Nose & Para nasal sinuses Dr. Ashraf Hussain

Had Cleopatra's nose been shorter, the whole face of the world would have changed. (Blaise Pascal  (1623 - 1662) French philosopher, mathematician, and physicist)

NOSE External nose Bones Nasal cavity Mucous membrane Olfactory portion Respiratory portion Communications of nasal cavity

Floor Roof Lateral wall Medial wall

Olfactory membrane Located on the roof of the nasal cavity Olfactory membrane Located on the roof of the nasal cavity. Contains cells/receptors which are in contact with the Olfactory bulb and nerve to provide sense of smell. (5% of nasal cavity area)

Relations of nasal cavity Important in the spread of infection Direct continuity with (i) the anterior cranial fossa (via the cribriform plate of the ethmoid bone) (ii) the nasopharynx and, through the pharyngotympanic tube, the middle ear (iii) the paranasal air sinuses (iv) the lacrimal apparatus and conjunctiva.

Nasal Mucosa

Cross section of nasal mucosal layer. Cilia is beating

Functions of Nose Olfaction Respiration Filtration of dust Humidification Elimination of secretions from paranasal sinuses and nasolacrimal ducts

Arteries supplying the Nose External Carotid Artery -Sphenopalatine artery -Greater palatine artery -Ascending pharyngeal artery -Posterior nasal artery -Superior Labial artery Internal Carotid Artery -Anterior Ethmoid artery -Posterior Ethmoid artery

Blood supply The upper part of the nasal cavity receives its arterial supply from the ethmoidal branches of the ophthalmic artery, a branch of the internal carotid. The sphenopalatine branch of the maxillary artery, a terminal of the external carotid, supplies the lower part of the cavity.

Just within the vestibule of the nose, on the anteroinferior part of the septum, it links with a septal branch of the facial artery and it is from this zone, Little’s area, that 90% of nose-bleeds occur.

BLOOD SUPPLY OF MEDIAL WALL OF NOSE

BLOOD SUPPLY OF LATERAL WALL OF NOSE

Kesselbach’s Plexus/Little’s Area: -Anterior Ethmoid (Opth) -Superior Labial A (Facial) -Sphenopalatine A (IMAX) -Greater Palatine (IMAX) Woodruff’s Plexus: -Pharyngeal & Post. Nasal AA of Sphenopalatine A (IMAX)

Epistaxis

venous drainage Veins accompany the arteries The veins drain downwards into the facial vein and upwards to the ethmoidal tributaries of the ophthalmic veins.

Innervation Sense of smell is via the olfactory nerve, which sends microscopic fibers from the olfactory bulb through the cribiform plate to reach the top of the nasal cavity. General sensory innervation is by branches of the Trigeminal nerve (V1 & V2) Nasociliary nerve (V1) Nasopalatine nerve (V2) Posterior nasal branches of Maxillary nerve (V2)

The entire nasal cavity is innervated by autonomic fibers. Sympathetic innervation to the blood vessels of the mucosa causes them to constrict, while the control of secretion by the mucous glands is carried on postganglionic parasympathetic nerve fibers originating from the facial nerve.

Lymphatics

Lymph from anterior regions of the nasal cavities drains forward onto the face by passing around the margins of the nares. These lymphatics ultimately connect with the submandibular nodes. Lymph from posterior regions of the nasal cavity and the paranasal sinuses drains into upper deep cervical nodes. Some of this lymph passes first through the retropharyngeal nodes.

Clinical features Nasal Fractures Epistaxis Rhinitis Deviated nasal septum Nasal polyps Boil on nose

Danger area of the face The skin of the external nose and its surrounds contains many sebaceous glands and hair follicles which may become blocked and infected Facial veins, which may become secondarily infected, communicate directly with the ophthalmic veins and hence with the cavernous sinus. For this reason, this zone is often known as the ‘danger area of the face’.

Deviated Nasal Septum The septum is frequently deviated to one or other side, interfering both with inspiration and with drainage of the nose and accessory sinuses.

Pathology Deviation Spur Usually in cartilagenous part Different shapes C shaped S shaped Spur At junction of cartilage and bone

Symptoms Nasal obstruction Nasal deformity Sense of smell and taste are disturbed Recurrent epistaxis

Nasal Polyp Smooth glistening grape like masses Multiple and bilateral Pale but Protruding polyp may appear pink Insensitive to probing Do not bleed on touch Multiple and bilateral Broadening of nose Increased intercanthal distance

Paranasal air sinuses Air filled spaces in bones Frontal Ethmoidal Sphenoidal Maxillary

Sinuses

Functions of sinuses Warm and humidify inspired air Resonance of voice Reduce the weight of skull

Guess what?

Guess what?