Nose and paranasal sinuses Introduction- External nose- boney and cartilagenous part, Bones- nasal bones & the frontal processes of the maxillae Cartilages- superior & inferior nasal cartilages, septal cartilage and some small cartilages

Nose and paranasal sinuses Nasal cavity- Extent-external nares to the posterior nasal apertures. Rt and lt halves by nasal septum Each half- roof, floor, medial & lateral walls Measurement-5cm height, 5-7cm length & 1.5cm wider near the floor and near the roof is 1-2mm

Nose and paranasal sinuses Nasal septum- Osseocartilaginous partition betw the 2halves of the nasal cavity Mucous membrane & forms the medial wall of both the nasal cavities Boney part- vomer & perpendicular plate of the ethmoid. Nasal spine of the frontal bone, the rostrum of the sphenoid & the nasal crests of nasal, palatine and maxillary bones Cartilaginous part- septal cartilage & the septal processes of the inferior nasal cartilages Cuticular part- fibrofatty tissue covered by the skin Borders- sup, inf, ant and post & rt and lt surfaces

Nose and paranasal sinuses Arterial supply- Anterosuperior- ant ethmoidal artery Posteroinferior-sphenopalatine artery Anteroinferior- superior labial branch of facial artery Posterosuperior- post ethmoidal artery Kiesselbach’s plexus- common site of bleeding from the nose or epistaxis and know as “Little’s Area” Venous drainage- From little’s area there are venous plexus which drains into the facial vein, posteriorly through the sphenopalatine vein to the pteryoid venous plexus

Nose and paranasal sinuses Nerve supply- General sensory- Anterosuperior-internal nasal branch of the anterior ethmoidal nerve Posteroinferior-nasopalatine branch of the pterygopalatine ganglion Posterosuperior- medial,posterior, superior nasal branches of the pterygopalatine ganglion Special sensory or olfactory nerves are confined to the upper part or olfactory area

Nose and paranasal sinuses Lymphatic drainage- Anterior half- submandibular nodes Posterior half- retropharyngeal & deep cervical nodes

Nose and paranasal sinuses Clinical anatomy- Little’s area on the septum is the common site of bleeding from the nose or epistaxis Pathological deviation of the nasal septum is often responsible for the repeated attacks of common cold, allergic rhinitis, sinusitis.

Nose and paranasal sinuses Lateral wall of nose- Irregular and having presence of 3 shelf-like bone projections- conchae Lateral wall separates the nose: orbit above, with the ethmoidal air sinuses & maxillary sinus below, from lacrimal groove and nasolacrimal canal in front

Nose and paranasal sinuses Lateral wall- 3parts Vestibule- small depression area in the anterior part Middle part-atrium of the middle meatus Posterior part-conchae

Nose and paranasal sinuses Skeleton of the lateral wall Boney- nasal, frontal process of the maxilla, labyrinth of the ethmoid with superior and middle conchae, inferior nasal conchae, perpendicular plate of the palatine bone together with its orbit and sphenoidal processes and medial pteyroid plate Cartilaginous- superior nasal cartilage, inferior nasal cartilage and 3-4 small cartilages of ala Cuticular lower part- fibrofatty tissue covered with skin

Nose and paranasal sinuses Conchae and meatuses inferior concha is independent bone Middle concha- projection from the medial surface of the ethmoidal labyrinth Superior concha- projection from the medial surface of the ethmoidal labyrinth Inferior meatus- nasolacrimal duct Middle meatus- ethmoidal bulla is a rounded elevation produced by the underlying middle ethmoidal sinus; hiatus semilunaris is a deep semicircular sulcus below the bulla; infundulum is a short passage at the anterior end of hiatus; opening of the frontal sinus, maxillary air sinus and middle ethmoidal air sinus Superior meatus- opening of the posterior ethmoidal air sinuses Sphenoethmoidal recess- opening of the sphenoidal air sinus

Nose and paranasal sinuses

Nose and paranasal sinuses Arterial supply of the lateral wall Anterosuperior quadrant- ant ethmoidal artery assisted by the post ethmoidal and facial arteries Anteroinferior quadrant- branches from the facial artery and greater palatine arteries Posterosuperior quadrant- sphenopalatine artery Posteroinferior quadrant- branches from the greater palatine artery Venous drainage- Veins forms plexus which drains anteriorly into the facial vein, posteriorly into the pharyngeal plexus of veins and from the middle part to the pterygoid plexus of the vein

Nose and paranasal sinuses Nerve supply- General sensory nerves Anterosuperior quadrant- ant ethmoidal nerve branch of ophthalamic nerve Anteroinferior quadrant-ant superior alveolar nerve branch of maxillary nerve Posterosuperior quadrant- post superior lateral nasal branches from the pterygopalatine ganglion suspended by the maxillary nerve Posteroinferior quadrant- ant or greater palatine branch from the pterygopalatine ganglion suspended by the maxillary nerve 2. Special sensory or olfactory nerve-

Nose and paranasal sinuses Lymphatic drainage- Anterior half- submandibular nodes Posterior half- retropharygeal and upper deep cervical nodes

Nose and paranasal sinuses Clinical anatomy- Common cold or rhinitis Paranasal air sinuses may get infected from the nose. Maxillary sinusitis is the commonest of such infections Hypertrophy of the mucosa over the inferior nasal concha is the common feature of allergic, rhinitis, which is characterized by sneezing, nasal blockage and excessive watery discharge from the nose

Nose and paranasal sinuses Frontal sinus Maxillary sinus Sphenoidal sinus Ethmoidal sinus

Nose and paranasal sinuses