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    Anatomy of Paranasal Sinuses

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    Pavan Tenglikar
    The document discusses the anatomy of the paranasal sinuses. There are four main paired sinuses: maxillary, frontal, ethmoid, and sphenoid. Each sinus has unique boundaries, drainage pathways, and developmental timing. The maxillary sinus is the largest sinus located under the cheek. The ethmoid sinus is a complex network of thin-walled air cells located in the skull. The frontal sinus demonstrates significant anatomical variability between individuals. The sphenoid sinus is located at the base of the skull near important structures like the pituitary gland and optic nerves.

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    Anatomy of Paranasal Sinuses

    Uploaded by

    Pavan Tenglikar
    127 views8 pages
    The document discusses the anatomy of the paranasal sinuses. There are four main paired sinuses: maxillary, frontal, ethmoid, and sphenoid. Each sinus has unique boundaries, drainage pathways, and developmental timing. The maxillary sinus is the largest sinus located under the cheek. The ethmoid sinus is a complex network of thin-walled air cells located in the skull. The frontal sinus demonstrates significant anatomical variability between individuals. The sphenoid sinus is located at the base of the skull near important structures like the pituitary gland and optic nerves.

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    The document discusses the anatomy of the paranasal sinuses. There are four main paired sinuses: maxillary, frontal, ethmoid, and sphenoid. Each sinus has unique boundaries, drainage pathways, and developmental timing. The maxillary sinus is the largest sinus located under the cheek. The ethmoid sinus is a complex network of thin-walled air cells located in the skull. The frontal sinus demonstrates significant anatomical variability between individuals. The sphenoid sinus is located at the base of the skull near important structures like the pituitary gland and optic nerves.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    127 views8 pages

    Anatomy of Paranasal Sinuses

    Uploaded by

    Pavan Tenglikar
    The document discusses the anatomy of the paranasal sinuses. There are four main paired sinuses: maxillary, frontal, ethmoid, and sphenoid. Each sinus has unique boundaries, drainage pathways, and developmental timing. The maxillary sinus is the largest sinus located under the cheek. The ethmoid sinus is a complex network of thin-walled air cells located in the skull. The frontal sinus demonstrates significant anatomical variability between individuals. The sphenoid sinus is located at the base of the skull near important structures like the pituitary gland and optic nerves.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 8

    Anatomy of paranasal sinuses

    Definition: Paranasal sinuses are air filled sacs found in the skull
    bone. These sacs infact surround the nasal cavity. There are 4
    paired sinuses. They are:

    1. Maxillary sinuses

    2. Frontal sinuses

    3. Ethmoidal sinuses

    4. Sphenoidal sinuses

    Maxillary sinus (Antrum of Highmore): These paired sinuses lie


    under the cheek. It is the largest of the group of para nasal sinuses.
    The capacity of the maxillary sinus is roughly 1 fluid ounze
    (30ml). It is more or less shaped like a pyramid.

    Base (medial wall): The base of the pyramid corresponds to the


    lateral nasal wall. This wall has its convexity facing the sinus. The
    central portion of the base is very thin, and in some areas could
    even be membranous. The natural ostium of this sinus is present in

    tenglikar Page 1 12/22/2010


    this wall. It is present more towards the roof of the sinus cavity
    than its base.

    Anterior: Wall corresponds to the facial surface of the superior


    maxilla. Over the canine fossa it is only 2mm in thickness. It is
    though this canine fossa area that maxillay antrum is entered
    during Caldwell Luc surgery.

    Boundaries of Canine fossa:

    Inferior: Bounded by the alveolar ridge

    Laterally: Bounded by the canine eminence which is caused by the


    canine tooth.

    Superior: Infra orbital foramen

    Medial: Pyriform aperture

    Posterior wall: of maxillary sinus is also known as temporal


    surface. It is very thick and is formed by the body of the superior
    portion of the maxilla.

    Roof: of the sinus is formed by its thin orbital wall which is


    traversed by the infra orbital foramen containing the infra orbital
    vessels and nerves. This wall is very fragile and any disease
    process involving the maxilla is likely to affect the orbit through

    tenglikar Page 2 12/22/2010


    this wall. This wall is further thinned out where the infra orbital
    canal is present.

    Floor: is formed alveolar process of the maxilla and the hard


    palate. The roots of the first and second molar reach up to the floor
    of the maxillary sinus. In children the floor lies at the same level as
    that of the nasal cavity. In adults it lies 5 - 10 mm below the nasal
    cavity. It is just separated from the floor of the sinus by a thin
    lamella of bone. This lamella may be dehiscent commonly. Dental
    infections involving the 1st and 2nd molars may involve the
    maxillary sinus through this thin lamella of bone.

    tenglikar Page 3 12/22/2010


    Figure showing the sizes of paranasal sinuses in various age groups

    The maxillay sinus has biphasic growth. The first phase of growth
    occur during the first 3 years of life while the second phase occur
    between 7 - 18 years.

    Ethmoid sinus:

    Is situated in the anterior skull base. It is made up of complex bony


    labyrinth of thin walled cells. A few ethmoid cells may be present
    at birth. The common infections affecting the pediatric age group
    occur in this sinuses. In adults 6 - 10 ethmoid cells may be present.

    Boundaries:

    Lateral wall: is formed by the orbital plate of the ethmoid


    otherwise known as the lamina papyracea. This is a thin lamina of
    bone separating the orbit from the ethmoidal air cells. This wall
    could be dehiscent (normal variant). Infections involving the
    ethmoid air cells may spread to the orbit through this wall.

    Roof: is formed by the frontal bone anteriorly and by the face of


    sphenoid and orbital process of palatine bone posteriorly.

    tenglikar Page 4 12/22/2010


    The ethmoidal cells increase in size from above downwards, and
    from before backwards.

    The cells of the ethmoid sinus are divided into two groups, the
    anterior and posterior group. The anterior ethmoidal cells drain
    into the infundibulum of the middle meatus while the posterior
    ethmoid cells drain into the superior meatus. The anatomy of the
    ethmoidal cells are highly variable, sometimes the middle turbinate
    may contain an air cell known as the concha bullosa. An enlarged
    concha bullosa may impede drainage from the middle meatus.
    Another common anatomical variation is the presence of agger
    nasi air cell. This is a large ethmoidal air cell present just anterior
    to the antero superior attachment of the middle turbinate. Since
    these cells lie in close proximity to the frontal recess area, they
    could impede ventilation and drainage of the frontal sinus. These
    agger nasi cells are commonly involved in the pathogenesis of the
    formation of frontal mucocele.

    Obstruction to the frontal sinus drainage by the presence of a lage


    agger nasi cell may cause secretions within the frontal sinus to be
    dammed inside. Accumulation of mucoid secretions cause
    enlargement of frontal sinus. At first the frontal sinus enlarges in
    size by expansion of its bony walls. At a later stage bone erosion

    tenglikar Page 5 12/22/2010


    can also occur. commonly the posterior table of the frontal sinus is
    eroded. The anterior table also can be eroded in rare cases.

    Haller cells are ethmoidal air cells belonging to the anterior


    ethmoidal group. These cells are also known as the infra orbital
    cells. Enlargement of these cells can impede the maxillary sinus
    drainage. Another variation is the extension of the posterior group
    of ethmoidal air cells supero lateral to the sphenoid sinus. These
    cells are known as onodi cells. These cells lie periliously close to
    the optic nerve making them at risk during fess surgeries.

    Diagrammatic representation of maxillary and ethmoidal sinuses

    tenglikar Page 6 12/22/2010


    Frontal sinus: Among the para nasal sinuses this sinus shows the
    maximum variations. Infact variations are so immense that it can
    safely be stated that frontal sinuses are unique in each and every
    individual. It may be absent in 5 % of individuals. It is more or less
    shaped like a L.

    Posterior wall: corresponds to the anterior wall of the anterior


    cranial fossa.

    Floor: is formed by the upper part of the orbits.

    Frontal sinus appear very late in life. Infact they are not seen in
    skull films before the age of 6.

    The sinus drains into the anterior part of the middle meatus
    through the fronto nasal duct.

    Sphenoid sinus:

    Is located in the skull base at the junction of the anterior and


    middle cranial fossa. Pnematisation of sphenoid starts during the
    4th year of childhood and gets completed by the 17th year. The
    sphnoid sinuses vary in size and may be asymmetric.

    They drain through the superior meatus via a small ostium about
    4mm in diameter located disadvantageously 20mm above the sinus
    floor.

    tenglikar Page 7 12/22/2010


    This sinus is related to several important vital structures. They are:

    1. Pituitary gland lies above the sphenoid sinus.

    2. Optic nerve and internal carotid arteries traverse its lateral wall.

    3. The nerve of pterygoid canal lie in the floor of the sinus.

    Hence infections of sphenoid sinus may involve the optic nerve if


    the canal of the optic nerve is dehiscent.

    Functions of para nasal sinuses:

    1. They lighten the skull.

    2. They add resonance to speech

    3. They play a role in conditioning the inspired air.

    tenglikar Page 8 12/22/2010

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