1. Nasal Cavity and Pterygopalatine Fossa
R. Shane Tubbs, MS, PA-C, PhD

3. columella
Five major cartilages

4. Piriform aperture
Anterior nasal spine
Nasal septum
Nasal bones

5. Nasal Cavity: Borders
Roof: frontal, ethmoid (cribriform), sphenoid, nasal bones
Floor: maxillary and palatine bones
Medial: nasal septum
Lateral: nasal conchae, lacrimal, maxillary, palatine bones

6. Nasal Septum vomer Perpendicular plate Septal cartilage Vomer
Medial crus of > alar cartilage
Nasal crests of maxillary, palatine, and sphenoid bones
Nasal spine of frontal bone
vomer

7. Vomeronasal Cartilage
Along inferior border of septal cartilage
Rudimentary in man
Vomeronasal nerve of Jacobson in lower animals- pheromones

8. sphenopalatine foramen
ethmoid
maxillary
inferior concha
sphenopalatine foramen

9. bulla
uncinate process

10. Features Bulla (bubble) Nasofrontal duct Uncinate process
Semilunar hiatus

12. Valve of Hasner (Czech Ophthalmologist 1819-1892)
Iatrogenic closure

13. Features Vestibule: skin/vibrissae, sweat and sebaceous glands
Upper 1/3
Lower 2/3
Limen (entrance) nasi (lateral nasal cartilage)
Agger (mound) nasi (ethmoid air cells)

14. Olfactory Nerves ~ 20 pairs Most commonly injured cranial nerve
CSF rhinorrhea
Do not regenerate in elderly

16. Pterygopalatine ganglion
Vidian
anterior ethmoidal
greater palatine
nasopalatine

18. Arterial Supply Sphenopalatine Anterior ethmoidal Posterior ethmoidal
Greater palatine
Superior labial and lateral nasal branch of facial

21. Plexus Cavernosi Concharum

22. Nasal Veins/Lymphatics
Veins: Drain via sphenopalatine foramen into pterygoid plexus and some via ethmoidal foramina to superior ophthalmic vein
Lymphatics: Majority join pharyngeal plexus and thus drain into retropharyngeal nodes

23. Paranasal Air Sinuses

27. Paranasal Air Sinuses Function Named for the bones they occupy Paired
Surrounded by diploic space of contiguous bones

28. Frontal Sinus Frontonasal duct- semilunar hiatus
Innervation: supraorbital n.
Variation
Acromegaly
Eskimos
Related to anterior cranial fossa
Tubbs et al. J Neurosurgery, 2002

30. Ethmoid Sinus (3-18 pairs)
Named on the basis of their openings
anterior: semilunar hiatus
middle: ethmoidal bulla or directly into middle meatus
posterior: superior meatus
Innervation: anterior and posterior ethmoidal nerves and branches of pterygopalatine ganglion

32. Sphenoid Sinus Sphenoethmoidal recess
Most variable cavity in the body!
15% of all cases of sinusitis
Ostium is 1.5 cm superior to its floor
Innervation: Posterior ethmoidal nerve and branches of pterygopalatine ganglion
Related to middle cranial fossa

34. ostium

36. Maxillary Sinus Maxillary: semilunar hiatus
Innervation: ant, middle, posterior superior alveolar nerves, infraorbital (V2)
Most commonly infected sinus
Drains superiorly as does sphenoid sinus

38. ostium

39. Antrum of Highmore (British surgeon 1613-1685)

40. mastoid air cells

41. Pterygopalatine Fossa
“A pyramidal space inferior to the apex of the orbit and lateral to the nasal cavity”
~ 2 x 1 cm
Arteries: post sup alveolar, descending palatine, pterygoid canal, pharyngeal, sphenopalatine
Maxillary nerve
Nerve of pterygoid canal (Vidian)
Pterygopalatine ganglion (posterior to middle nasal concha)
Pterygopalatine nerves

42. Four canals: Vidian, vomerovaginal, palatovaginal, greater palatine canal
Two foramina: rotundum, sphenopalatine
Two fissures: inferior orbital, pterygomaxillary

44. pterygopalatine fossa

45. Pterygopalatine Fossa
Lateral: pterygomaxillary fissure
Medial: perpendicular plate of palatine with sphenopalatine foramen
Posterior: Pterygoid process with Vidian canal, rotundum
Anterior: maxillae with inferior orbital fissure, posterior superior alveolar foramen (lateral)
Roof: > wing sphenoid, superior orbital fissure
Inferior: pyramidal process, palatine canal (oral cavity)

47. perpendicular plate

48. Pterygopalatine Ganglion
Parasympathetic root
Sympathetic root
Sensory root

49. Distribution of Pterygopalatine Ganglion
Sphenoid sinus (pharyngeal branch)
Posterior ethmoid cells
Nose
Hard and soft palate
Inner gingivae of maxillary teeth
Palatine tonsil
Choana
Uppermost pharynx
Orbit

52. geniculate ganglion

57. Vidian Nerve Course

58. Sluder’s neuralgia (pterygopalatine neuralgia) excessive tearing, cluster HA
Vidian neurectomy
Crocodile tears