ANATOMY OF NOSE AND PARA NASAL
Dr. Rajesh Kumar Kundu
The nose consists of
the external nose and
the nasal cavity,
Both are divided by a
septum into right and
The external nose has
two elliptical orifices
called the naris
(nostrils), which are
separated from each
other by the nasal
The lateral margin, the
ala nasi, is rounded
Nasion : midline point at which nasal bones join
the frontal bone.
Rhinion : inferior point of the midline suture
between nasal bones where they meet the upper
Dorsum of nose: ridge formed by the union of
lateral surfaces of nose in the midline.
Bridge of nose: anterior surface of nose formed by
the nasal bones.
Columella: midline nasal soft tissue anterior to
septum separating the two nares.
Alae nasi: wings of nose,(rounded eminences)at
the inferior ends of the lateral nasal surfaces of
The framework of the
external nose is made
up above by the nasal
bones, the frontal
processes of the
maxillae, and the
nasal part of the
Below, the framework
is formed of plates of
Nasal bones(two) articulate with the nasal process
of frontal bone superiorly & with the ascending
processes of maxilla laterally.
These bones are thicker superiorly than inferiorly.
Their medial articular
surfaces are wider &
extend poster inferiorly into
nasal cavity to form crest.
This crest forms part of
septum & articulates with :
spine of nasal process of
perpendicular plate of
septal cartilage of nose
The pyriform aperture is bounded by these
bones and the alveolar processes of maxilla.
The alveolar processes merge in midline to
form the anterior nasal spine to which
cartilaginous septum is attached.
Lower lateral cartilage
(greater alar or lobular
forms the shape of nasal tip &
maintains patency of nostrils.
MUSCLES OF THE NOSE
Are arranged in two overlapping layers.
All innervated by facial nerve.
Procerus: (Pyramidalis nasi)
Is continuation of frontal
muscle onto the nose
Is attached to nasal bones
& upper lat.cartilage
or elevates nose
(Levator labii superioris)
• Inserted into septum
& back part of ala
•Arise from incisive
fossa of maxilla
•Action… draws ala of
The Nasalis (Compressor naris)
BLOOD SUPPLY OF EXTERNAL NOSE
origin.. lateral nasal
(upper part of
NERVE SUPPLY OF EXTERNAL NOSE
Supratrochlear & infratrochlear branches of the
ophthalmic nerve supply the skin of root,bridge,upper
portion of side of nose
Infraorbital branch of the
maxillary nerve supply
the skin on side of
nearly the lower half
Ext.nasal branch of
Ant. Ethmoidal nerve
skin over dorsum to
Main Submandibular/Submental nodes
Bilateral drainage & flow to the parotid
separated by nasal
Ant .nares or nostrils
are oval shaped
Post nares or choanae
is oval shaped
opening of the cavity.
Ant. & inf part of nasal cavity.
Lined by skin & contains sebaceous
hair follicles .
Hair follicles is called vibrissae.
Upper limit is limen nasai.
Medial wall is formed by the collumella &
the lower part of the nasal septum upto its
The nasal cavity has
a lateral wall,
a medial or septal
THE FLOOR OF NASAL CAVITY
palatal process of
horizontal process of
the palatine bone
THE ROOF OF NASAL CAVITY
It is formed
anteriorly beneath the bridge
of the nose by the nasal and
in the middle by the
cribriform plate of the
located beneath the anterior
posteriorly by the downward
sloping body of the sphenoid
THE MEDIAL WALL OF NASAL CAVITY
The Nasal Septum
Divides the nasal cavity into right and left halves
It consists of 3 parts:
It has osseous and cartilaginous part
post.sup: per. plate of ethmoid.
crest of maxillary bone
crest of palatine bone
Perpendicular plate of
forms upper 1/3 or more of
the nasal septum
Unites sup. with cribrifom
plate of ethmoid.
post…crest of sphenoid
Post inf portion of nasal septum
Septal (or quadrangular) cartilage
Is continuous with upper lateral cartilage
towards bridge of nose.
-Containg medial crura and fibrous tissue
-Covered either side by skin.
C) Membranous septum
-Consists of double layer of skin
- No bony or cartilaginous support
-Lies between columellar & caudal border of
BLOOD SUPPLY OF SEPTUM
•Ant & post ethmoidal
•Superior labial artery
Nerve supply of septum
Anterior ethmoidal nerve.(ant sup)
Ant sup alveolar(ant inf)
Nasal branch of ant palatine nerve
The anterior septum drains with the external
nose to the submandibular nose.
The posterior part of septum drains to the
retropharyngeal and anterior deep cervical
THE LATERAL WALLS OF NASAL CAVITY
Marked by 3
>The space below each
concha is called a
>Named from below
covered by thick
in anterior portion of
lateral wall of inferior
Slit like opening is
protected by fold of
the plica lacrimalis or
valve of Hasner
Portion of ethmoid bone
Consists of two parts
Medial lamina/lamina ta
Post part of middle
Ant ethmoidal roof to a
crest of Palatine bone.
Medial lamina :
ant part of middle turbinate
Ascends upwards lining ethmoid air cells
Attached to roof of ethmoid at junction of fovea with
Most superior portion of middle meatus is inferior to
genu known as frontal recess..Ostia of frontal sinus
and some ant ethmoidal cells are located here.
Rest of middle meatus posteroinferiorly contains
Crescent shaped bone curved
Variation of attachment
base of skull
Paradoxical middle turbinate:
Greater curvature of middle turbinate is
concave to middle meatus
Double middle turbinate:
Anteriorly bent UP may come in contact
with middle turbinate
Narrows middle meatus & appear as
Is appx. ½ length of middle turbinate
Starts about midde of lower turbinate & becomes
continous with them
Number 1 to 5
Onodi cells – post. Ethmoidal cell
Sur.imp.- optic nerve related to lat. wall
Sphenoethmoidal recess lies between superior &
Unilaterally or bilaterally in 60% of individuals
Ostia of pos. ethmoidal cells open into supreme
LINING MEMBRANE OF INTERNAL NOSE
1.Vestibule- lined by skin containing hair, hair
follicles & sebeseous gland.
2. Olfactory region
2. olfactory region:-comprises superior nasal
less vascular (yellow in colour)
nerve cell bodies that give rise to olfactory
Serous glands( of bowman)
3. Respiratory region
Remainder of nasal cavity(lower two-third)
Covered by mucous
Highly vascular with mucous & serous
Covered by pseudo stratified columnar
Contains plenty of goblet cells
In submucous layer ..serous & mucous
OPENINGS INTO THE NASAL CAVITY
Nasolacrimal Canal drains
into Inferior Meatus
Sphenoid sinus opens into
Posterior ethmoidal air
cells open into superior
Anterior & middle ethmoid
air cells, maxillary and
frontal sinuses open into
BLOOD SUPPLY TO THE NASAL CAVITY
From branches of the maxillary artery, one of the
terminal branches of the external carotid artery.
The most important branch is the sphenopalatine
The sphenopalatine artery anastomoses with the
septal branch of the superior labial branch of the
facial artery in the region of the vestibule.
The submucous venous plexus is drained by veins
that accompany the arteries.
BLOOD SUPPLY TO THE NASAL CAVITY
Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.
NERVE SUPPLY OF THE NASAL CAVITY
The olfactory nerves from the olfactory
mucous membrane ascend through the
cribriform plate of the ethmoid bone to the
olfactory bulbs .
The nerves of ordinary sensation are
branches of the
1.Anterior ethmoidal nerve.
2.Branches from sphenopaltine
3.Branches from the infra-orbital
NERVE SUPPLY OF THE NASAL CAVITY
CN I – Olfactory Nerves (SVA)
branch of V1
branches of V2
branch of V2 to
LYMPHATIC DRAINAGE OF THE NASAL CAVITY
The lymph vessels draining the vestibule end
in the submandibular nodes.
The remainder of the nasal cavity is drained
by vessels that pass to the upper deep
cervical nodes,retropharygeal and lateral
THE PARANASAL SINUSES
The paranasal sinuses
are cavities found in the
interior of the maxilla,
frontal, sphenoid, and
ethmoid bones .
They are lined with
filled with air.
They communicate with
the nasal cavity through
DRAINAGE OF MUCUS AND FUNCTION OF
The mucus produced by the mucous membrane is
moved into the nose by ciliary action of the
Drainage of the mucus is also achieved by the
siphon action created during the blowing of the
1. Resonators of the voice
2. They also reduce the skulls weight
3. Help warm and moisten inhaled air
4. Act as shock absorbers in trauma
Pyramidal in shape
Paired & symmetric
Located within the body of the
maxilla behind the skin of the
cheek. Antrum of Highmore
Largest pns/ pyramidal cavity in
3-4mm in diameter
Post part of medial wall
Drains into middle meatus through ethmoidal
when present seen post to natural ostia
Almost always circular
Easily seen during endoscpy
.Ciliated columnar epithelium
.Highest density of goblet cells (9700/mm²)
Lymphatic drainage is relatively
poor,butfollows predominantly into
thepterygopalatine fossa and to
Superior : infraorbital and neve,orbit
Inferior: upper dention and hard palate
Posterior: pterygopalatine and infratemporal
Anterior: cheek with skin ,fat, & facial ms
Seen in frontal bone
Two sinuses are rarely
May have septa which
subdivide the cavity & interfere
Bent and Kuhn classification of frontal
TypeI…single frontal recess cell above the
agger nasi cell, but below the frontal sinus
TypeII…tier of more than one cell in frontal
recess above the agger nasi cell, but
below the frontal sinus
TypeIII…large single cell pneumatizing
cephaloid into frontal sinus
TypeIV…single isolated cell within the
Opening of the frontal sinus
Drainage into frontal recess anterior to the
Drainage above but not into the
Drainage into infundibulum(15%)
Drainage above the bulla(1%)
Blood supply of frontal sinus
Small vein that unites the
Supraorbital and Superior
Ethmoid means sieve like
Ethmoid is trapezoid box
wide posteriorly(4-5cm AP
2-3cm high width 0.5cm
Multiple air containing cells
in ethmoidal labyrinth(3-18)
Boundaries of ethmoidal
CLASSIFICATION OF ANT ETHMOIDAL CELLS
Anterior group-(drains –middle meatus)
Middle group(drains-middle meatus)
Posterior group(drains-superior meatus)
Bagatella et al classification of
ant. group of cells
pre infundibular group(0-
1)agger nasi cells
Lateral infundibular group(0-2)
Post infundibular group(0-2)
Posterior ethmoidal cells
Onadi cells… posterior
ethmoidal cells seen just in
front of sphenoid
Haller cell..ant ethmoidal cells
seen anteriorly & below the
Ant ethmoidal nerve
Post etmoidal nerve
Maxillary branch of trigeminal nerve
ant.& middle ethmoidal cells-submandibular
Post ethmoidal –retropharyngeal nodes
Right & left are rarely symmetrical in shape
Pneumatization may extend
into body of sphenoid bone
basilar portion of occipital bone
nasal septum/perpendicular plate of
Dimensions … (L..4-44mm)( w..25-34mm)(h..
DEVOLOPMENT OF NOSE
The development of NOSE starts at about
4th week of gestational age.
Three prominences appear around
covering the developing forebrain
proliferates,& forms downward projection that
overlaps upper part of stomatodaeum.
MANDIBULAR ARCHES(Rt & Lt)….arising
from 1st pharyngeal arch.
Mandibular arch divides into maxillary and
The Nose is derived from frontonasal process in
4th fetal week.
5th fetal week ectodermal plaques develop on lateral
aspect of FNP & become paired NASAL
PLACODES,early precursors of nares.
End of 5th week these convex placodes develop into
concave nasal grooves, the medial & lateral sides
of placodes protrudes forwards to become Medial &
Lateral Nasal Process.
6th fetal week nasal grooves become blind-ending
Nasal Pits with forward &downward growth of
7th fetal week nasal pit deepens forms Nasal Sac
which forms future nasal cavity.
7th-8th fetal week lateral wall of nasal capsule
begins to form series of ridges of mesenchymal
1st ridge, the maxilloturbinal(7th
5 to 6 ridges appear superior to 1st (8th
week)…through regression & fusion, these ridges
3 to 4 ethmoturbinals.
1st ethmoturbinal (nasoturbinal)…aggar
2nd ethmoturbinal ….MIDDLE TURBINATE.
3rd forms …SUPERIOR TURBINATE, rest
regress or join supreme turbinate.
Appear as outgrowths from nasal cavity.
Frontal ,maxillary,& ethmoidal sinuses arise from
evaginations of lateral nasal wall.
Sphenoid sinus arises from a posterior
evagination of nasal capsule.
The sinuses begin to develop in 3rd fetal month &
only ethmoidal & maxillary sinus, are present at
Maxillary sinus begins as an outpounching of
lateral nasal wall at 10th fetal week.
Ethmoidal sinus begins at 3rd month of fetal life.
Frontal sinus develops during 4th fetal
months as an outpounching medial the
most superior aspect of uncinate process.
Sphenoid sinus are unique in that they
arise from within the nasal capsule of
undeveloped until 3 yrs
by 7 yrs pneumatization reaches sella
by age 9 to 12 it is generally complete