Paranasal sinus-2002-01-slides

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Paranasal sinus-2002-01-slides

  1. 1. Paranasal Sinuses: Anatomy and Function Glen T. Porter, MD Francis B. Quinn, MD UTMB Department of Otolaryngology Galveston, TX January 2002 1
  2. 2. Case Report—1000B.C. 2
  3. 3. Sinus Anatomy Overview 7 bones 4 paired sinuses 4 turbinates 3 meati Drainage system Nervous supply Vascular supply Related structures 3
  4. 4. Embryology Maxilloturbinal Ethmoturbinal Middle turbinate Superior turbinate Supreme turbinate Agger nasi Uncinate process Ethmoid infundibulum Sinuses 4 Maxillary Ethmoid
  5. 5. Sinus Development 5
  6. 6. 6 Pediatric Sinuses
  7. 7. Bony Structure Ethmoid Maxilla Palatine Lacrimal Pterygoid plate of Sphenoid Nasal Inferior Turbinate 7
  8. 8. Arterial Supply External Carotid Maxillary A. Sphenopalatine Internal Carotid Ophthalmic A. Ant. Ethmoid Post. Ethmoid Supraorbital Supratrochlear 8
  9. 9. Innervation 9
  10. 10. Neurovascular Supply 10
  11. 11. Sinus Drainage Schema 11
  12. 12. Ethmoid Sinus Development Present at birth ! Anterior/Posterior ! Variability ! Structure Volume/shape ! Roof ! Lateral wall ! 12
  13. 13. Ethmoid Roof •Anterior 2/3 •Posterior 1/3 Keros I Keros II Keros III 13
  14. 14. Ethmoid Cells Supraorbital, Frontal Bulla, Concha Bullosa, Haller’s, Onodi Cells 14
  15. 15. Ethmoid Sinus—Related Structures Basal Lamella of the Middle Turbinate ! Three planes Agger nasi cell ! Childhood sinus Ethmoid Bulla ! ! Hiatus Semiluninaris/Superior Hiatus Semilunaris Suprabullar/retrobullar recesses (Sinus Lateralis) Ethmoid Infundibulum/Uncinate Process Anterior/Posterior Ethmoid Arteries Osteomeatal complex 15
  16. 16. Basal/Ground Lamella 16 Basal/Ground Lamella Of the Middle Turbinate
  17. 17. The Agger Nasi Cell 17
  18. 18. Ethmoid Bulla Uncinate Process Hiatus Semilunaris 18
  19. 19. Ethmoid Infundibulum 19
  20. 20. Suprabullar/Retrobullar Recess 20
  21. 21. Ethmoid Arteries 21
  22. 22. Osteomeatal Complex 22 Middle meatus Maxillary Sinus Ostium Anterior Ethmoid Drainage
  23. 23. Maxillary Sinus Development Present at birth ! Biphasic growth ! Level of the floor ! Structure Volume & shape ! Walls, floor, roof ! 23
  24. 24. Maxillary Sinus 24
  25. 25. Maxillary Sinus 25
  26. 26. Maxillary Sinus Related Structures Fontanelles ! Natural ostium ! Haller’s Cells &Sinusitis ! Osteomeatal complex ! Accessory Ostium ! Nasolacrimal duct ! 26
  27. 27. Fontanelles 27
  28. 28. Natural Ostium -Haller’s cells Accessory Ostium 28
  29. 29. Nasolacrimal Duct 29
  30. 30. Frontal Sinus Development ! ! Frontal bone at birth Age 5 Structure ! ! ! Volume and shape Ostium Walls ! Anterior vs. posterior Related Structures ! 30 Frontal recess
  31. 31. Frontal Sinus Ostium Frontal recess Boundaries Dumbbell shape Sinus Lateralis Frontal Bulla 31
  32. 32. Sphenoidal Sinus Development Arise within the nasal capsule (no pouch) Age 3 begins to pneumatize Structure ! ! ! Volume/variable pneumatization Wall thickness Position within the sphenoid ! ! 32 Relation to sella turcica Sellar and postsellar relationships
  33. 33. Sphenoid Sinus Pneumatization 33
  34. 34. Sphenoid Sinus Sphenoid Sinus 34
  35. 35. Sphenoid Sinus 35
  36. 36. Sphenoid Sinus Ostium ! ! ! Size (.5-4mm) Location (sinus floor, anterior nasal floor, anterior sinus wall, superior turbinate, cribiform plate) Bony dehiscence Related Structures ! ! ! 36 Sphenoethmoidal recess Sphenoid rostrum Onodi cell
  37. 37. Sphenoid Ostium Sphenoethmoid Recess Sphenoid Rostrum 37
  38. 38. The Onodi Cell 38
  39. 39. Microscopic Anatomy Mucosa ! Cilliated columnar epithelial cells Anatomy ! Beat frequency ! Inhibitory effects of contact ! ! Noncilliated columnar cells Distribution ! Function ! ! 39 Basal cells
  40. 40. Microscopic Anatomy—Cont’d Goblet Cells Glycoproteins—viscosity and elasticity ! Innervation (para=thick, symp=thin) ! Basement membrane ! Submucosal glands ! 40 Distribution
  41. 41. Microscopic Anatomy 41
  42. 42. Mucous Blanket Two layers Superficial layer ! Sol layer ! Function Superficial layer traps bacteria and particulate matter. ! Enzymes, antibodies, immune cells ! 42
  43. 43. Mucociliary Transport Directional Flow of Mucous ! Toward the choanae Ostium drainage—a stubborn beast ! Hilding, MD Contact inhibition Haller’s cells ! Surgery ! 43
  44. 44. Mucociliary Transport 44
  45. 45. Function of Paranasal Sinuses Humidifying and warming inspired air Regulation of intranasal pressure Increasing surface area for olfaction Lightening the skull Resonance Absorbing shock Contribute to facial growth 45
  46. 46. New Frontiers Sleep apnea and the sinuses ! ! Humidification contributes up to 6.9mm Hg serum pO2 Mouth breathers noted to have decreased end-tital CO2—increased serum CO2—apneas (high baseline) Nitric Oxide (NO) ! ! ! 46 NO produced primarily in sinuses Toxic to bacteria, fungi, viruses Increases cilliary motility
  47. 47. Case Report 39 yom with h/o sinus disease c/o headache, rhinorrhea. PMHx of “sinus surgery” years ago ROS reveals h/o two episodes of meningitis in past few years PE: right superior nasal mass. S/p FESS. Clear rhinorrhea. 47
  48. 48. 48
  49. 49. References Anon, Jack B., et al, Anatomy of the Paranasal Sinuses, Theime, New York, c1996. Bhatt, Nikhil J., Endoscopic Sinus Surgery: New Horizons, Singular Publishing Group, Inc., San Diego, c1997. Bailey, Byron J., et al, Head & Neck Surgery -- Otolaryngology, Lippincott Williams & Wilkins, Philadelphia, c2001. Lundberg, J., Weitzberg, E. Nasal Nitric Oxide in Man. Thorax 1999; 54(10):947-952. McCaffrey, Thomas V., Rhinologic Diagnosis and Treatment, Thieme, New York, c1997. Marks, Steven C. Nasal and Sinus Surgery, W.B. Saunders Co., Philadelphia, c2000. Navarro, Joao A.C., The Nasal Cavity and Paranasal Sinuses, Springer, Berlin, c2001. Watelet, J.B., Cauwenberge P. Van, Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. Allergy 1999; 54, Supp 57:14-25. 49

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