1. ANATOMY OF NOSE
RELATED TO FESS
DR USAMA KHALID
MS ENT (2019-2022)
BAHAWAL VICTORIA HOSPITAL ,BWP
2. INTRODUCTION
• Non-invasive surgical procedure that discloses sinus air cells
and sinus ostia by having an endoscope.
• Restores the paranasal sinus function by re-establishing the
physiologic pattern of ventilation & mucocilliary clearance.
3. OSTIO MEATAL COMPLEX
• The ostiomeatal complex is a functional concept rather than
an anatomic structure with define boundaries.
• It represents the final common pathway for drainage and
ventilation of anterior ethmoid,maxillary and frontal sinuses.
4.
5. INCLUDES:
• Uncinate process
• Ethmoid infundibulum
• hiatus semilunaris
• Anterior ethmoidal cells
• Ostia of anterior ethmoid, maxillary and frontal sinuses.
6. Uncinate process
• First structure encountered in the middle meatus when
middle turbinate is medialized
• Cresenteric bone that forms part of ethmoid bone
• Lies in sagital plane and forms medial wall of the ethmoid
infundibulum.
• Must be removed to gain access to the ant ethmoid sinuses,
maxillar sinus and frontal recess.
10. Hiatus Semilunaris
• Two dimensional slit between free edge of uncinate process
and ethmoid bulla.
• It’s a cleft that connects the middle meatus into the
infundibulum laterally.
11.
12.
13. Ethmoid infundibulum
• Funnel shaped three dimensional space between uncinate
process medially and the lamina papyracea laterally into which
the anterior sinuses drain
14.
15. Inferior Turbinate
• It’s a separate bone
• Below it ,into the inferior meatus , opens the nasolacrimal
duct.
16.
17. Middle Turbinate
• Part of ETHMOID bone.
• Basal lamella of MT is the entire MT attachment to the lateral nasal wall
and skull base.
• Basal lamella is divided into 3 parts
• Anterior attachment to agar nasi and cribriform plate.
• Middle attachment to lamina papyracea
• Posterior attachment to lateral nasal wall at the lamina papyracea ,
maxilla, and perpendicular process of palatine bone.
18.
19.
20. Superior Turbinate
• It’s a part of ethmoid bone and located superior and posterior
to middle turbinate
• Overlie the superior meatus into which post ethmoidal cells
drian.
• Medial surface contains the olfactory epithelium.
• Variable attachments to sphenoid face or lamina papyracea.
21.
22. Ethmoid complex
The ethmoid complex is divided by basal lamina into the anterior
and posterior ethmoid cells. Any cell that drains in middle meatus
is considered as anterior cell while those that open into the
superior meatus are posterior ethmoidal cells. THERE ARE NO
MIDDLE CELLS.
23.
24.
25. Boundaries of ethmoid
complex
Laterally Lamina papyracea of orbit
Superolaterall
y
Orbital process of frontal bone
Superiorly Fovea ethmoidalis and orbital plate of the frontal bone
Medially Middle and superior turbinates
Superomediall
y
Lateral lamella of cribriform plate
Posteriorly Sphenoid sinus
26.
27. Ethmoid Bulla( bulla
ethmoidalis)
• It is an Anterior ethmoid cell that lies posterior to uncinate
process and anterior to the basal lamella.
• Its lateral wall is the medial wall of orbit
• Its attachment to the skull base superiorly defines the
posterior end of the frontal recess.
28.
29. Frontal Sinus And
Recess
• The frontal sinus drains through the frontal recess into the
middle meatus.
• Frontal sinus recess is an hourglass shaped space (shaded
area in pic) with the waist at the frontal sinus ostium.
30.
31. Boundaries Of FrontalRecess
Anteriorly Aggar nasi cells and nasal beak.
Posteriorly Bulla ethmoidalis
Posterosuperiorly Anterior skull base
Medially Cribriform plate and middle turbinate
Laterally Lamina papyracea
32.
33. FRONTAL RECESS CELLS
Frontal cells
Lie above agar nasi and pneumatize
anterior to frontal sinus and recess
1. a single cell superior to aggaer nasi
2. One or more cells abover agger nasi
3. A single cell that extends from agger
nasii cell into the frontal sinus but
less than 50% of frontal sinus height
4. An isolated cell within the frontal cell
or extends into frontal sinus more
than 50% of its height.
Supraorbital ethmoid cell Cells posterior to frontal sinus,
pneumatizing superior to the orbital roof
Interfrontal sinus cells Pneumatizing intersinus septum and
drains into one frontal sinus medial to
frontal ostium
Suprabullar cell Cells superior to ethmoid bulla
Frontal bulla cell Cell superior to ethmoid bulla
pneumatizing into posterior frontal
table(ant skull base)
34.
35.
36. Agger Nasi
• Its an elevation just anterior to the anterior most attachment
of middle turbinate.
• When pneumatized it contains air cells the agger nasi cells
which communicate with frontal recess.
37.
38. Sphenoid Sinus
• Occupoid sphenoid bone
• Pituitary fossa and middle cranial fossa superiorly
• Cavernous sinus and ICA laterally
• Pons and posterior cranial fossa posteriorly
• Forms roof of nasopharynx
• Optic nerve lies next to or even within the sinus
• Pterygoid canal with nerve inferiorly.
39.
40. Maxillary Sinus
• Present at birth
• Located beneath the orbit.
• Anterior to the infratemporal and pterygopalatine fossa.
• Natural ostium elliptical in shape and is situated in lower part
of infundibulum.
