Dr. Saad Al Asiri SURGICAL ANATOMY OF NOSE & PARANASAL SINUS by: MD, DLO, KSF, Rhino General Secretary Assistant for Training & Program Accreditation ENT Consultant and Rhinologist
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Anatomy of the Nose Bony part Nasal pyramid consists of Cartilages & bones Covered by muscles & skin Bony part Upper one third is bony Lower two - cartilaginous
Bony part - two nasal bones Meet in the midline and rest on the upper part of nasal processes of frontal bone and are themself hold between the frontal processes of maxilla
Cartilaginous part Upper lateral cartilage Lower lateral "alar" Lesser alar "Sesamoid" Septal cartilage "Septum"
Nasal muscles Nasal skin Procerus Nasals levator labii superioris Anterior & post dilator nares Depressor septi Nasal skin Covered all muscles Contain sebaceous glands Rhinophyma
Common anomalies of nose Anterior nasal atresia Bifid nose & nose duplication Congenital Congenital nasal tumor, Encephalocele, glioma, dermid, haemangioma
Lymphatic Blood supply of external nose Facial artery Ophthalmic A Infraorbital branch of maxillary A Lymphatic Submental Submandibular Pre-auricle LN
Nasal cavity Roof, floor, medial & lateral wall Medial wall "septum" divides the nasal cavity into left & right nasal cavities Nasal valve area of highest resistance triangular in shape bounded by septum, pyriform aperture and upper lateral cartilage
Why nasal valve is important plate Roof Cribriform of ethmoid Front nasal bone Inferior part of sphenoid bone Floor palatine processes of maxilla post one third horizontal part of palatine bone
Septum Vomer - lower & post part of septum Perpendicular plate of ethmoid - upper and anterior septum Septal cartilage - quadrilateral in shape is wedged between the two bones Other bones - above & front - nasal bone + nasal spine of frontal bone Above & behind - rostrum & crest of sphenoid Below is crest of maxilla & palatine bone
Blood Supply of Nasal Septum External & internal carotid A. Ex C A - spheno palatine A → maxilla A branches of G. Palatin A → maxilla A super labial → facial A Internal C A - anterior & posterior ethmoid A
Little area - sites - arteries involve : - sphenopalatine A - anterior ethmoid A - superior labial & great P A - why this area is important? Nerve supply of nasal septum
Lateral wall of the nose - below and front by nasal surface of maxilla - above by ethmoidal Labrinth - posteriorly by plate of palatine bone - the inferior turbinate is a separate bone - turbinates & meati "three each" - m meatus - uncinate process - O M complex - inferior meatus - nasolacrimal duct
Pterygopalatine fossa - space located behind to the posterior wall of maxillary sinus - communication - content Mucous membrane of nose - vestibule - skin & hair follicle & sebaceous gland - pseudostratified ciliated columns, types of epithelium & goblet cell, mucous, serious glands Olfactory mucous membrane -super T. + roof of nasal cavity and upper ICM of N. Septum
Blood supply of nasal cavity - anterior & posterior ethmoid A - sphenopalatine A → maxilla A -greater P.A. → maxilla A - superior Lab A → facial A Venous drainage "valveless" * - anterior → cavernous sinus - middle + post → pterygoid + pharyngeal plexus
-infraorbital → maxillary N → pterygo Platin ganglion Nerve Supply I. Sensory nerve supply -infraorbital → maxillary N → pterygo Platin ganglion -anterior superior alveolar N → maxilla N -nasociliary N → anterior ethmoid
II. Secretomotor supply -vidian nerve - nerve of pterygoid canal -vidian nerve is formed by Greater superficial petrosal branch of facial nerve Deep petrosal → plexus around internal carotid A. III. Olfactory nerve
lymphatic drainage of nasal cavity anterior part → submental + submandibular LN Post part → upper deep cx LN
Paranasal Sinuses Anatomy* Function of the nose Respiration air filtered, heated, humidified Olfaction Vocal resonance of voice Airway protection Nasal cycle Rhythmic congestion, decongestion of nasal mucosa Role of nasal mucosa in evoke allergic reaction Paranasal Sinuses Anatomy*
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