ANATOMY OF THE NOSE AND PARANASAL SINUSES

-A.PRIYANKA

EXTERNAL NOSE
Anterior extension of the nasal cavity Pyramidal in shape

A: Elevator muscles 1. Procerus 2. Levator labii alaequae nasi 3. Anomalous nasi B: Depressor muscles 4. Alar nasalis 5. Depressor septi nasi C: Compressor muscles 6. Transverse nasalis 7. Compressor narium minor D: Minor dilator muscles 8. Dilator naris anterior E: Other 9. Orbicularis oris 10. Corrugator

NASAL MUSCULATURE

 Lower two-third : Cartilaginous

NASAL BONES SEPTAL CARTILAGE FRONTAL PROCESS OF MAXILLA UPPER LATERAL CARTILAGE LESSER ALAR CARTILAGES

SUPPORTING FRAMEWORK Upper one-third : Bony

 ARTERIAL SUPPLY:Lateral nasal and septal branches of facial artery and Dorsal nasal branch of ophthalmic artery VENOUS DRAINAGE:Facial vein and ophthalmic vein LYMPHATICS:Submandibular and superficial parotid lymph nodes NERVE SUPPLY:Infratrochlear and external nasal branch of nasociliary nerve,nasal branch of infra-orbital nerve,buccal branch

NASAL CAVITY
Extends from the nostrils to the choanae Divided into right and left cavities by the nasal septum Has roof ,floor ,medial and lateral walls ROOF : Nasal bones,cribriform plate of the ethmoid and body of the sphenoid bone FLOOR : Palatine process of

ROOF AND FLOOR OF NASAL CAVITY

MEDIAL WALL
Formed by nasal septum Nasal septum consists of COLUMELLAR SEPTUM MEMBRANOUS SEPTUM SEPTUM PROPER -Vomer -Perpendicular plate ethmoid

ARTERIAL SUPPLY

NERVE SUPPLY

LATERAL WALL
3 Parts i. Vestibule ii.Atrium of the middle meatus iii.Posterior part containing conchae and meatus

ARTERIAL SUPPLY

NERVE SUPPLY

VENOUS DRAINAGE OF THE NASAL CAVITY

Facial vein Through sphenopalatine vein to pterygoid venous plexus

LYMPHATIC DRAINAGE OF NASAL CAVITY

Anterior half lymph : submandibular nodes Posterior half : retropharyngeal and deep cervical lymph nodes

LINING EPITHELIUM
Vestibule hair,hair and sebaceous gland Respiratory region : pseudo stratified ciliated columnar epithelium with : skin with follicles

OLFACTORY EPITHELIUM

RESPIRATORY REGION LINING EPITHELIUM

Paranasal sinuses
Paranasal sinuses are air filled spaces in skull bones lined by mucosa and drain into nasal cavity.

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

Bent and Kuhn classification of Frontal cells

Type1 --- single frontal recess cell above the agger nasi cell, but below the frontal sinus Type11 --- tier of more than one cell in frontal recess above the agger nasi cell, but below the frontal sinus Type111 --- large single cell pneumatizing cephaloid into frontal sinus Type1V --- single isolated cell within

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%)

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

ETHMOID SINUS
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)

CLASSIFICATION
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) 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 orbit.

HALLERS CELL

ARTERIAL SUPPLY
Anterior ethmoidal artery(ophthalmic artery) Post. Ethmoidal artery Sphenoidal artery(maxillary artery)

VENOUS DRAINAGE
Nasal veins Ant. Ethmoidal vein Post. Ethmoidal vein

 Ant ethmoidal nerve Post etmoidal nerve Maxillary branch of trigeminal nerve

NERVE SUPPLY

LYMPHATICS
ant.& middle ethmoidal cellssubmandibular group Post ethmoidal retropharyngeal nodes

SPHENOID 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)

TYPES (PNEUMATISA TION)

ARTERIAL SUPPLY

Posterior ethmoidal artery(roof of sinus) Sphenopalatine artery(floor of sinus)

NERVE SUPPLY
Trigeminal (1/11 div)

LYMPHATICS
Retropharyngeal nodes

MAXILLARY SINUS
Antrum of Highmore Largest pns/ pyramidal cavity in maxillary bone Dimensions : height(3.3cm) width(2-3cm) ant.post(3-4cm) volume(15ml)

MAXILLARY OSTIUM
3-4mm in diameter Post part of medial wall Drains into middle meatus through ethmoidal infundibulum

ARTERIAL SUPPLY Facial artery

Infraorbital artery Greater palatine artery Sphenopalatine artery

NERVE SUPPLY
Greater palatine nerve Post lateral nasal nerves Superior alveolar (infraorbital nerve)

ARTERIAL SUPPLY

ARTERIAL SUPPLY

CT PNS-CORONAL VIEW

ARTERIAL SUPPLY

MAXILLARY SINUS

ETHMOID SINUS

INFERIOR TURBINATE

SPHENOID SINUS

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