NOSE WITH SINUS

2. ANATOMY OF NOSE &
PARANASAL
SINUSES

3. EXTERNAL NOSE
Radix/root of nose
Bridge
Nasofacial angle
Dorsum
Alar nasal angle
Pronasale (tip)
Ala nasi (nasal wings)
columella
Anterior nares /nostrils

4. EXTERNALNOSE
Upper 1/3 rd
(nasion
region)
Middle 1/3 rd
Lower 1/3 rd

5. BONY PARTS

6. CARTILAGINOUS PARTS
Lesser alar
cartilage
Lateral nasal
cartilage
Greater alar
cartilage
Denseconnective
tissue

7. BASAL VEIW
Middle crus
Lateral crus
Medial crus

8. NASAL CAVITY
Extends from nostrils to posterior nasal

9. WALLS OF NASAL CAVITY
Roof
Floor
Medial/septal wall
Lateral wall

10. ROOF OF NASAL CAVITY
Frontal & nasal
bones
Cribriform plate of
ethmoid
Body of
sphenoid

11. THE FLOOR OF NASAL CAVITY
Palatine
process of
maxilla
Horizontal
plate of
palatine bone

12. MEDIAL WALL
Divides nasal
cavity into two
halves.
Seldom lies in
midlineVestibule of
nose
It is formed by the Nasal Septum
Upper part : vertical plate of Ethmoid bone and Vomer
Anterior part : Septal Cartilage
Septum rarely lies in the midline , thus increasing the size of one half of nasal
cavity to other

13. NASALSEPTUM
Vertical plate of ethmoid
Septal cartilage
vomer

14. LATERALWALL

15. LATERAL WALL OFNOSE
 Marked by 3 bony projections:
Superior concha
Middle concha
Inferior concha
 The space below each concha
is called a meatus.

16. SUPERIOR MEATUS
 Space below the superior
concha.
 Superior concha is a process
of ethmoid bone.
 Smallest of all meatus.
 Posterior ethmoidal
sinuses opens into it.
 Sphenoethmoidal recess is
space above superior concha.
 Sphenoidal sinus opens
into it.

17. MIDDLE MEATUS
 Space below middle
concha.
 Bulla Ethmoidalis: Around
swelling which is formed by
middle ethmoidal air sinuses
opening at it’s upper border .
 Hiatus semilunaris: lying just
below the Bulla .
 Anterior end of hiatus
:Infundibulum (funnel
shaped channel continuous
with FRONTAL SINUS .
 Maxillary Sinus opens into
Middle Meatus through
Hiatus Semilunaris

18. INFERIOR MEATUS
 Largest of the meatuses.
Space below the inferior
concha.
 Inferior concha is thin, curved
,independent bone.
 Naso lacrimal duct opens in the
anterior part guarded by a fold of
Mucous memberane

19. SKIN OVER THE NOSE
Skin is mobile over
upper thirds but firmly
adherent in the lower
part to cartilages.

20. MUCOUS MEMBRANE
 Area above S.C Upper 1/3 rd –
olfactory mucus memberane
sensitive to smell
 Lower 2/3 rd – Respiratory
region, Lined by pseudo stratified
ciliated columnar epithelium,
mucoperiosteum-Thick ,spongy
,highly vascular with numerous
mucous glands.
 Mucous membrane covering
vestibule of nose has coarse hairs /
vibrissae.
 Contains Arteriovenous anastamosis
–warms the air passing through it.

21. NERVE SUPPLY
External nose –Infra orbital nerve, Infra trochlear,
External nasal nerve.
 Olfactory neves
 Anterior ethmoidal
nerve (V1)
 Nasal branches of
pterigo palatine
ganglion
 Nasopalatine nerve

23. BLOOD SUPPLY
NASAL CAVITY : Branches of Maxillary
Artery
 Anterior & posterior ethmoidal
arteries
 Sphenopalatine artery
 It anastomoses with the septal branch of
superior Labial branch of Facial Artery in
the region of vestibule
 The submucous venous plexus is
drained byveins accompanying arteries

24. KIESSELBACH'S PLEXUS
 These arteries are
 (mnemonic –LEGS)
 Superior Labial
 Anterior Ethmoidal
 Greater palatine
 Sphenopalatine
 Little's area, is a region in the anteroinferior part of the
nasal septum, where there is confluence of 4 arteries
forming this plexus.

25. NOSEBLEED (EPISTAXIS)
 Traumatic
 Iatrogenic
 Inflammatory
 Foreign bodies
 Trauma (including nose picking)
allergy
 Benign & malignant neoplasms
 Anterior nasal bleed
 Posterior nasal bleed

26. LYMPHATIC DRAINAGE
 Submandibular
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
through the
retropharyngeal nodes.

27. PARANASAL SINUSES

28. MAXILLARY SINUS
 It opens into middle meatus
by Hiatus semilunaris
 largest of all paranasal
sinuses
 Pyramidal shaped , Lying
just under the cheek.
 Capacity of 30ml.
 ROOF: Floor of the orbit
 FLOOR: roots of premolars
and molar teeth

29. OSTIUM OF MAXILLARY SINUS
 Opens in the
Posteroinferior end of
hiatus semilunaris.
 Close to roof of sinus.
 Unfavorable for
drainage of sinus.
 In children the floor lies
at or above the level of
the floor of the nasal
fossa.
 In adults it lies about
1.25cm below the floor
of the nasal fossa

30.  Anterior wall (anterolateral wall)–lateral wall of the
Maxilla.
 Posterior wall – temporal surface of maxilla.
 Roof – floor of the orbit(infraorbital vessels and
nerve).
 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

31. FRONTALSINUS
Second largest sinuses
◦ 2 – 2.5 cm
Rarely symmetrical
Contained within the
frontal bone .
Separated from each
other by a bony septum.
Each sinus is roughly
triangular
Extending upward above
the medial end of the
eyebrow and backward
into the medial part of
the roof of the orbit.

32. FRONTONASAL DUCT
Opens into the middle meatus
The average capacity is about 7 ml in the adult.
True frontonasal duct only in 15% of people.

33. SPHENOIDAL SINUS
 Lie within the body of
the sphenoid bone
 Below sella turcica
(extends between
dorsum sellae and post
clinoid processes)
 The average capacity is
7ml.

34. OPENING OF SPHENOID SINUS
Opens into the sphenoethmoidal recess above
the superior concha.
Ostium -Size (0.5-4mm)

35. ETHMOIDAL SINUS
They are anterior,
middle, and posterior.
They are contained
within the ethmoid bone,
between the nose and
the orbit.
Anterior & middle
drains into middle
nasal meatus
Posterior drain into
superior nasal
meatus

36. DRAINAGE OF SINUSES

37. OSTEOMEATAL COMPLEX
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
ethmoidalis)
2.Air spaces (Frontal recess,
ethmoidal infundibulum, middle
meatus)
3.Ostia of anterior ethmoidal, maxillary
and frontal sinuses.

38. APPLIED ASPECTS

39. Sinus infections refer to the inflammation of the para-
nasal cavities caused by irritation of the sinus
membranes.
Sinus cavities get irritated / infected
Overproduction of mucus
Sinus cavity openings may swell and block
Blocked/congested
Any accumulated mucus can become a haven for
bacteria propagation
Unbearable pain
SINUSITIS

40.  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.
 Sphenoiditis, sphenoid
 Frontal sinusitis

41.  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 .
 postnasal drip.

42. GENERAL MEASURES:
 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.
 Nasal irrigation

43. OROANTRAL FISTULA

44. NOSEBLEED (EPISTAXIS)
 Traumatic
 Iatrogenic
 Inflammatory
 Foreign bodies
 Trauma (including nose picking)
allergy
 Benign & malignant neoplasms
 Anterior nasal bleed
 Posterior nasal bleed

45. General measures:
 The nostrils are compressed against the nasal
septum.
 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.
Treatement
 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
performed.

46. RHINITIS
 Seasonal/Acute:
Itching, Sneezing,
Rhinorrhea.
 Perennial/Chronic:
The blocked nose
 Main causative
organisms –
Rhinoviruses
coronaviruses

47. ALLERGIC RHINITIS
local manifestation of an allergic reaction.

48. SEPTAL DEVIATION