Part of MID FACE. Entrance of the respiratory tract. Plays role in warming ,humidifying and filtering the air. Important role in facial esthetics. Nostrils opens into nasal cavities. Nasal cavities are housed in a frame work of bones and fibroelastic cartilages. The bones surrounding the nasal cavities contains air filled cavities called paranasal sinuses.
Brain occupies most of head region. Eyes are laterally located. Stomodeum represents future mouth. At the upper margin of Stomodeum – fronto nasal process formed from mesoderm. The frontonasal process inferiorly differentiates into two projections known as “Nasal Placodes”.
Nasal pits are continuous with stomodeum, Sink to form the nostril. Nasal pits –partly surrounded by unevenly grown median and lateral nasal processes. Around the gut tube pharyngeal arches are formed. The oronasal membrane is fully formed by the end of 5th week of development. It gives rise to the floor of the nose (palate develops from this membrane).
Later medial process joins the maxillary process forming closed maxillary arch. Lateral nasal swelling also join maxillary process and gives nasolacrimal duct at their junction. frontonasal prominence gives rise to inferior mesodermic projection-form the nasal septum dividing the nose into two cavities.
Medial swellings on both the sides fused forming middle part of nose,philtrum & premaxilla.
Lateral swellings forms the alae of nose.
Anterior most ethmoidal air cell is known as agger nasi. Large agger nasi air cell can impede frontal sinus drainage due to its close proximity to the frontal sinus drainage pathway. Haller cells belong to the anterior ethmoidal group of air cells. These cells are also known as infra orbital cells. Enlargement of this cell may block drainage of the maxillary sinus. Extension of posterior ethmoidal cells supero lateral to the sphenoid sinus is known as onodi cell. This cell lies in close proximity to optic nerve. Inflammation of this cell may cause blindness. This anatomy is also crucial in endoscopic sinus surgical procedures Separated from the orbit by a thin plate of bone so that infection can readily spread from the sinuses into the orbit
Nose and paranasal sinuses
Dr. Anil kumar
DEVELOPMENT OF PARANASAL
At about 25 – 28 weeks of gestation, three medially
directed projections arise from the lateral wall of the
Between these projections small lateral diverticula
invaginate into the primitive choana to eventually form
the meati of the nose.
This serves as the beginning of the development of
Sinuses begin developing as small sacculations of the
mucosa of the nasal meati and recesses.
As the pouches or sacs develop and grow they will
invade the respective bones to form air sinuses and
Development is brougt about by resorption of inner
surface and apposition on the outer surface by
remodelling to accomidate the stresses.
Maxillary sinus - first to be
developed and aerated at
shows biphasic growth. The
first growth phase during the
first three years of life, and
the next growth phase occur
between 7 – 18 years.
Initially located medial to the
orbit, later sinus extends
laterally & Inferiorly.
Floor of sinus does not
extend below the level of
nasal cavity until the
eruption of permenant teeth.
is undevoleped and
Aeration begins at
age 3years and then
sphenoid: 1=newborn, 2=3yo,
3=5yo, 4=7yo, 5=12yo, 6=adult,
Ethmoid air cells-develop during puberty and
develop slowly until approximately 17-18 years
Pneumatization of this sinus begins during the
4th year of childhood and gets completed by the
17th year of life
Frontal sinus is last
sinus to develop ,as a
direct continuation or by
upward migration of
anterior ethmoidal air
Remains as a small blind
sac within the frontal
bone till 2 years of
age,from 2 to 9 years
pneumatization of frontal
frontal: 4=newborn, 5=1yo,
CONGENITAL ANOMALIES OF
due to unilateral absence of
due to bilateral absence of
CONGENITAL ANOMALIES OF
due to imperfect fusion
between the maxillary process
and the lateral nasal process.
duplication of the medial
CONGENITAL ANOMALIES OF
NASAL CLEFTS :
failure of the frontal nasal
process to develop
appropriately results into
two separated halves of
incomplete fusion of
the right and left
NOSE & PARANASAL SINUSES
To filter the air
Humidifying and warming inspired air
Increasing surface area for olfaction
Lightening the skull
Contribute to facial growth
LATERAL WALL OF NOSE
Marked by 3 projections:
The space below each
concha is called a
Space below the
Superior concha is a
process of ethmoid
Smallest of all meatus.
sinuses opens into it.
recess is space above
opens into it.
Space below middle
Middle concha is the
medial process of
-frontal & maxillary
-middle ethmoidal air
Largest of the
Space below the
Inferior concha is thin,
Naso lacrimal duct
opens in the anterior
SKIN OVER THE NOSE
Skin is mobile over
upper thirds but firmly
adherent in the lower
part to cartilages.
Upper 1/3 rd –olfactory region,
mucous membrane- more delicate
Lower 2/3 rd – Respiratory
region, Lined by pseudo stratified
ciliated columnar epithelium,
,highly vascular with numerous
Mucous membrane covering
vestibule of nose carries stiff hairs /
Contains Arteriovenous anastamosis
–warms the air passing through it.
MUSCLES OF THE NOSE
most cephalic muscle of
the nose, pyramidal
Insertion –from glabellar
Assists in dilatation of
It has 2 components:
(1)transverse nasalis /compressor
nasi: the muscle spans the dorsum
of the nose, covering the upper
ORIGIN :maxilla above and lateral to incisive
INSERTION: with its counterpart and procerus &
levator labi superioris aeque nasi muscle.
(2) the pars alaris (alar nasalis).
ORIGIN: above lateral and canine.(more lateral &
slightly caudal to the bony origin of the depressor
septi nasi muscles).
INSERTION : into ala above lateral crus of the
Origin: upper part of frontal
process of maxilla.
It extends lateral to the
nose in a cephalocaudal
direction and has ﬁbers
that are attached to the
nostril, contributing to the
dilatation of the nares.
Insetion:lateral crus of
major alar cartilage and
lateral part of upper lip.
Release of the muscles will
dilate the nostrils,
Dilator naris anterior
Origin:ULC and alar part
Primary dilator of nose
Depressor alae or
originates from the border
of the pyriform crest and
then rises vertically, like
a fan, up to the ala,
acting as a depressor
and constrictor of the
Arises from the maxilla
(just below the nasal
fuses with some ﬁbers
of the orbicularis oris
Inserted along the
columella, medial crus
of alar cartilage.
Nasal branches of
External nose –Infra orbital nerve, Infra trochlear,
External nasal nerve.
Dorsal nasal artery
Superior labial artery
Anterior & posterior ethmoidal
Superior labial artery
Infraorbital and superior dental
Pharyngeal branch of maxillary
Greater palatine artery
These arteries are
Little's area, is a region in the anteroinferior part of the
nasal septum, where there is confluence of 4 arteries
forming this plexus.
lymphnodes: from the
external nose and anterior
part of the nasal cavity.
Upper deep cervical nodes:
drain the rest of the nasal
cavity, either directly or
Antrum of Highmore.
largest of all paranasal
Pyramidal shaped ,
Lying just under the
Capacity of 30ml.
Anterior wall (anterolateral wall)–lateral wall of the
maxilla (canine fossa).
Posterior wall – temporal surface of maxilla.
Roof – floor of the orbit(infraorbital vessels and
Floor – alveolar process of maxilla & hard palate.
Medial wall (base of maxillary sinus)- lateral wall of
the nasal cavity.
Laterally (apex of sinus) – zygomatic bone
OSTIUM OF MAXILLARY SINUS
Opens in the
Posteroinferior end of
Close to roof of sinus.
drainage of sinus.
In children the floor lies
at or above the level of
the floor of the nasal
In adults it lies about
1.25cm below the floor
of the nasal fossa
Lie within the body of
the sphenoid bone
Below sella turcica
dorsum sellae and post
The average capacity is
Superiorly – Pituitary gland (hypophysial
fossa) Lateral wall – Optic
nerve and internal carotid
Floor – Nerve of pterygoid canal
RELATIONS OF SPHENOIDAL SIN
OPENING OF SPHENOID SINUS
Opens into the sphenoethmoidal recess above
the superior concha.
Ostium -Size (0.5-4mm)
They are anterior,
middle, and posterior.
They are contained
within the ethmoid bone,
between the nose and
Anterior & middle
drains into middle
Posterior drain into
Second largest sinuses
◦ 2 – 2.5 cm
Contained within the
frontal bone .
Separated from each
other by a bony septum.
Each sinus is roughly
Extending upward above
the medial end of the
eyebrow and backward
into the medial part of
the roof of the orbit.
Opens into the middle meatus
The average capacity is about 7 ml in the adult.
True frontonasal duct only in 15% of people.
This is the area bounded by the middle
turbiante medially, the lamina
papyracea laterally, and the basal
lamella superiorly and posteriorly. The
inferior and anterior borders of the
osteomeatal complex are open.
This is in fact a narrow anatomical
region consisting of :
1. Multiple bony structures (Middle
turbinate, uncinate process, Bulla
2. Air spaces (Frontal recess,
ethmoidal infundibulum, middle
3. Ostia of anterior ethmoidal, maxillary
and frontal sinuses.
Sinus infections refer to the inflammation of the para-
nasal cavities caused by irritation of the sinus
Sinus cavities get irritated / infected
Overproduction of mucus
Sinus cavity openings may swell and block
Any accumulated mucus can become a haven for
Acute, which last for 3 weeks or less
Chronic, which usually last for 3 to 8 weeks but can
continue for months or even years
Recurrent, which are several acute attacks within a
year Sinusitis can be classified based on which
sinus cavities it affects:
Antritis/ maxillary sinusitis
Ethmoiditis / ethmoid sinusitis.
Symptoms of Sinusitis
location of pain depends on which sinus is affected.
Headache when you wake up in the morning is
typical of a sinus problem.
Infection in the maxillary sinuses can cause your
upper jaw and teeth to ache and your cheeks to
become tender to the touch.
Fever ,Weakness ,Tiredness etc.
A cough that may be more severe at night.
Runny nose (rhinitis) or nasal congestion .
Drinking plenty of fluids to thin the secretions and
keep them flowing.
Hot showers to loosen the mucus.
Alternate hot and cold compresses- place the hot
compress across your sinuses for 3 minutes, then
the cold compress for 30 second.
The nostrils are compressed against the nasal
The patient is told not to swallow blood running
down the pharynx.
The patient is kept in an upright posture
An ice bag can be placed on the back of the
neck to induce reflex vasoconstriction.
Anterior nasal bleed is treated by packing the
area with gauze soaked in L.A, by using
electrocautery, or with silver nitrate
If bleeding persists anterior nasal packing is
Anterior nasal packing
If it is posterior nasal
bleed, posterior nasal
packing has to be done.
Reliable method is by
using Foleys catheter.
posterior nasal packin
Cystic fibrosis is a systemic disease of unknown
etiology affecting the mucus producing exocrine
glands of upper respiratory tract, liver, pancreas,
intestine and the non-mucus producing salivary
and sweat glands.
The abnormal secretions produced may lead to
disease in any of the involved organ systems.
The paranasal sinuses are ultimately involved with
the viscous secretions generally result in chronic
The blocked nose
local manifestation of an allergic reaction.
Type I – inferior one half of nasal bones.
Type II –entire nasal bone separated at nasofrontal
Type III –nasal bones and frontal process of
Type IV – nasal bones frontal process of maxilla.
nasal spine of frontal bone and ethmoid bone.
PA (Caldwell) view
Open mouth Waters view
Sub Mento Vertex view
Image is done in vertical
position. air fluid level is clearly
Image is done vertically, but CR
is angled 45 degrees. gradual
fading of the fluid line.
Image is done horizontally and
the CR is vertical no evidence
of an air-fluid level.
Exudate in the sinuses is not a
fluid but is commonly a heavy
semi gelatinous material that
clings to the walls of cavity and
takes several minutes to shift
the position .so you must
position the patient for several
minutes to allow the exudate to
gravitate to the desired
location before the exposure is