Nose 1

Anatomy of the nose &
paranasal sinuses
• External nose:
• Pyramidal in shape the lower lateral
rounded part is called(ala while the medial
lower part is called Columella.
The nasal skeleton:
Bony part formed of:
• Two nasal bones.
 Nasal process of frontal bone (above-on each
side).
 Nasal process of maxillary bone (below-on
each side).
Cartilaginous part formed of:
 Upper and lower lateral cartilages.
 Septal cartilage.
Nasal cavity:
• Two cavities separated by the septum

• Each cavity has anterior opening (anterior
nares), posterior opening (choana), root,
floor, medial and lateral walls.
• Anterior nares: bounded by columella medially and
ala laterally.
• Choana: bounded by the vomer medially and medial
pterygoid laterally.
• Roof: Cribriform plate of ethmoid bone.
• Floor: Hard palate
 (anterior 2/3 = Maxilla, posterior ½ = palatine bone).
• Medial wall: the nasal septum formed of:
 Quadrangular cartilage: anterior part.
 Perpendicular plate of ethmoid bone: posterosuperior.
 Vomer :posteroinferior.
 Membranous part and maxillary crest most
anterior.
• Lateral wall:
 It shows: 3 elevations, 4 spaces (elevation
=turbinate, space = meatus)
Perpendicular
Plate (ethmoid)
Septal
Cartilage Vomer
 Inferior urbinate: the largest of 3 rich in blood supply and veins.
• The inferior meats below it, and shows the Opening of nasolacrimal
duct.
 Middle turbinate: middle in size and site.
• The middle meatus opens below it and show the following features:
A) The bulla ethmoidalis: rounded projection; the largest of the anterier
ethmoidal air cells
B) Hiatus semilunaris: Semilunar groove below the bulla.
C) Uncinate process: Shelf of bone(media to the bulla.
• N.B.: The following sinuses open in the middle meatus:
The frontal sinus opens through the frontal recess at the most anterior
part
• The maxillary sinus opens in the posterior
part.
• The anterior ethmadal sinus opens in
middle part.
• Ostiomeatal complex (OMC): It is the area
of drainage of (anterior group of sinuses.
Present between lamina paparycea i.e.
medial orbital wall: laterally and middle
(turbinate: medially.
 Superior turbinate: the smallest, and the superior
meatus below it.
• The posterior ethmoid opens in the superior
meatus.
 Sphenoethmoidal recess: above the superior
turbinate
• The sphenoid sinus opens into it.
• N.B. Nasal valve; The narrowest part, at the in tog
junction of lower and upper lateral cartilages i.e.
anterior end of inferior turbinates.
Blood supply
• (1) External nose

• Nasal branches of facial artery.
• Nasal branches of infra-orbital artery.
• Dorsonasal branches of ophthalmic artery.
• (2) Nasal cavity.
• Anterior and posterior ethmoidal arteries:superior
part
• Sphenopalatine artery: posterior part.
• Superior labial of facial and Greater palatine of
maxillarv arferies: antero-inferior part.
Venous drainage
• The nasal veins are connected to the

cavernous sinus through the ophthalmic
veins.
• N.B.: The dangerous triangle of the face:
• Infection in which may lead to cavernous
sinus thrombosis.
• Boundaries: extends from root of nose
superiorly to the coner of mouth on each
side.
Nerve supply
• Sensory: Maxillary nerve.
• Olfactory (smell): Olfactory nerve (1st cranial).
• Autonomic: Nerve of pterygoid canal (Vidian),
formedof
 Sympathetic (Deep pertrosal nerve)
Vasoconstrictor
 Parasympathetic (Greater Superficial Petrosal
nerve): secretomotor
Histology
• Lower part (vestibule): skin contains
vibrissae hair.
• Middle part (respiratory part): respiratory
mucosa.
• Upper part (olfactory part): olfactory
neuroepithelium.
Paranasal sinuses
• Four pairs of sinuses arranged into 2 groups:
• 1- Anterior group: frontal, maxillary, and
anterior ethmoid
• All open into the middle meatus (OMC).
• 2- Posterior group: posterior ethmoid and
sphenoid.
• The 1st opens into superior meatus!
• The 2nd opens into sphenoethmoidal recess.
• All the sinuses are lined by respiratory mucosa.
(A)The Maxillary Sinus (Antrum):
• Pyramidal in shape with the apex directed to the
zygomatic bone.
• Boundaries:
• Roof: Orbit and infra-orbital nerve and vessels.
• Floor: Alveolar process 2nd premolar and 1st molar
teeth.
• Anterior: Cheek
• Posterior: Pterygo-palatine fossa.
• Medially: Nasal cavity.
• it opens in the posterior part of middle meatus.
(B)The Frontal Sinus:
• It is hot present at birth and starts to
appear 2-4 years.
• It opens in the anterior part of middle
meatus.
(C)The Ethmoid Sinuses:
• Formed of anterior and posterior ethmoid
sinuses, separated from each other by
bone, which is called the ground lamella.
• The anterior ethmoidal sinus opens in the
middle meatus.
• The posterior ethmoidal sinus opens in the
superior meatus.
(D) The sphenoid sinus:
• Cavity within the body of the sphenoid
bone.
• The pituitary gland presents above it in the
sella turcica.
• It is related to the internal carotid artery
(ICA) and optic nerve.
• It opens into the spheno-ethmoidal recess
Lymphatic drainage of nose and sinuses
• Anterior part to submandibular lymph

nodes (LNs) while the posterior
pharyngeal LNs then both to upper deep
cervical LNs.
The Paranasal Sinuses
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.
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 wam and moisten inhaled air
4. Act as shock absorbers in trauma
Maxillary Sinus
• Pyramidal in shape
• Paired & symmetric
• Located within the body
of the maxilla behind the
skin of the cheek.
• The roof is formed by the
floor of the orbit, and the
floor is related to the
roots of the 2nd premolars
and 1st molar teeth.
• The maxillary sinus
opens into the middle
meatus of the nose
Frontal Sinuses
• Rarely symmetrical
• Contained within the frontal
bone .
• Separated from each other by
a bony septum.
• Each sinus is roughly
triangular
• Extending upward above the
medial end of the eyebrow
and backward into the medial
part of the roof of the orbit.
• Opens into the middle meatus
Sphenoidal Sinuses
• Lie within the body of
the sphenoid bone
• Below sella turcica
– Extends between
dorsum sellae and
post clinoid processes
• Opens into the
sphenoethmoidal
recess above the
superior concha
Ethmoid Sinuses
• They are anterior, middle, and
posterior
• They are contained within the
ethmoid bone, between the nose
and the orbit
• Anterior & middle
– Drains into middle nasal meatus
• Posterior
– Drain into superior nasal meatus
• Separated from the orbit by a thin
plate of bone so that infection
can readily spread from the
sinuses into the orbit
Sinus Drainage Schema
Clinical Notes
• Examination of the
Paranasal Sinuses
• Sinusitis
• Basal skull fracture
PHYSIOLOGY OF THE NOSE
AND PARANASAL SINUSIS
Function of Nose
1. Respiration
2. Air-Conditioning
3. Protection
4. Olfaction
5. Resonance
6. Eustachian tube
7. Drainage
Function of Para-nasal Sinuses
1. Resonance of voice
2. Respiratory
3. Air-conditioning
4. Redaction of the weight Skull
5. Rapid grow of the Face

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Anatomy of the nose &

• Two cavities separated by the septum

• (1) External nose

• The nasal veins are connected to the

• Anterior part to submandibular lymph

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