SURGICAL ANATOMY OF

NOSE & PNS

 EMBRYOLOGY

 olfactory/nasal placode - olfactory pit – nasal

sac – fusion of maxillary process – primitive
choana- nasal septum – vomero nasal organ

 Anomalies
arrhinia, proboscis deformity, polyrrhinia
 Cleft lip – max. & premaxilla

 Facial cleft - max.& lateral process

 Cleft palate – palatine process & septum

 Choanal atressia
 NASAL CAVITY

 LATERAL NASAL WALL

turbinate

 UNCINATE PROCESS
 INFUNDIBULUM
3-D space
Ant- uncinate
lat - LP
sup - FR
inf - max.sinus ostium
med – uncinate
Ant.&Post. fontanellae
 Recess terminalis
 Variations

 Ethmoidal bulla
ant - uncinate
post – basal lamella
lat - LP
med- MT
 Suprabullar & retrobullar space
 Hiatus semilunaris inferioris –
b/w uncinate and bulla

 Hiatus semilunaris superioris

 Acce.max ostium
circular, easily seen, 2-D,
 Basal lamella
 Agger Nasi cell

 Anterior most
ethmoidal cell

 Anterior to MT
attachment

 Unilateral / bilateral

 Multiseptate
 OMC 3-D
lat - LP
med- MT
sup- FR
inf – max.ostium
Include uncinte, infudibulum, SLH, cleft b/w
uncinate and MT, bulla and MT
 Anatomy - Frontal Recess
Boundaries
 Laterally – Lamina Papyracea
 Medially – Middle turbinate
 Anterior – Agger nasi
 Posterior – Bullar lamella
Bulla
Haller cells
 Supraorbital cell

 Pneumatized suprabullar
recess

 Above orbit

 May be extensive

 Seen in coronal & saggital

scan

 Posterior to frontal sinus

Frontal type
I

Agger
Frontal Type
II

Agger
Frontal Type
III & IV
Concha bullosa
Paradoxical MT
 Incidence

 Agger Nasi - 89%

 Supraorbital- 62%
 Frontal I - 37%
 Frontal II - 19%
 Supra bullar - 15%
 Interfrontal septal - 14%
 Frontal bullar - 9%
 Frontal III - 8%

 Lee,Kuhn & Citardi: 2004

 ETHMOIDAL ROOF- fovea ethmoidalis
Kero’s classification

I II III
 Sphenoid sinus
Onodi cells
 2mm cuts
 Anterior Ethmoidal artery (beaking)