1. ANATOMY OF NOSE,NASAL CAVITY&PARANASAL AIR SINUSES
DR.G.CHANDRALEKHA
AIMST UNIVERSITY

2. Objectives is to discuss the gross anatomy ,blood supply, nerve supply,lymphatic drainage and applied aspects of nasal cavity and paranasal air sinuses
Learning outcomes: describe the parts, formation and features of the walls of the nasal cavity with suitable diagrams.
Describe blood aupply, nerve supply, lymphatic drainage and applied aspects of the nasal cavity
Describe the functions and gross anatomy of paranasal airsinuses with proper illustrations
Describe the blood supply, nerve supply, lymphatic drainage and surgical anatomy of paranasal air sinuses

3. Nose Peripheral olfactory organ or organ of smell Has two parts
- outer external nose
projects from the center of the face
- internal nasal cavity
divided by a septum into
right and left nasal chambers.

4. Nostril 
Septum
3. Apex
4. Dorsum of the nose
5. Root of the nose
6. Ala of the nose

5. External Nose BONES: - occupies the upper part of the organ
- Nasal bones, and
- Frontal processes of the maxillæ

7. Nasal Cavity Situated one on either side of the median plane Opens
front through nares
behind through choanæ with the nasal part of the pharynx
Nares
pear-shaped apertures
Choanæ
two oval openings
Vestibule:
dilated portion in the aperture of the nostril is a slight dilatation,
lateral relation - ala and lateral crus of the greater alar cartilage
Medial relation - medial crus of greater ala cartilage
lined by skin containing hairs and sebaceous glands
extends as a small recess toward the apex of the nose
Division:
Above and behind the vestibule
OLFACTORY REGION - superior nasal concha, opposed part of septum-bipolar neurons
RESPIRATORY REGION - the rest of the cavity.-pseudostratified ciliated columnar epithelium

8. Nasal cavity

9. Nasal cavity
The nasal cavity is related to the anterior and middle cranial fossae, orbit, and paranasal sinuses and is separated from the oral cavity by the hard palate.
In addition to the nostrils and choanae, the nasal cavity presents openings for the paranasal sinuses and the nasolacrimal duct,the sphenopalatine foramen.
The nasal cavity is divided into right and left halves (each of which may be termed a nasal cavity) by the nasal septum.
Each half has a roof, floor, and medial and lateral walls.

10. The BOUNDARIES
The roof of the nasal cavity is formed by nasal cartilages, nasal and frontal bones, the cribriform plate of the ethmoid and the body of the sphenoid.
The floor, wider than the roof, is formed by the palatine process of the maxilla and the horizontal plate of the palatine bone, i.e., by the palate.
The medial wall, or nasal septum, is formed (from anteiror to posterior) by (1) the septal cartilage (destroyed in a dried skull), (2) the perpendicular plate of the ethmoid bone, and (3) the vomer .
It is usually deviated to one side. The lowest part of the septum (the columella) is membranous and mobile.

11. ROOF Formed by 1. nasal bone 2.Nasal process of frontal bone
3. crista galli
4. cribriform part of ethmoid bone
5. body of sphenoid bone
with sphenoidal air sinuses
6. basilar part of occipital
bone

12. Floor
By palatine process of the maxilla and the horizontal plate of the palatine bone, i.e., by the palate.
Palatine bone-horizontal part
Horizontal plate of maxilla

13. ETHMOID BONE

14. Medial wall perpendicular plate of ethmoid bone vomer bone
cartilage of the septum
crest of the maxillary bone
crest of the palatine bone
B, Lateral aspect of the medial wall (nasal septum) of the right nasal cavity. The lower limit of the ethmoidal contribution to the septum varies widely. The attachment of the septal cartilage to the vomer and the maxilla allows considerable movement without dislocation

15. Cartilage of the septum
(cartilagines nasi)

16. The lateral wall
The lateral wall is uneven and complicated and is formed by several bones: nasal, maxilla, lacrimal and ethmoid, inferior nasal concha, perpendicular plate of palatine, and medial pterygoid plate of sphenoid.
 The lateral wall presents three or four medial projections termed nasal conchae (supreme,superior,middle,inferior), which overlie passages (meatuses-superior,middle and inferior).
The inferior concha is a separate bone; the others are portions of the ethmoid bone.
The conchae were formerly known as turbinates.
It should be noted that the plural of meatus is meatus in Latin and meatuses in English (cf fetus).

17. Medial aspect of the bony framework of the lateral wall of the right nasal cavity. The lateral boundary of the piriform aperture is formed by the nasal bone and the maxilla; that of the choana is formed by the medial pterygoid plate of the sphenoid bone. Note the line of the spheno-occipital junction.

19. Openings in the superior meatus
Superior meatus- sphenoethmoidal recess
Posterior ethmoidal sinus
middle

20. Openings in the middle meatus
 The middle meatus, under cover of the middle concha, receives the openings of the
frontal sinuses.
 Most anterior ethmoidal cells open on an elevation (bulla ethmoidea).
A curved slit (hiatus semilunaris) inferior to the bulla receives the opening of the maxillary sinus.

21. Medial aspect of the lateral wall of the right nasal cavity
Medial aspect of the lateral wall of the right nasal cavity. A shows the four conchae. Note that each meatus is named after the concha that forms its roof. In B, the conchae have been largely removed. The frontal sinus may open into (1) the frontal recess (as shown here) or (2) the ethmoidal infundibulum.

22. Inferior meatus
The frontal sinus and some anterior ethmoidal cells open either into an extension (ethmoidal infundibulum) of the hiatus or directly into the anterior part (frontal recess) of the middle meatus. 
The inferior meatus, which lies between the inferior concha and the palate, receives the termination of the nasolacrimal duct.
The nasal cavity can be examined in vivo either through a nostril or through the pharynx. 
A nasal speculum in a nostril is used in anterior rhinoscopy.
A postnasal mirror inserted into the pharynx through the mouth enables the choanae to be inspected in posterior rhinoscopy

23. Innervation
The nerves of ordinary sensation are derived from the first two divisions of the trigeminal nerve- touch, pressure and temperature in the nose.
The nerves for the posterior and larger portion of the nasal cavity come from branches of the pterygopalatine ganglion that are derived from the maxillary nerve. 
The chief sympathetic (vasoconstrictor) and parasympathetic (vasodilator and secretory) innervation of the nasal cavity follow nerve branches arising in the region of the pterygopalatine ganglion, but some sympathetic fibers are carried along the walls of arteries. 

24. Innervation and blood supply of the right nasal cavity.

25. LATERAL WALL NERVE SUPPLY
1.anterior ethmoidal nerve-ophthalmic
2.infraorbital nerve-maxillary
olfactory nerve
3.nasal,nasopalatine &palatine nerves from pterygopalatine ganglion

27. MEDIAL WALL
1.ANTERIOR ETHMOIDAL NERVE
2.POSTERIOR ETHMOIDAL NERVE
3.EXTERNAL NASAL NERVE
4.SEPTAL NERVE FROM NASOPALATINE NERVE
5. GREATER PALATINE NERVE

28. Blood supply and lymphatic drainage
The most important arteries to the nasal cavity are the 1.sphenopalatine (from the maxillary) artery and the
2.anterior ethmoidal (from the ophthalmic) artery. Bleeding from the nose (epistaxis) occurs usually from
3.the junction between septal branches of the superior labial and sphenopalatine arteries. 
The lymph vessels drain into deep cervical nodes. Communications probably occur between the nasal lymphatics and the subarachnoid space, probably through the sheath of the olfactory nerve.

31. Paranasal Air Sinuses
Air spaces within the bones on either side of the nasal cavity.
Functions:
1]Lighten the skull
2]Give resonance to the voice
3]Warm the inspired air
4] shape to the face and
5] some degree of warmth and humidification to inspired air.
They are 4 in number:
1] Maxillary,
2] Frontal
3]Sphenoidal
4] Ethmoidal

33. Paranasal sinuses
The paranasal sinuses are cavities in the interior of the maxilla and the frontal, sphenoid, and ethmoid bones.
The sinuses develop as outgrowths from the nasal cavity; hence they all drain directly or indirectly into the nose.
 Nasal infection (rhinitis), e.g., during a "cold in the head," may spread to the sinuses (sinusitis).
The sinuses can be examined radiographically, and a light placed against the roof of the mouth enables the maxillary sinus to be transilluminated.

34. Coronal scheme of the nasal cavity to show the conchae, meatuses, and certain paranasal sinuses.

36. Paranasal air sinuses
Maxillary air sinus = opens into the hiatus semilunaris in the middle meatus of nose
Sphenoidal air sinus = opens into the sphenoethmoidal recess
Frontal air sinus = Opens in the anterior part of middle meatus
Ethmoidal air sinuses
Anterior ethmoidal sinus open into the anterior part of the
middle meatus of nose
Middle ethmoidal sinus Opens on the bulla ethmoidalis in the middle meatus.
Posterior ethmoidal air sinus opens into the Superior meatus.

37. Frontal sinus
The frontal sinus may be regarded as an anterior ethmoidal cell that has invaded the frontal bone postnatally.
The right and left frontal sinuses, frequently of different sizes, are separated by a bony septum that is usually deviated to one side.
The frontal sinus drains into the middle meatus in a variable manner directly or by a frontonasal duct, which opens into the frontal recess or the ethmoidal infundibulum.
The frontal sinus commonly extends in the roof of the orbit (posterior).

39. Maxillary sinus
The maxillary sinus, the largest of the sinuses, is within the body of the maxilla.
It is shaped like a pyramid;
its base is usually medial,
with its apex in the zygomatic process of the maxilla.
Its roof is the floor of the orbit,
and its floor is the alveolar process of the maxilla. 

40. Maxillary sinus
The maxillary sinus drains into the middle meatus by means of the semilunar hiatus.
The floor of the maxillary sinus is slightly below the level of the nasal cavity, and it is related to the upper teeth (varying from teeth 3 to 8 to teeth 6 to 8).
 Maxillary sinusitis is frequently accompanied by toothache.
Infection may spread among the various sinuses, the nasal cavity, and the teeth.
 The opening of the maxillary sinus can be cannulated in vivo through the nostril.

42. Sphenoidal sinus
The sphenoidal sinus is in the body of the sphenoid bone, and it varies greatly in size.
Its superior aspect is related to the hypophysis (pituitary) and
the optic nerves and chiasma and
laterally to the cavernous sinus and internal carotid artery 
The sphenoidal sinus drains into the spheno-ethmoidal recess superior to the superior concha.
The sinus is divided into right and left parts by a bony septum.

43. The spheno-ethmoidal recess.
The spheno-ethmoidal recess, above and posterior to the superior concha, receives the opening of the sphenoidal sinus.
The superior meatus, under cover of the superior concha, receives the openings of the posterior ethmoidal cells and (in a dried skull) the sphenopalatine foramen.

44. Ethmoid sinuses
The ethmoid sinuses of the ethmoid bone are two of the four paired paranasal sinuses.
They are composed of a variable number of air cells and divided into the anterior, middle and posterior groups.
The ethmoidal air cells consist of numerous thin-walled cavities situated in the ethmoidal labyrinth and completed by the frontal, maxilla, lacrimal,sphenoidal, and palatine bones.
They lie between the upper parts of the nasal cavities and the orbits, and are separated from these cavities by thin bony laminae.

47. Maxillary air sinus

48. Ethmoid sinuses The groups of the ethmoidal air cells:
The posterior group (sometimes the posterior ethmoid sinus) drains into the superior meatus above the middle nasal concha; sometimes one or more opens into thesphenoidal sinus.
The middle group (sometimes the middle ethmoid sinus) drains into the middle meatusof the nose on or above the bulla ethmoidalis.
The anterior group (sometimes the anterior ethmoid sinus) drains into the middle meatus of the nose by way of the infundibulum.

49. Applied anatomy
Dangerous area of nose- Little,s area-epistaxis - Bleeding of the nose
Sinonasal inflamation
Infection and inflamation spread
Sinusities
Drainage
Deviated nasal septum

50. Any question?