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ANATOMY OF NOSE AND PARA NASAL
SINUSES
By:
Dr. Rajesh Kumar Kundu
THE NOSE
 The nose consists of
the external nose and
the nasal cavity,
 Both are divided by a
septum into right and
left...
EXTERNAL NOSE
 The external nose has
two elliptical orifices
called the naris
(nostrils), which are
separated from each
o...
ANATOMICAL LANDMARKS
 Nasion : midline point at which nasal bones join
the frontal bone.
 Rhinion : inferior point of th...
EXTERNAL NOSE
EXTERNAL NOSE
 The framework of the
external nose is made
up above by the nasal
bones, the frontal
processes of the
maxil...
EXTERNAL NOSE
CONT.
 Nasal bones(two) articulate with the nasal process
of frontal bone superiorly & with the ascending
processes of ma...
CONT..
 Their medial articular
surfaces are wider &
extend poster inferiorly into
nasal cavity to form crest.
This crest ...
CONT..
 The pyriform aperture is bounded by these
bones and the alveolar processes of maxilla.
The alveolar processes mer...
NASAL CARTILAGES
 Upper lateral cartilage
 Lower lateral cartilage
 Accessory cartilage
Upper lateral
(triangular)
cart...
CONT..
Lower lateral cartilage
(greater alar or lobular
cartilage)
forms the shape of nasal tip &
maintains patency of nos...
MUSCLES OF THE NOSE
 Are arranged in two overlapping layers.
 All innervated by facial nerve.
Dilators…
procerus
dilator...
CONT..
Procerus: (Pyramidalis nasi)
 Is continuation of frontal
muscle onto the nose
 Is attached to nasal bones
& upper...
CONT..
Depressor septi:
• Inserted into septum
& back part of ala
•Arise from incisive
fossa of maxilla
•Action… draws ala...
 The Nasalis (Compressor naris)
transverse part
alar part
BLOOD SUPPLY OF EXTERNAL NOSE
origin.. lateral nasal
branch
from angular
(upper part of
facial or
ext maxillary).
 dorsal...
NERVE SUPPLY OF EXTERNAL NOSE
 Supratrochlear & infratrochlear branches of the
ophthalmic nerve supply the skin of root,b...
LYMPHATIC DRAINAGE
 Main Submandibular/Submental nodes
 Bilateral drainage & flow to the parotid
nodes
INTERNAL NOSE
 Nasal cavity
 Paired cavities
separated by nasal
septum
 Ant .nares or nostrils
are oval shaped
 Post n...
NASAL VESTIBULE
 Ant. & inf part of nasal cavity.
 Lined by skin & contains sebaceous
glands ,
hair follicles .
 Hair f...
NASAL CAVITY
 The nasal cavity has
 a floor,
 a roof,
 a lateral wall,
 a medial or septal
wall.
THE FLOOR OF NASAL CAVITY
 Floor…ant 3/4th
palatal process of
maxillary bone.
post 1/4th
horizontal process of
the palati...
THE ROOF OF NASAL CAVITY
 Narrow
 It is formed
 anteriorly beneath the bridge
of the nose by the nasal and
frontal bone...
THE MEDIAL WALL OF NASAL CAVITY
 The Nasal Septum
 Divides the nasal cavity into right and left halves
 It consists of ...
CONT..
Perpendicular plate of
ethmoid…
 forms upper 1/3 or more of
the nasal septum
 Unites sup. with cribrifom
plate of...
Vomer…
 Post inf portion of nasal septum
 Articulates with…
COTN..
Septal (or quadrangular) cartilage
 Is continuous with upper lateral cartilage
towards bridge of nose.
B)Columella...
THE NASAL SEPTUM
BLOOD SUPPLY OF SEPTUM
•Sphenopalatine artery
•Ant & post ethmoidal
artery
•Facial artery
•Superior labial artery
branch
L...
Nerve supply of septum
 Anterior ethmoidal nerve.(ant sup)
 Ant sup alveolar(ant inf)
 Nasal branch of ant palatine ner...
LYMPHATIC DRAINAGE
 The anterior septum drains with the external
nose to the submandibular nose.
 The posterior part of ...
THE LATERAL WALLS OF NASAL CAVITY
Marked by 3
projections:
 Superior concha
 Middle concha
 Inferior concha
>The space ...
THE LATERAL WALLS OF NASAL CAVITY
CONT..
Inferior
turbinate/meatus
 Largest turbinate.
 Separate bone
covered by thick
mucous membrane
 Nasolacrimal open...
CONT..
Middle turbinate/meatus
 Portion of ethmoid bone
 Consists of two parts
Lateral lamina/lamina
basilaris
Medial la...
CONT..
Medial lamina :
 ant part of middle turbinate
 Ascends upwards lining ethmoid air cells
 Attached to roof of eth...
CONT..
Uncinate process:
 Crescent shaped bone curved
downward/backwards
 Variation of attachment
lamina papyracea
base ...
CONT..
CONT..
 INFUNDIBULUM
Infundibulum
CONT..
FRONTAL RECESS
CONT…
Concha bullosa:(36%)
 Aerated middle turbinate/unilateral or
bilateral
 May obstruct middle meatus osteomeatal
com...
CONT..
CONT..
Paradoxical middle turbinate:
 Greater curvature of middle turbinate is
concave to middle meatus
Double middle tur...
CONT..
Superior turbinate/meatus
 Is appx. ½ length of middle turbinate
 Starts about midde of lower turbinate & becomes...
LINING MEMBRANE OF INTERNAL NOSE
 1.Vestibule- lined by skin containing hair, hair
follicles & sebeseous gland.
 2. Olfa...
CONT..
3. Respiratory region
 Remainder of nasal cavity(lower two-third)
 Covered by mucous
membrane(exp.vestibule)
 Hi...
OPENINGS INTO THE NASAL CAVITY
Nasolacrimal Canal drains
into Inferior Meatus
Sphenoid sinus opens into
sphenoethmoidal re...
BLOOD SUPPLY TO THE NASAL CAVITY
 From branches of the maxillary artery, one of the
terminal branches of the external car...
BLOOD SUPPLY TO THE NASAL CAVITY
Sphenopalatine a.
Maxillary a.
Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corpo...
NERVE SUPPLY OF THE NASAL CAVITY
 The olfactory nerves from the olfactory
mucous membrane ascend through the
cribriform p...
NERVE SUPPLY OF THE NASAL CAVITY
CN I – Olfactory Nerves (SVA)
Anterior ethmoidal
branch of V1
Posterior nasal
branches of...
LYMPHATIC DRAINAGE OF THE NASAL CAVITY
 The lymph vessels draining the vestibule end
in the submandibular nodes.
 The re...
THE PARANASAL SINUSES
THE PARANASAL SINUSES
 The paranasal sinuses
are cavities found in the
interior of the maxilla,
frontal, sphenoid, and
et...
DRAINAGE OF MUCUS AND FUNCTION OF
PARANASAL SINUSES
 The mucus produced by the mucous membrane is
moved into the nose by ...
MAXILLARY SINUS
 Pyramidal in shape
 Paired & symmetric
 Located within the body of the
maxilla behind the skin of the
...
CONT..
Boundries
 Ant..surface of
maxilla
 Post…infratempor
al fossa
 Med…lat.wall of
nasal cavity
 Sup…floor of
orbit...
CONT..
 Maxillary Ostia
 3-4mm in diameter
 Post part of medial wall
 Drains into middle meatus through ethmoidal
infu...
CONT..
Accessory ostium:
 when present seen post to natural ostia
 Almost always circular
 Easily seen during endoscpy
...
BLOOD SUPPLY
 Facial artery
 Infraorbital artery
 Greater palatine artery
 Sphenopalatine artery
Nerve supply
 Greate...
CONT..
 Lymphatic drainage
Lymphatic drainage is relatively
poor,butfollows predominantly into
thepterygopalatine fossa a...
FRONTAL SINUS
 Seen in frontal bone
 Two sinuses are rarely
symmetrical
 Dimensions…height(28-
32mm)
width(24-26mm)
dep...
CONT..
Bent and Kuhn classification of frontal
cells.
 TypeI…single frontal recess cell above the
agger nasi cell, but be...
CONT..
Opening of the frontal sinus
 Drainage into frontal recess anterior to the
infundibulum(55%)
 Drainage above but ...
CONT..
Blood supply of frontal sinus
 Supraorbital artery
 Supratrochlear artery
Venous drainage
 Small vein that unite...
ETHMOIDAL SINUSES
 Ethmoid means sieve like
 Ethmoid is trapezoid box
narrow/taller anteriorly
wide posteriorly(4-5cm AP...
CLASSIFICATION OF ANT ETHMOIDAL CELLS
 Anterior group-(drains –middle meatus)
 Middle group(drains-middle meatus)
 Post...
Bagatella et al classification of
ant. group of cells
 pre infundibular group(0-
1)agger nasi cells
 Lateral infundibula...
BLOOD SUPPLY OF ETHMOID SINUS
 Anterior ethmoidal artery(ophthalmic artery)
 Post. Ethmoidal artery
 Sphenoidal artery(...
NERVE SUPPLY
 Ant ethmoidal nerve
 Post etmoidal nerve
 Maxillary branch of trigeminal nerve
Lymphatics
 ant.& middle ...
SPHENOIDAL SINUS
 Sphenoid means
wedged(frotal,temporal,occipital)
 Right & left are rarely symmetrical in shape
 Pneum...
Boundries
Sup…pituitary/optic chisma
Lat…ICA/optic nerve/venous cavernosis
Post…brain stem/basilar artery
Floor…vidian ner...
TYPES ON BASIS OF PNEUMATISATION
1. conchal…(3%)
2. Presellar(11%)
CONT..
 Postsellar(86%)
BLOOD SUPPLY
 Posterior ethmoidal artery(roof of sinus)
 Sphenopalatine artery(floor of sinus)
Nerve supply
 Trigeminal...
EMBRYOLOGY IN BRIEF
DEVOLOPMENT OF NOSE
 The development of NOSE starts at about
4th week of gestational age.
 Three prominences appear arou...
CONT..
 The Nose is derived from frontonasal process in
4th fetal week.
 5th fetal week ectodermal plaques develop on la...
CONT..
 7th-8th fetal week lateral wall of nasal capsule
begins to form series of ridges of mesenchymal
tissue.
1st ridge...
CONT.
8th week
SUMMARY OF EMRYONIC PRECURSORS
PARANASAL SINUSES
 Appear as outgrowths from nasal cavity.
 Frontal ,maxillary,& ethmoidal sinuses arise from
evaginatio...
CONT..
CONT..
 Frontal sinus develops during 4th fetal
months as an outpounching medial the
most superior aspect of uncinate pro...
SINUS DRAINAGE SCHEMA
Anatomy of nose and paranasal sinuses
Anatomy of nose and paranasal sinuses
Anatomy of nose and paranasal sinuses
Anatomy of nose and paranasal sinuses
Anatomy of nose and paranasal sinuses
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Anatomy of nose and paranasal sinuses

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ANATOMY OF NOSE AND PNS

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Anatomy of nose and paranasal sinuses

  1. 1. ANATOMY OF NOSE AND PARA NASAL SINUSES By: Dr. Rajesh Kumar Kundu
  2. 2. THE NOSE  The nose consists of the external nose and the nasal cavity,  Both are divided by a septum into right and left halves.
  3. 3. EXTERNAL NOSE  The external nose has two elliptical orifices called the naris (nostrils), which are separated from each other by the nasal septum.  The lateral margin, the ala nasi, is rounded and mobile.
  4. 4. ANATOMICAL LANDMARKS  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 lateral cartilages.  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 nose.
  5. 5. EXTERNAL NOSE
  6. 6. EXTERNAL NOSE  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 frontal bone.  Below, the framework is formed of plates of hyaline cartilage
  7. 7. EXTERNAL NOSE
  8. 8. CONT.  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.
  9. 9. CONT..  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 frontal bone  perpendicular plate of ethmoid  septal cartilage of nose
  10. 10. CONT..  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.
  11. 11. NASAL CARTILAGES  Upper lateral cartilage  Lower lateral cartilage  Accessory cartilage Upper lateral (triangular) cartilage: ∆ in shape boundaries
  12. 12. CONT.. Lower lateral cartilage (greater alar or lobular cartilage) forms the shape of nasal tip & maintains patency of nostrils. Each comprises Medial crus Lateral crus
  13. 13. MUSCLES OF THE NOSE  Are arranged in two overlapping layers.  All innervated by facial nerve. Dilators… procerus dilator naris Constrictors… nasalis depressor septi
  14. 14. CONT.. Procerus: (Pyramidalis nasi)  Is continuation of frontal muscle onto the nose  Is attached to nasal bones & upper lat.cartilage  Action…shortens or elevates nose Dilator naris: (Levator labii superioris)  Ant/post part  Dilates nostrils/pulls upper lip
  15. 15. CONT.. Depressor septi: • Inserted into septum & back part of ala •Arise from incisive fossa of maxilla •Action… draws ala of nose downwards constricts nares
  16. 16.  The Nasalis (Compressor naris) transverse part alar part
  17. 17. BLOOD SUPPLY OF EXTERNAL NOSE origin.. lateral nasal branch from angular (upper part of facial or ext maxillary).  dorsal nasal artery  infraorbital artery  external nasal artery
  18. 18. 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 of nose  Ext.nasal branch of Ant. Ethmoidal nerve skin over dorsum to tip
  19. 19. LYMPHATIC DRAINAGE  Main Submandibular/Submental nodes  Bilateral drainage & flow to the parotid nodes
  20. 20. INTERNAL NOSE  Nasal cavity  Paired cavities separated by nasal septum  Ant .nares or nostrils are oval shaped  Post nares or choanae is oval shaped nasopharyngeal opening of the cavity.
  21. 21. NASAL VESTIBULE  Ant. & inf part of nasal cavity.  Lined by skin & contains sebaceous glands , 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 mucocutaneous juction.
  22. 22. NASAL CAVITY  The nasal cavity has  a floor,  a roof,  a lateral wall,  a medial or septal wall.
  23. 23. THE FLOOR OF NASAL CAVITY  Floor…ant 3/4th palatal process of maxillary bone. post 1/4th horizontal process of the palatine bone
  24. 24. THE ROOF OF NASAL CAVITY  Narrow  It is formed  anteriorly beneath the bridge of the nose by the nasal and frontal bones,  in the middle by the cribriform plate of the ethmoid,  located beneath the anterior cranial fossa,  posteriorly by the downward sloping body of the sphenoid
  25. 25. THE MEDIAL WALL OF NASAL CAVITY  The Nasal Septum  Divides the nasal cavity into right and left halves  It consists of 3 parts:  1.Collumellar septum  2.Membranous septum  3.Septum proper  A)SEPTUM PROPER  It has osseous and cartilaginous part  post.sup: per. plate of ethmoid.  Anteriorly: septal cartilage.  Post. Inferiorly: vomer crest of maxillary bone crest of palatine bone Perpendicul ar Plate (ethmoid)Septal Cartilag e Vome r
  26. 26. CONT.. Perpendicular plate of ethmoid…  forms upper 1/3 or more of the nasal septum  Unites sup. with cribrifom plate of ethmoid.  Articulates with ant.sup…frontal/nasal bone post…crest of sphenoid bone post.inf…vomer ant.inf…septal cartilage Perpendic ular Plate (ethmoid)
  27. 27. Vomer…  Post inf portion of nasal septum  Articulates with…
  28. 28. COTN.. Septal (or quadrangular) cartilage  Is continuous with upper lateral cartilage towards bridge of nose. B)Columellar septum -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 septal Cartilage.
  29. 29. THE NASAL SEPTUM
  30. 30. BLOOD SUPPLY OF SEPTUM •Sphenopalatine artery •Ant & post ethmoidal artery •Facial artery •Superior labial artery branch LITTLE’S AREA WOODRUFF’S PLEXUS
  31. 31. Nerve supply of septum  Anterior ethmoidal nerve.(ant sup)  Ant sup alveolar(ant inf)  Nasal branch of ant palatine nerve
  32. 32. LYMPHATIC DRAINAGE  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 nodes.
  33. 33. THE LATERAL WALLS OF NASAL CAVITY Marked by 3 projections:  Superior concha  Middle concha  Inferior concha >The space below each concha is called a meatus. >Named from below inferior,middle,superi or,supreme conchae.
  34. 34. THE LATERAL WALLS OF NASAL CAVITY
  35. 35. CONT.. Inferior turbinate/meatus  Largest turbinate.  Separate bone covered by thick mucous membrane  Nasolacrimal opening in anterior portion of lateral wall of inferior meatus  Slit like opening is protected by fold of mucous membrane, the plica lacrimalis or valve of Hasner LACRIMAL PROCESS ETHMOIDAL PROCESS MAXILLARY PROCESS
  36. 36. CONT.. Middle turbinate/meatus  Portion of ethmoid bone  Consists of two parts Lateral lamina/lamina basilaris Medial lamina/lamina ta Lateral lamina:  Post part of middle turbinate  Downwards/backwards from Ant ethmoidal roof to a small crest of Palatine bone.
  37. 37. CONT.. Medial lamina :  ant part of middle turbinate  Ascends upwards lining ethmoid air cells  Attached to roof of ethmoid at junction of fovea with cribrifom.  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 ethmoidal bulla uncinate process semilunar hiatus
  38. 38. CONT.. Uncinate process:  Crescent shaped bone curved downward/backwards  Variation of attachment lamina papyracea base of skull middle turbinate UC BE
  39. 39. CONT..
  40. 40. CONT..  INFUNDIBULUM Infundibulum
  41. 41. CONT.. FRONTAL RECESS
  42. 42. CONT… Concha bullosa:(36%)  Aerated middle turbinate/unilateral or bilateral  May obstruct middle meatus osteomeatal complex(sinusitis)  May get infected form mucocele
  43. 43. CONT..
  44. 44. CONT.. 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 additional turb
  45. 45. CONT.. Superior turbinate/meatus  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 & supreme turbinate supreme turbinate  Unilaterally or bilaterally in 60% of individuals  Ostia of pos. ethmoidal cells open into supreme meatus(75%)
  46. 46. LINING MEMBRANE OF INTERNAL NOSE  1.Vestibule- lined by skin containing hair, hair follicles & sebeseous gland.  2. Olfactory region  3.Respiratory region 2. olfactory region:-comprises superior nasal concha & corresponding opp.septum (olfactory slit). Features ..  less vascular (yellow in colour)  nerve cell bodies that give rise to olfactory nerve fiber(nonmylinated)  Serous glands( of bowman)
  47. 47. CONT.. 3. Respiratory region  Remainder of nasal cavity(lower two-third)  Covered by mucous membrane(exp.vestibule)  Highly vascular with mucous & serous glands  Covered by pseudo stratified columnar ciliated epithelium  Contains plenty of goblet cells  In submucous layer ..serous & mucous gland.
  48. 48. OPENINGS INTO THE NASAL CAVITY Nasolacrimal Canal drains into Inferior Meatus Sphenoid sinus opens into sphenoethmoidal recess Posterior ethmoidal air cells open into superior meatus Anterior & middle ethmoid air cells, maxillary and frontal sinuses open into middle meatus
  49. 49. 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 artery.  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.
  50. 50. BLOOD SUPPLY TO THE NASAL CAVITY Sphenopalatine a. Maxillary a. Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.
  51. 51. 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 ganglion. 3.Branches from the infra-orbital nerve.
  52. 52. NERVE SUPPLY OF THE NASAL CAVITY CN I – Olfactory Nerves (SVA) Anterior ethmoidal branch of V1 Posterior nasal branches of V2 Cut nasopalatine branch of V2 to septum
  53. 53. 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 pharyngeal.
  54. 54. THE PARANASAL SINUSES
  55. 55. THE PARANASAL SINUSES  The paranasal sinuses are cavities found in the interior of the maxilla, frontal, sphenoid, and ethmoid bones .  They are lined with mucoperiosteum and filled with air.  They communicate with the nasal cavity through relatively small apertures.
  56. 56. DRAINAGE OF MUCUS AND FUNCTION OF PARANASAL SINUSES  The mucus produced by the mucous membrane is moved into the nose by ciliary action of the columnar cells.  Drainage of the mucus is also achieved by the siphon action created during the blowing of the nose.  Functions: 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
  57. 57. MAXILLARY SINUS  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 maxillary bone  Dimensions : height(3.3cm) width(2-3cm) ant.post(3-4cm) volume(15ml)
  58. 58. CONT.. Boundries  Ant..surface of maxilla  Post…infratempor al fossa  Med…lat.wall of nasal cavity  Sup…floor of orbital cavity  Inferior…alveolar & palatineprocess of maxilla
  59. 59. CONT..  Maxillary Ostia  3-4mm in diameter  Post part of medial wall  Drains into middle meatus through ethmoidal infundibulum
  60. 60. CONT.. Accessory ostium:  when present seen post to natural ostia  Almost always circular  Easily seen during endoscpy HISTOLOGY .Ciliated columnar epithelium .Highest density of goblet cells (9700/mm²)
  61. 61. BLOOD SUPPLY  Facial artery  Infraorbital artery  Greater palatine artery  Sphenopalatine artery Nerve supply  Greater palatine nerve  Post lateral nasal nerves  Superior alveolar (infraorbital nerve)
  62. 62. CONT..  Lymphatic drainage Lymphatic drainage is relatively poor,butfollows predominantly into thepterygopalatine fossa and to thesubmandibular nodes. RELATIONS  Superior : infraorbital and neve,orbit  Inferior: upper dention and hard palate  Posterior: pterygopalatine and infratemporal fossa  Anterior: cheek with skin ,fat, & facial ms
  63. 63. FRONTAL SINUS  Seen in frontal bone  Two sinuses are rarely symmetrical  Dimensions…height(28- 32mm) width(24-26mm) depth(18-20mm) volume(6-7ml)  May have septa which partially subdivide the cavity & interfere with drainage.
  64. 64. CONT.. Bent and Kuhn classification of frontal cells.  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 frontal sinus
  65. 65. CONT.. Opening of the frontal sinus  Drainage into frontal recess anterior to the infundibulum(55%)  Drainage above but not into the infundibulum(30%)  Drainage into infundibulum(15%)  Drainage above the bulla(1%)
  66. 66. CONT.. Blood supply of frontal sinus  Supraorbital artery  Supratrochlear artery Venous drainage  Small vein that unites the Supraorbital and Superior ophthalmic veins. Nerve supply  Supraorbital nerve(ophthalmic nerve)  Supratrochlear nerve(ophthalmic nerve) Lymphatic drainage  Submandibular nodes
  67. 67. ETHMOIDAL SINUSES  Ethmoid means sieve like  Ethmoid is trapezoid box narrow/taller anteriorly wide posteriorly(4-5cm AP 2-3cm high width 0.5cm ant/1.5cm p)  Multiple air containing cells situated in ethmoidal labyrinth(3-18)  Boundaries of ethmoidal sinus
  68. 68. CLASSIFICATION OF ANT ETHMOIDAL CELLS  Anterior group-(drains –middle meatus)  Middle group(drains-middle meatus)  Posterior group(drains-superior meatus)
  69. 69. 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)  Bullar cells(2-5) Posterior ethmoidal cells  Intramural cells  Extramural cells Onadi cells… posterior ethmoidal cells seen just in front of sphenoid Haller cell..ant ethmoidal cells seen anteriorly & below the
  70. 70. BLOOD SUPPLY OF ETHMOID SINUS  Anterior ethmoidal artery(ophthalmic artery)  Post. Ethmoidal artery  Sphenoidal artery(maxillary artery) Venous drainage  Nasal veins  Ant. Ethmoidal vein  Post. Ethmoidal vein
  71. 71. NERVE SUPPLY  Ant ethmoidal nerve  Post etmoidal nerve  Maxillary branch of trigeminal nerve Lymphatics  ant.& middle ethmoidal cells-submandibular group  Post ethmoidal –retropharyngeal nodes
  72. 72. SPHENOIDAL SINUS  Sphenoid means wedged(frotal,temporal,occipital)  Right & left are rarely symmetrical in shape  Pneumatization may extend into body of sphenoid bone pterygoid process basilar portion of occipital bone nasal septum/perpendicular plate of ethmoid  Dimensions … (L..4-44mm)( w..25-34mm)(h.. 5-33mm) volume (7.5ml)
  73. 73. Boundries Sup…pituitary/optic chisma Lat…ICA/optic nerve/venous cavernosis Post…brain stem/basilar artery Floor…vidian nerve
  74. 74. TYPES ON BASIS OF PNEUMATISATION 1. conchal…(3%) 2. Presellar(11%)
  75. 75. CONT..  Postsellar(86%)
  76. 76. BLOOD SUPPLY  Posterior ethmoidal artery(roof of sinus)  Sphenopalatine artery(floor of sinus) Nerve supply  Trigeminal (1/11 div) Lymphatics  Retropharyngeal nodes
  77. 77. EMBRYOLOGY IN BRIEF
  78. 78. DEVOLOPMENT OF NOSE  The development of NOSE starts at about 4th week of gestational age.  Three prominences appear around stomatodaeum(future mouth)…. FRONTONASAL PROCESS…mesoderm 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 mandibular process.
  79. 79. CONT..  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 maxillary process.  7th fetal week nasal pit deepens forms Nasal Sac which forms future nasal cavity.
  80. 80. CONT..  7th-8th fetal week lateral wall of nasal capsule begins to form series of ridges of mesenchymal tissue. 1st ridge, the maxilloturbinal(7th week)…INFERIOR TURBINATE. 5 to 6 ridges appear superior to 1st (8th week)…through regression & fusion, these ridges 3 to 4 ethmoturbinals. 1st ethmoturbinal (nasoturbinal)…aggar nasi(ascending portion)…..uncinate process(descending portion). 2nd ethmoturbinal ….MIDDLE TURBINATE. 3rd forms …SUPERIOR TURBINATE, rest regress or join supreme turbinate.
  81. 81. CONT. 8th week
  82. 82. SUMMARY OF EMRYONIC PRECURSORS
  83. 83. PARANASAL SINUSES  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 birth.  Maxillary sinus begins as an outpounching of lateral nasal wall at 10th fetal week.  Ethmoidal sinus begins at 3rd month of fetal life.
  84. 84. CONT..
  85. 85. CONT..  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 embryonic nose. undeveloped until 3 yrs by 7 yrs pneumatization reaches sella tursica by age 9 to 12 it is generally complete
  86. 86. SINUS DRAINAGE SCHEMA

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