus
of the cranial
cavity through
foramen
cecum
midline
between the
crista galli
and frontal
bone

z This has clinical importance in that infections of the nose and nearby areas
can be transmitted to the meninges and brain

Sphenopalatine
foramen
z Between the
nasal cavity and
the
pterygopalatine
fossa
z Posterolateral
wall of the
superior nasal
meatus. just
superior to the
attachment of the
posterior end of
the middle nasal
concha
z Sphenopalatine
notch in the - Major structures:
palatine bone and z Sphenopalatine branch of the maxillary artery
the body of the z Nasopalatine branch of the maxillary nerve
sphenoid bone. z Superior nasal branches of the maxillary nerve
Blood
supply of
the nasal
cavity

z Sphenopalatine artery: (largest) terminal branch of the maxillary artery

z Branches

- Posterior lateral nasal branches

- Posterior septal branches

Blood
supply of
the nasal
cavity

z Greater palatine artery: (terminal branch of the maxillary artery), first

through greater palatine foramen to the posterior aspect of the palate.
Then through the incisive canal from the roof of the oral cavity
Blood
supply of
the nasal
cavity

z Facial artery branches:

z Superior labial artery: supplies anterior regions of the nasal septum
z lateral nasal artery supplies the external nose and nasal vestibule

Blood
supply of
the nasal
cavity

- Ophthalmic Artery branches:

z Posterior ethmoidal artery: (through the cribriform plate)

z Anterior ethmoidal artery (through a slit-like foramen immediately lateral to

the crista galli)
Blood
supply of
the nasal
cavity

z Anterior region of the medial wall where there are anastomoses and
where the vessels are relatively close to the surface
z This area is the major site of nosebleeds (epistaxis).
Nerve
supply of
the nasal
cavity

z The olfactory nerve: receptors in the olfactory epithelium at the top

of each nasal cavity. through perforations in the cribriform plate to
synapse with neurons in the olfactory bulb of the brain.

Nerve
supply of
the nasal
cavity

- Branches from the ophthalmic nerve:

z The anterior ethmoidal nerve: (medial and lateral wall of the nasal cavity)

between the nasal bone and lateral nasal cartilage, and then terminates as
the external nasal nerve, which supplies skin around the naris, in the nasal
vestibule, and on the tip of the nose.
Nerve
supply of
the nasal
cavity

z Nasal branches from the maxillary nerve:

z Posterior superior lateral nasal nerves: (through the sphenopalatine
foramen, supply the lateral wall of the nasal cavity)
z Posterior superior medial nasal nerves: supplies the roof and the nasal
septum
Nerve
supply of
the nasal
cavity

z Nasal branches from the maxillary nerve:

z Nasopalatine nerve: (largest) passes forward and down the medial wall of
the nasal cavity to pass through the incisive canal onto the roof of the oral
cavity, and terminates by supplying the oral mucosa posterior to the incisor
teeth

Nerve
supply of
the nasal
cavity

z Nasal branches from the maxillary nerve:

z Posterior inferior nasal nerves: from greater palatine nerve (pass through
small bony foramina to innervate the lateral wall of the nasal cavity
Nerve
supply of
the nasal
cavity

z Nasal branches from the maxillary nerve:

z Anterior superior alveolar: branch of the infra-orbital nerve (passes
medially through the maxilla to supply the lateral wall near the anterior end
of the inferior concha)

Paranasal sinuses

z Ethmoidal cells
z Sphenoidal sinus

z Maxillary sinus

z Frontal sinus

- Features
z Lined by respiratory
mucosa, which is
ciliated and mucus
secreting
z Open into the nasal
cavities
z Innervated by
branches of the
trigeminal nerve
The frontal sinus
z Shape: Triangular
- Base: vertically
- Apex: laterally
z Drainage: into the lateral
wall of the middle meatus
via the frontonasal duct,
which penetrates the
ethmoidal labyrinth and
continues as the ethmoidal
infundibulum at the front
end of the semilunar
hiatus
z Blood supply: anterior
ethmoidal arteries
z Nerve supply: supra-
orbital nerve from the
ophthalmic nerve
The ethmoidal sinuses
z Anterior, middle, and
posterior and they are
contained within the
ethmoidal labyrinths
z Drainage

- Anterior sinuses: open

into the infundibulum
- Middle sinuses: open into
the middle meatus, above
the bulla ethmoidalis
- Posterior sinuses: open
into the superior meatus.
z Blood supply: anterior
and posterior ethmoidal
arteries
z Nerve supply: anterior
and posterior ethmoidal
branches of the nasociliary ƒ Orbital branches from the maxillary nerve
nerve from the ophthalmic
The maxillary sinuses
z Shape: Pyramidal
z Location: within the body
of the maxilla
z Roof: floor of the orbit
z Floor: related to the roots
of the premolars and molar
teeth.
z Drainage: into the middle
meatus of the nose
through the hiatus
semilunaris.
z Blood supply: infra-orbital
and superior alveolar
branches of the maxillary
arteries.
z Nerve supply: infra-orbital
and alveolar branches of
the maxillary nerve
The sphenoidal sinuses
z Location: within the body of
the sphenoid
z Relations:

- Above: cranial cavity,

particularly to the pituitary gland
- Laterally: cranial cavity,
particularly, cavernous sinuses
- Below and front: nasal cavities
z Drainage: via apertures on the
posterior wall of the spheno-
ethmoidal recess
z Blood supply: pharyngeal
arteries from maxillary
z Nerve supply:

z Posterior ethmoidal branch of

the ophthalmic nerve Note: pituitary gland can be surgically
z Orbital branches from the approached through the roof of the nasal cavities
maxillary nerve then anteroinferior aspect of the sphenoid bone
and into the sphenoidal sinuses