1. Nose and paranasal sinuses
Ehab ZAYYAN, MD, PhD

2. External nose Root and tip
Nostrils (nares): are the external orifices of the nose. Bounded laterally by the ala and medially by the nasal septum
Nasal skeleton:
Nasalis bones
Frontal processes of the maxillae
Nasal part of the frontal bone
Upper and lower nasal cartilages
Septal cartilage

6. Nasal cavity From the nostrils till the choana
Divided into right and left by the nasal septum
Floor: palatine process of the maxilla and horisontal plates of the palatine bones
Roof: body of the sphenoid, cribriform plate of the ethmoid, frontal bone, nasal bone, nasal cartilages

8. Lateral nasal wall
Superior, middle and inferior conchae. The area below each concha is called meatus

9. Meatus Sinuses Superior meatus Sphenoid sinus Posterior ethmoid cells
Middle meatus
Frontal sinus
Maxillary sinus
Anterior ethmoid cells
Inferior meatus
Nasolacrimal duct

15. Nasolacrimal duct

17. The middle meatus is continuous in front with a depression called the atrium.
Within the nostril in front of the atrium is the vestibule. It is lined by modified skin and short curved hair called the vibrissae

20. MEDIAL NASAL WALL

21. Medial nasal wall

22. The mucous membrane lines the nasal cavity except the vestibule
The mucous membrane lines the nasal cavity except the vestibule. There are two types of mucous membranes:
1. Olfactory mucosa
2. Respiratory mucosa

23. 1. olfactory mucous membrane: lines the superior surface of the superior concha and the sphenoethmoidal recess. It also lines the corresponding part of the nasal septum

24. The axons of the fibers pass through the openings in the cribriform plates of the ethmoid bone and end in the olfactory bulb

25. 2. The respiratory mucous membrane:
Lines the rest of the nasal cavity.
Its function is to warm, moisten and clean the inspired air.
Warming: venous plaxus in the submucosa
Moisture: mucous by the glands and goblet cells
Ciliary action….

26. Nerve supply of the nasal cavity
The olfactory nerve: arise from special olfactory cells in the olfactory mucous membrane
Nerves of general sensation: derived from opthalmic and maxillary divisions of the trigeminal nerve:
- anterior ethmoid nerve
- nasal, nasopalatine , greater and lesser palatine nerves of the pterygopalatine ganglion

31. Sympathetic innervation:
T1-T3 → SCSG → ICA plexus → deep petrosal nerve → vidian nerve → PPG
Parasympathetic innervation:
Superior salivatory nucleus → facial nerve → GSPN → vidian nerve → PPG → nasal branches through the sphenopalatine foramen

33. Blood supply of the nasal cavity
ECA
1. Sphenopalatine artery (maxillary artery)
2. Greater palatinal artery branch in the incisive canal (maxillary artery)
3. Superior labial branch of the facial artery
ICA
4. Anterior ethmoid artery (ophthalmic artery)
5. Posterior ethmoid artery (ophthalmic artery)

34. Third part of the maxillary artery in the PPF

38. Kiesselbach area (Little area) of the nasal septum
The area of the septum about 1 cm posterior to the nares. It is very rich in blood supply and a common site of epistaxis.
Anterior ethmoid artery
Sphenopalatine artery
Greater palatinal artery
Septal branch of facial artery

40. Anterior rhinoscopy

41. Posterior rhinoscopy

42. Paranasal sinuses
Cavities found in the interior of the maxilla, frontal,sphenoid and ethmoid bones.
Lined with mucoperiostium and filled with air.
The mucous produced by the glands in the mucous membranes is moved into the nose by the ciliary action of the columnar cells.
The function of the sinuses is to act as resonators of the voice and to reduce the weight of the skull.

44. Paranasal sinuses

55. Osteomeatal complex
The most commonly infected structure in the sinuses
Can be obstructed and inflammed easily with even minimal edema
Can not be examined by anterior rhinoscopy but with endoscopy
Can not be evaluated by conventional radiology but needs CT

56. Obstruction of the osteomeatal complex
Anatomic variations
Foreign body
Mucociliary dysfunction
Allergy
Infections
Local inflammation ↓
Obstruction of the osteomeatal complex
Sinusitis

57. FESS
The target of Functional Endoscopic Sinus surgery (FESS) is to remove the pathology of the osteomeatal complex to maintain normal ventilation and drainage to the sinuses.