2. Nose & Para nasal sinuses
Dr. Ashraf Hussain

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

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

7. Floor
Roof
Lateral wall
Medial wall

9. 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)

12. 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.

16. Nasal Mucosa

17. Cross section of nasal mucosal layer. Cilia is beating

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

20. 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

21. 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.

22. 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.

23. BLOOD SUPPLY OF MEDIAL WALL OF NOSE

24. BLOOD SUPPLY OF LATERAL WALL OF NOSE

25. 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)

27. Epistaxis

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

30. 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)

31. 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.

33. Lymphatics

34. 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.

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

36. 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’.

37. 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.

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

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

41. 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

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

43. Sinuses

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

46. Guess what?

47. Guess what?