presentation of anatomy of lateral wall of nose

1. LATERAL WALL OF NOSE
Brijal H Patel
3rd Year Resident
Department of otorhinolaryngology
BJMC Ahmedabad

3. EMBRYOLOGY: 1) FRONTONASAL PROCESS, 2) 1ST PHARYNGEAL ARCHES
LATERAL WALL OF NOSE : FROM LATERAL NASAL PROCESS
The 5-week embryo—formation of facial processes The 6-week embryo

4.  INTERMAXILLARY PROCESS-
NASAL SEPTUM
 LATERAL NASAL PROCESS-
NASAL ALAE AND LATERAL
NASAL WALL--> ELEVATION
FORMS TURBINATES
 MAXILAARY PROCESS+
LATERAL NASAL PROCESS =
NASO-OPTIC GROOVE-->
NASOLACRIMAL DUCT

5. 5

6. • meatus- passage
• supreme turbinate-< 20% population--> drains post ethmoids
• inferior turbinate- ant- lacrimal, sup- ethmoid, posteroinfe -palatine
bone, laterally- maxilla
has large submucosal cavernous plexus and sinusoids--> under
control of ANS.
IM->NLD- Just ant to junction of ant 1/3rd and post
2/3rd IM -hasners valve
• mm- drains ant ethmoid, frontal, maxillary
• superior meatus- posterior ethmoids--> lateral to ST
• sphenoethmoidal recess- sphenoid sinus --> medial to ST

7. ATTACHMENTS OF MIDDLE TURBINATE
anterior
1/3rd(sagittal
plane) attached to
cribriform plate at
the junction of
medial and lateral
lamella and with
the frontonasal
process of maxilla
middle 1/3rd
(coronal
plane)
attached to
lamina
papyracea
(LP), and
stabilized MT,
k/a ground/
basal lamella
posterior
1/3rd attaches
to LP and
perpendicular
plate of
ethmoid bone
extend up to
posterior
choana
(1) to cribriform plate and frontonasal
process of the maxilla, (2) lamina papyracea,
(3) to perpendicular plate of palatine

8. Uncinate process attachments and its variations
a)may turn forwards to
be attached to the
insertion of the middle
turbinate/LP--> M/C
b) extend upto the base
skull.
c) attach to the middle
turbinate.
lie free in the middle
meatus.
may be pneumatized.
lies within the frontal
recess

10. UP Lying free in
middle meatus
Pneumatized
uncinate process

11. Fontanelles

12. • wide natural Maxillary ostium is reduced in life to small
ostium by 4 bones( lacrimal-ant, ethmoid-sup,
perpendicular plate of palatine bone-post, IT- inf) and
membraneous area.
• uncinate process(UP) - devide memb area b/t 2 halves
--> ant and post fontenella--> accesory ostium--> seen with
chronic sinusitis
• FONTANELLES

13. OSTEOMEATAL COMPLEX

14. 14
[5] CONCHA BULLOSA
BLOCKADGE OF OMC-
- CONCHA BULLOSA
- PARADOXICAL MT
Mx - remove lateral wall/ part of MT
- septal causes- DNS,Hypertrophy of
turbinate, pneumatised septum

15. Paradoxically curved middle
turbinate
The turbinate sinus

16. Drainage of: (1) maxillary sinus (black), (2) bulla (blue),
(3) frontal sinus (light brown), (4) sphenoid sinus (green)

17. SUPRABULBAR RECESS AND RETRO BULBAR RECESS
(1) The hiatus semilunaris inferoris, (2) the
hiatus semilunaris superioris
LATERAL SINUS/ SINUS LATERALIS: SBR+
RBR
BOUNDARIES:
SUP- ROOF OF ETHMOID
INF: ROOF OF BE
MED: MT
LAT: LP/ORBITAL PLATE

18. MASTER CONTROLLER OF SINUS DRAINAGE??
frontal recess(FS), infundibulum(MS) PART OF ???

19. The cribriform plate and ethmoid fovea:
(1) Horizontal lamella, (2) Lateral
lamella(0.2 mm)
(3) Orbital plate of frontal bone(0.5 mm)
(4) Anterior ethmoidal artery(0.05mm)

20. ETHMOID AIR CELLS: tend to migrate into
the surrounding bones to develop variable patterns of
pneumatization.
• Ethmoid bulla--> most constant and ant air cells
TORUS LATERALIS/ LATERAL BULGE
• Anteriorly—into the lacrimal bone and frontonasal process of the
maxilla as the agger nasi cells.[1] ant most--> excessively
pneumatized --> frontal sinusitis
• Superiorly—above the ethmoidal bulla over the orbit and behind
the frontal sinus to form the supraorbital cell.[4]
• Inferolaterally—into the roof of the maxillary sinus as the Haller
cell.[2] if extensively pneumatised, block infundibulum-->
maxillary sinusitis
• Posteriorly—above the sphenoid sinus as the Onodi
cell.[7] well pneumatized beyond the optic nerve -->
accidentally damage ON.

21. Haller’s cell

22. • Anterosuperiorly—into the frontal bone to form the frontal sinus.[3]
• Isolated cells may be present within the ethmoid infundibulum. These are the
infundibular cells
• Superiorly—into the frontal recess to form the different types of frontal cells.
Different types of frontal cells
Type I A single cell above the agger nasi cell.
Type II Two or more cells above the agger nasi cell.
Type III A large cell extending well into the frontal sinus
mimicking the frontal sinus itself (frontal bulla).
Type IV An isolated “loner cell” separately within the
frontal sinus.

23. FRONTAL RECESS AND FRONTAL CELLS

24. Onodi cell in relation to the sphenoid sinus and the optic nerve[7]

25. KEROS CLASSIFICATION
The length of the lateral lamella and the depth of the olfactory fossa are classified by
Keros into 3 types:
• Type I — 1-3 mm
• Type II — 4-7 mm
• Type III — 8-17 mm

26. The anterior ethmoidal cells may migrate anterosuperiorly into the frontal
recess to produce different types of frontal cells
Type I A single cell above the agger nasi cell
Type II Two or more cells above the agger nasi cell.
Type III A large cell extending well into the frontal sinus mimicking the
frontal sinus itself (frontal bulla).
Type IV An isolated “loner cell” separately within the frontal sinus.

27. Relationship of the maxillary ostium to the
nasolacrimal duct and lamina papyracea
Orbital contents showing orbital fat
anteriorlyand medial rectus posteriorly

28. : Intraconal compartment of orbit—the medial rectus has been reflected anteriorly

29. (1) Anterior ethmoid artery, (2) posterior ethmoid artery, (3) sphenopalatine
artery, (4) septal branch of the sphenopalatine artery
Blood supply of lateral nasal wall

30. ETHMOID ARTERIES

31. CLINICAL IMPORTANCE
 ARTERIAL LIGATIONS
 Sphenopalatine artery ligation via
endoscopic approach
 Intermaxillary artery ligation
(transantral approach)
 External carotid artery ligation
 Anterior ethmoidal artery ligation
(external approach vs endoscopic
approach)

32. NERVE SUPPLY OF LATERAL NASAL WALL

33. THANK YOU