Anatomy of The Nose

1. Anatomy of the nose
By
Dr Nassar Ayoub
Zeeshan Ali
M-1036

2. External Nose
Internal Nose
Musculature of Nose
Vascular Supply.
Nerve supply.
Lymphatic Drainage
Paranasal Sinuses

3.  External Nose
It is pyramidal in shape with its root up and the base directed downwards
Nares – external opening of nose Choanae - open into the nasopharynx
1. Bony Part: Posterior 1/3rd is bony
1. Nasal Bone
2. Frontal Process of Maxilla
3. Nasal Part of Frontal Bone
2. Cartilaginous Part: Anterior 2/3rd is cartilaginous
1. Upper Lateral Cartilage
2. Lower Lateral Cartilage/Alar Cartilage
3. Septal Cartilage

4. • (a) Upper lateral cartilages. They
extend from the undersurface of
the nasal bones above, to the alar
cartilages below.
• (b) Lower lateral cartilages (alar
cartilages).
• (c) Lesser alar (or sesamoid)
cartilages. Two or more in number.
They lie above and lateral to alar
cartilages.
• (d) Septal cartilage. Its
anterosuperior border runs from
under the nasal bones to the nasal
tip.

5.  Internal Nose
Nasal Cavity
• Extends from Nostrils externally
to Choanae internally
• Nasal Septum divides Nasal
Cavity into two compartments
Nasal Septum
1. Septal Cartilage
2. Perpendicular Plate of
Ethmoid Bone
3. Vomer

6.  Boundaries of
Nasal Cavity
• Floor
1. Palatine Process of
Maxilla
2. Horizontal Process of
Palatine Bone

7. Roof
1. Nasal Bone
2. Frontal Bone
3. Cribriform Plate of Ethmoid Bone
4. Sloping body of Sphenoid Bone

8. Medial Wall
1. Septal Cartilage
2. Perpendicular
Process of
Ethmoidal Bone
3. Vomer

9. Lateral Wall
• 3 Projections
Superior, Middle and Inferior Conchae/Vestibule
Space below each Concha is called Meatus
Spenoethmoidal Recess – Above superior concha
> Sphenoid Air Sinus Superior Meatus – Below
superior concha > Posterior ethmoid sinuses
Middle Meatus – Below middle concha
I. Bulla Ethmoidalis > formed by Middle
ethmoidal air sinuses
II.Hiatus semilunaris – Lies below bulla >
Maxillary Sinus
Infundibulum – continuous with frontal sinus
Inferior Meatus – Below inferior concha >
Nasolacrimal Duct

11. Regions of Nasal Cavities
•Each nasal cavity consists of three general regions
•Nasal vestibule
– small dilated space just internal to the naris that is
lined by skin and contains hair follicles
•Respiratory region
–Largest part of the nasal cavity
–Rich neurovascular supply
–Lined by respiratory epithelium composed mainly of
ciliated and mucous cells
•Olfactory region
–small, is at the apex of each nasal cavity
–Lined by olfactory epithelium which contains the
olfactory receptors

12. • Vestibular Region
• From anterior nostrils to inferior
concha
• Respiratory Region
• From inferior concha to the
posterior nostril and up to the
superior concha
• Olfactory Region
• Above the superior concha up to
the roof of nose and adjoining
part of septum

13.  Musculature of Nose
1. Elevator muscle group — which
includes the procerus muscle and
the levator labii superioris
alaeque nasi muscle.
2. Depressor muscle group — which
includes the alar nasalis muscle
and the depressor septi nasi
muscle.
3. Compressor muscle group —
which includes the transverse
nasalis muscle.
4. Dilator muscle group — which
includes the dilator naris muscle
that expands the nostrils

14. Innervation and Vasculature of Muscles
• Facial Nerve
• Maxillary and Ophthalmic
Arteries
• Anterior facial and
Ophthalmic Vein
• Ophthalmic Vein drains into
cavernous sinus – Septic
Cavernous Thrombosis
• Lymphatics – Along Anterior
facial vein to Submandibular
nodes or Preauricular nodes

15. Nasal Skin
• The skin over the
nasal bones and
upper lateral
cartilages is thin and
freely mobile while
that covering the alar
cartilages is thick and
adherent, and
contains many
sebaceous glands.

16. Blood Supply
(i) Branches from the internal carotid artery, the branch of the anterior ethmoid artery,
the branch of the posterior ethmoid artery, which derive from the ophthalmic artery
(ii) Branches from the external carotid artery, the sphenopalatine artery, the greater
palatine artery, the
superior labial artery, and the angular artery.
•The external nose is supplied with blood by the facial artery, which becomes the
angular artery that courses over the superomedial aspect of the nose. The sellar region
(sella turcica, “Turkish chair”) and the dorsal region of the nose are supplied with blood
by branches of the internal maxillary artery (infraorbital) and the ophthalmic arteries
that derive from the internal common carotid artery system.
•Internally, the lateral nasal wall is supplied with blood by the sphenopalatine artery
(from behind and below) and by the anterior ethmoid artery and the posterior ethmoid
artery (from above and behind). The nasal septum also is supplied with blood by the
sphenopalatine artery, and by the anterior and posterior ethmoid arteries, with the
additional circulatory contributions of the superior labial artery and of the greater
palatine artery. These three (3) vascular supplies to the internal nose converge in the
Kiesselbach plexus (the Little area), which is a region in the anteroinferior-third of the
nasal septum, (in front and below)
•Veins follow Arterial Pattern

19. Nerve Supply of Nose
• Three cranial nerves
– Olfaction - the olfactory nerve [I]
– General sensation - the trigeminal
nerve [V],
• Anterior - ophthalmic nerve [V 1 ]
• Posterior - maxillary nerve [V 2 ]
– Glands - parasympathetic fibers in
the facial nerve [VII] (greater
petrosal nerve),
• Sympathetic fibers

20. Nerve Supply
• (a) Olfactory nerves
•They carry sense of smell
and supply olfactory
region of nose. They are
the central filaments of
the olfactory cells and are
arranged into 12-20
nerves which pass
through the cribriform
plate and end in the
olfactory bulb

21. • (b) Nerves of common sensation
• They are:
• (i) Anterior ethmoidal nerve.
• (ii) Branches of sphenopalatine
ganglion.
• (iii) Branches of infra-orbital nerve.
They supply vestibule of nose both
on its medial and lateral side.
• Most of the posterior two-thirds of
nasal cavity (both septum and
lateral wall) is supplied by branches
of sphenopalatine ganglion which
can be blocked by placing a pledget
of cotton soaked in anaesthetic
solution near the sphenopalatine
foramen situated at the posterior
extremity of middle turbinate.
Anterior ethmoidal nerve which
supplies anterior and superior part
of the nasal cavity (lateral wall and
septum) can be blocked by placing
the pledget high up on the inside of
nasal bones where the nerve
enters.

23. • (c) Autonomic nerves
• Parasympathetic nerve fibres supply the nasal glands and control nasal
secretion. They come from greater superficial petrosal nerve, travel in the
nerve of pterygoid canal (vidian nerve) and reach the sphenopalatine
ganglion where they relay before reaching the nasal cavity. They also
supply the blood vessels of nose and cause vasodilation.
• Sympathetic nerve fibres come from upper two thoracic segments of
spinal cord, pass through superior cervical ganglion, travel in deep petrosal
nerve and join the parasympathetic fibres of greater petrosal nerve to form
the nerve of pterygoid canal (vidian nerve). They reach the nasal cavity
without relay in the sphenopalatine ganglion. Their stimulation causes
vasoconstriction.

25. Lymphatic Drainage
• Lymphatics from the external nose
and anterior part of nasal cavity
drain into submandibular lymph
nodes
• The rest of nasal cavity drain into
upper jugular nodes either directly
or through the retropharyngeal
nodes.
• Lymphatics of the upper part of
nasal cavity communicate with
subarachnoid space along the
olfactory nerves.

26. Paranasal sinuses
• four paired paranasal sinuses
• The paranasal air sinuses are lined with
respiratory epithelium
1- Maxillary sinuses, the largest of the
paranasal sinuses, are under the eyes, in the
maxillary bones (open in the back of the
semilunar hiatus of the nose).
2- Frontal sinuses, superior to the eyes, in the
frontal bone, which forms the hard part of
the forehead.
3- Ethmoidal sinuses, which are formed from
several discrete air cells within the ethmoid
bone between the nose and the eyes.
4- Sphenoidal sinuses, in the sphenoid bone.

27. Functions of paranasal sinuses
• The presence of these
sinuses lightens the
skull
• They add resonance
to speech