You are on page 1of 66

Dr K.

RAM SHETTY
OBJECTIVES
• ANATOMICAL LOCATION
• FUNCTIONS
• OSTEOLOGY
• NASAL SEPTUM
• ARTERIAL SUPPLY
• NERVE SUPPLY
• LYMPHATIC DRAINAGE
• APPLIED ANATOMY
INTRODUCTION
• RESPIRATORY PASSAGE
• OLFACTION
• RESPIRATORY MUCOSA
• OLFACTORY MUCOSA
• EXTERNAL NOSE
• INTERNAL NOSE
EXTERNAL NOSE
• Pyramidal projection
• Parts:apex,root and dorsum
• Inferiorly:external nares[nostrils]
• External nares:nasal septum[med]
• Laterally:ala of the nose
• Bones and cartilage form the frame work
Bones and cartilages
• Bones[upper part] • Cartilage[lower part]
• Nasal bones • Upper lateral nasal
• Frontal process of cartilage
maxilla • Lower lateral nasal
• Nasal part of frontal cartilage
bone • Septal cartilage
• Minor Alar cartilages
• Accessory nasal
cartilage
Arterial supply& venous
drainage
• Dorsal nasal branch of opthalmic artery
• Infra orbital branch of maxillary artery
• Alar and septal branch of facial artery
• Venous drainage:facial & opthalmic veins
Nerve supply
• Sensory nerves:external nasal
• Infratrochlear[opthalmic nerve]
• Infraorbital[maxillary nerve]
• Motor nerves:buccal branches of facial
nerve
NASAL CAVITY
• Extent:external nasal apertures to
posterior nasal aperture
• Nasal septum divides the cavity
• Roof,floor,medial and lateral wall
• Three regions: vestibule,respiratory region
& olfactory region
• 5cm in height,5-7cm in length& 1.5cm in
width
Roof and floor of the nasal
cavity
• Slopes in front and behind
• Cribriform plate of ethmoid
• Anterior slope:nasal bone ,frontal bone
nasal cartilage
• Posterior slope:body of sphenoid bone
• Floor:palatine process of maxillae
• Horizontal plates of palatine bone
Nasal septum
• Median osseocartilagenous partition
• Bony part:vomer,perpendicular plate of the
ethmoid bone
• Cartilagenous part:septal cartilage,septal
process of inferior nasal cartilage
• Four
borders:superior,inferior,anterior,posterior
• Two surfaces:right and left
Arterial supply
• Anterosuperior:anterior ethmoidal artery
• Posterosuperior:posteriorethmoidal artery
• Anteroinferior:labial branch of facial artery
• Posteroinferior:sphenopalatine artery
• Kiesselbach plexus
Venous drainage
• Anteriorly:facial vein
• Posteriorly:through the sphenopalatine
vein into the pterygoid plexus of veins
Nerve supply
• General sensory nerves:trigeminal nerve
• Anterosuperior:internal nasal branch of
anterior etmoidal nerve
• Posterosuperior: posterio superior
branches of pterygopalatine ganglion
• Posteroinferior: nasopalatine branch of
pterygopalatine ganglion
• Anteroinferior :Anterior Superior Alveolar
nerve
Lymphatic drainage
• Anterior half:submandibular lymph nodes
• Posterior half:retropharyngeal and deep
cervical lymph nodes
Lateral wall of the nose
• Lateral wall is irregular due to conchae
• Superiorly:orbit above and ethmoidal air
sinus intervening
• Inferiorly:maxillary sinus
• Anteriorly:lacrimal groove and
nasolacrimal canal
• Divided into 3
parts:vestibule,atrium,conchae
Skeleton of the lateral wall
• Bony part • Cartilaginous part
• Nasal bone • Superior nasal
• Frontal process of cartilage
maxilla • Inferior nasal cartilage
• Lacrimal bone • 3 or4 small cartilages
• Labryinth of ethmoid of the ala
• Perpendicular plate of
palatine bone
• Medial pterygoid
Chonchae and meatuses
• Bony projections directed downwards and
medially
• Inferior concha:independent bone
• Middle concha:medial surface of the
ethmoidal labryinth
• Superior concha:arises from the medial
surface of the ethmoidal labryinth
Nasal Vestibule
• Boundaries:ala and lower nasal cartilage
• Above and behind:limen nasi
• Epithelium:stratified squamous keratinized
• Hair
• Sebacous glands
• Sweat glands
Meatuses of the nose
• Inferior meatuses:nasolacrimal duct opens
in the anterior1/3 &posterior 2/3
• Middle meatus :ethmoidal bulla,hiatus
semilunaris & infundibulum
• Ethmoidal bulla:produced by the middle
ethmoidal sinus
• Hiatus semilunaris:deep semicircular
sulcus below the bulla
meatuses
• Infundibulum:short passage at the anterior
end of the hiatus
• Superior meatuses:lies below the superior
concha
• Sphenoethmoidal recess:just above the
superior concha
• Atrium:is present in front of middle
meatuses
Arterial supply
• Anterosuperior part:anterior and posterior
etmoidal arteries & facial artery
• Anteroinferior quadrant:facial and greater
palatine arteries
• Posterosuperior quadrant:sphenopalatine
artery
• Posteroinferior quadrant:greater palatine
artery
Venous drainage
• Anteriorly: facial vein
• Posteriorly:pharyngeal plexus of veins
• Middle part:pterygoid plexus of veins
Nerve supply
• General sensory:trigeminal nerve
• Anterosuperiorpart:anterior etmoidal nerve
• Anteroinferiorpart:ant superior alveolar
nerve
• Posterosuperior part: pterygopalatine
ganglion
• Posteroinferior part:palatine branch of
pterygopalatine ganglion
Lymphatic drainage
• Anterior part:Submandibular nodes
• Posterior part:Retropharyngeal and upper
deep cervical lymph nodes
Clinical anatomy
• Rhinitis
• Deviated nasal septum
• Septal perforations
• Epistaxis
• CSF Rhinorrhea
Paranasal sinuses
• Air filled spaces present in bones around
thenasal cavities
• Open into nasal cavity
• Frontal sinus
• Maxillary sinus
• Sphenoidal sinus
• Ethmoidal sinus
Frontal sinus
• It is rudimentary or absent during birth
• Present in the frontal bone
• Deep to superciliary arch
• Opens into the middle meatus
• Blood supply:supraorbital artery
• Nerve supply:supraorbital nerve
• Lymphatic drainage:submandibular nodes
• Lies in the body of maxilla

• Largest of all sinuses

• Pyramidal in shape

• Opens into middle meatus

• Height:3.5cm,width2.5cm,anteroposterior
depth:2.5cm
• Apex:zygomatic process of maxilla

• Base:body of maxilla

• Roof:orbital surface of maxilla

• Floor:alveolar process of maxilla


• Arterial supply:facial,infraorbital and
greater palatine arteries

• Venous drainage:facial and pterygoid


plexus of veins

• Lymphatic drainage:submandibular nodes

• Nerve supply:infra orbital and anterior,


middle and posterior alveolar nerves
• It lies within the sphenoid bone
• It opens into the sphenoethmoidal recess
• Superiorly:optic chiasma and hypophysis
cerebri
• Inferiorly:nasopharynx
• Laterally:I.C.A and Cavernous sinus
• Arterial supply:posterior etmoidaI &I.C.A
• Nerve supply:posterior ethmoidal nerve
and pterygopalatine ganglion
• Venous drainage:pterygoid plexus of veins
and cavernous sinus

• Lymphatic drainage:retropharyngeal lymph


nodes
• Lies within the labryinth of ethmoid bone
• Above:orbital plate of frontal bone
• Behind:orbital process of palatine bone
• Anteriorly:lacrimal bone
• Anterior ethmoidal group
• Middle ethmoidal group
• Posterior ethmoidal group
• Ant ethmoidal sinus:opens into hiatus
semilunaris

• Middle ethmoidal sinus:opens into the


bulla ethmoidalis

• Posterior ethmoidal sinus:opens into


superior meatuses of nose
• Sinusitis
• Pansinusitis
• Caldwell- luc operation
• F.E.S.S
• Carcinoma of maxillary sinus