नासा हि शिरसो द्वारम्।

DR SRAVYA M V
FIRST YEAR PG
DEPT. OF SALAKYATANTRA
GAVC TRIPPUNITHURA
Contents

• Introduction
• Anatomy of nose
• Nasya
• Shringataka
• Pterygopalatine fossa
• Cavernous sinus
• Endoscopic endonasal neurosurgeries
• Conclusion
• Reference
Nasa

• One among panchendriya adhishtana

• Bahya srotas situated in shiras

• Nasal tract - vestibule to nasopharynx

• Pathway for drug administration

• In the form of ‘nasya’

• Nasal mucosa connects CNS & atmosphere

Shiraso dwaram ..
Bahya srotas

नव महन्ति छिद्राणि- सप्त शिरसि, द्वे चाधः| Ca Sa 7/12

श्रवणनयनवदनघ्राणगुदमेढ्राणि नवस्रोतांसि नराणां बहिर्मुखानि | Su Sa 5/10

 Anatomy of nose
External nose Internal nose

Osteocartilaginous Nasal skin Nasal Vestibule Nasal cavity proper

framework musculature Roof
Floor
Medial wall
Lateral wall
Nasal cavity proper

Lateral wall

• Inferior meatus nasolacrimal duct

• Middle meatus middle ethmoidal sinus

frontal sinus

maxillary sinus

anterior ethmoidal sinus

• Superior meatus posterior ethmoidal sinus

• Spheno ethmoidal recess - sphenoid sinus

Medial wall

• Osteocartilaginous

Vomer
Perpendicular plate of ethmoid
Septal cartilage
Floor

• Palatine process of maxilla

• Horizontal plate of palatine bone

Roof

Anterior slope

Nasal part of frontal bone

Nasal bone

Nasal cartilage

Middle horizontal

Cribriform plate of ethmoid bone

Posterior slope

Inferior surface of body of sphenoid

Nasya

• औषधमौषधसिद्धो वा स्नेहो नासिकाभ्यां दीयत इति नस्यम्। Su ci 40/21

• ऊर्ध्वजत्रुविकारेषु विशेषान्नस्यमिष्यते। Ah Su 20/1

• नासा हि शिरसो द्वारम् । तत्रावसेचितमौषधं स्रोतः शृङ्गाटकं प्राप्य व्याप्य च मूर्धानं नेत्रश्रोत्रकण्ठादि
सिरामुखानि च मुञ्जादिषीकामिवसक्तामूर्ध्वजत्रुगतां वैकारिकीमशेषमाशु दोषसंहतिमुत्तमाङ्गादपकर्षति।
A S su 39/3
• जत्रूर्ध्वं पाणितापेन पुनः पुनःस्वेदयेत्। A S su

• किञ्चित् प्रविलम्बितशिरसे। Su Ci

• दत्तमात्रे नस्ये कर्णललाटके शभूमिगण्डमन्यास्कन्दपाणिपादतलान्यनुसुखं मर्दयेत्। A S su

• शृङ्गाटकमभिप्लाव्य निरेति वदनाद्यथा। Su Ci

• Atiyoga – मस्तुलुङ्गागमम्। Su Ci
Shringataka marma

जिह्वक्षिनासिकाश्रोत्रखचतुष्टयसङ्गमे ।

तालून्यास्यानि चत्वारि स्रोतसां,तेषु मर्मसु

विद्धः शृङ्गाटकाख्येषु सद्यस्त्यजति जीवितम्। Ah Sa 4/34

घ्राणश्रोत्राक्षिजिह्वा संतर्पणीनां सिराणाम् मध्ये सिरा सन्निपातः शृङ्गाटकानि।

Su sa 6/27
• Mentioned in the context of ,
• Nasya
• Anjana
• Kshavathu
• Sandhi
Anjana
Lekhana :-
नेत्रवर्त्मसिराकोशस्रोतः शृङ्गाटकाश्रितम्।
मुखनासाक्षिभिर्दोषमोजसा स्रावयेत्तु तत्।। Su U 18/54

Aschyotana

गत्वा सन्धिशिरोघ्राणमुखस्रोतांसि भेषजम्।

ऊर्ध्वगान्नयने न्यस्तमपवर्तयते मलान्।। Ah Su 23/8
Kshavathu

घ्राणाश्रिते मर्माणि संप्रदुष्टे यस्यानिलो नासिकया निरेति।

कफानुयातो बहुशः सशब्दस्तं रोगमाहुः क्षवथुं विधिज्ञः।। Su U 22/11

तीक्ष्णोपयोगादतिजिघ्रतो वा भावान् कटू नर्क निरीक्षणाद्वा।

सूत्रादिभिर्वा तरुणास्थिमर्माण्युद्घाटितो अन्यः क्षवथुर्निरेति।। Su U 22/12
Sandhi
श्रोत्रशृङ्गाटके षु शङ्खावर्ताः। Su Sa 5/27
Anatomical considerations of shringataka marma ,
• Middle & inferior conchae
• Pterygopalatine fossa
• Cavernous sinus
 Middle & inferior conchae

• नासावंशास्थि मर्म - Dalhana

• Shankhavarta - resembling shell

• 4 in number
 Pterygopalatine fossa

• Anteriorly – orbit

• Inferiorly – oral cavity

• Medially – nasal cavity

• Posteriorly – pharynx

• Location – posterolateral aspect of nasopharynx (talu)

Contents

• Maxillary artery – except tongue

(संतर्पणीनां सिराणाम् )

• Maxillary nerve – except ear & tongue

• Pterygopalatine ganglion – eyes, nose,

oral cavity
 Cavernous sinus

• Large venous space

• In the middle cranial fossa

• On either side of body of sphenoid

• Anteriorly – medial end of superior

orbital fissure

• Posteriorly – apex of petrous temporal

bone
Relations

outside the sinus

Superiorly

Optic tract, optic chiasma, olfactory

tract, internal carotid artery, anterior
perforated substance

Inferiorly

Foramen lacerum, junction of body &

greater wing of sphenoid bone
Medially

Hypophysis cerebri, sphenoidal air sinus

Laterally

Temporal lobe with uncus

Below laterally

Mandibular nerve

Anteriorly

Superior orbital fissure ,apex of orbit

Posteriorly

Apex of petrous temporal (internal acoustic meatus), crus cerebri of midbrain

Within the lateral wall

• Oculomotor nerve

• Trochlear N

• Ophthalmic N

• Maxillary N

• Trigeminal ganglion
Medial part

• Internal carotid artery venous & sympathetic plexus

• Abducent nerve
Tributaries

From orbit

• Superior ophthalmic vein

• Inferior ophthalmic vein

• Central vein of retina

From brain

• Superficial middle cerebral vein

• Inferior cerebral vein from temporal lobe

From the meninges

• Sphenoparietal sinus

• Frontal trunk of middle meningeal vein

Draining channels

• Superior petrosal sinus transverse sinus

• Inferior petrosal sinus internal jugular vein

• Emissary veins pterygoid plexus of veins

• Superior ophthalmic vein facial vein

• Anterior & posterior intercavernous sinuses

All communications are valveless

Factors helping expulsion of blood from sinus

• Expansile pulsation of internal carotid artery within the sinus

• Gravity

• Position of head
• Venous drainage from all sense organs

• Bony relations – except tongue

• Injury – fatal – intracranial course of internal carotid artery

• Nasya – mucosal surface - venous return – systemic circulation

 • At the opening of nasal passage
Vestibule
• Filter the air, low vascularization

• Systemic drug absorption

Lining membrane Respiratory • Highest vascularity
of internal nose region
• Enlarged surface area – nasal conchae -
magnification of mucosa by microvilli &

Olfactory cilia
region
• Transportation of drugs to brain & CSF
• Mucosa – direct contact
Internal nose
Nasal route of administration in modern sciences

• Inhalation of vaporized, nebulized, powdered, or aerosolized drug

• Direct instillation

• 3 routes - directly by olfactory neurons

- through supporting cells & surrounding capillary beds

- directly into CSF

 By olfactory neurons
 Through supporting cells
 Directly into CSF
 Advantages

• Blood brain barrier prevents most • High total blood flow

of the drugs • Avoidance of first pass metabolism

• Alternate method of drug • Ready accessibility

administration • No gastrointestinal degradation

• Painless
• Local & systemic actions
• Non invasive
• Large surface area
Endoscopic endonasal neurosurgeries

Pituitary adenoma

• Trans sphenoidal surgery – more preferred

• Preserve normal pituitary function

• Permits more accurate control of tumour removal

• In larger tumours with parasellar & suprasellar

growth
Suprasellar meningioma

• Minimally invasive

Foramen magnum meningiomas

• Restricted field of surgery

 Conclusion

• Nose is one among the bahya srotas situated in head

• Nasal cavity is in direct connection with brain through cribriform plate of

ethmoid bone

• Nasya medicine reaches shringataka which is connected to other srotases in head

• Shringataka can be considered as cavernous sinus

• Endoscopic endonasal neurosurgeries confirms nose as the gateway to head

• Nasa hi siraso dwaaram

Reference

• Diseases of ear , nose & throat – P L Dhingra Shruti Dhingra

• Ramamoorthi &Tandon’s Textbook of neurosurgery

• BD chaurasia’s human anatomy

• Susruta Samhita

• Charaka samhitha

• Ashtanga sangraha

• Ashtangahrdaya
Thank you