NOSE AND PARANASAL SINUSES: ANATOMY and PHYSIOLOGY

1.01a
August, 10, 2017

Francisco A. Victoria, MD, FPSO-HNS

Department of Internal Medicine
Aa
TOPIC OUTLINE FACIAL SKELETON
I. Basic Anatomy of the Nose, Paranasal Sinuses, and Face  Knowing the various components of the bony facial skeleton
a. Facial Skin and Soft Tissues and their relationship to one another is important in:
b. Facial Skeleton o Trauma management
c. External Nose o Diagnosis and treatment of inflammatory diseases of
d. Nasal Cavities
the facial skeleton and their complications
e. Paranasal sinuses
f. Vascular supply  Most dangerous triangle of the face: From the root of the
g. Nerve Supply nose to the angle of the mouth.
h. Functional Anatomy of the Ostiomeatal Unit
II. Morphology of the Nasal Mucosa BONE CARTILAGE
a. Respiratory Mucosa  Immobile  Mobile
b. Olfactory Mucosa
 Nasal bone  Lateral nasal cartilages
III. Basic Physiology and Immunology of the Nose
a. Physical Principles of Nasal Airflow  Frontal process of  Greater alar lateral crus
b. Conditioning of the Inspired Air maxilla  Greater alar medial crus
c. Protective Functions of the Nasal Mucosa
d. Speech Production  Upper jaw bone
e. Olfaction  Houses the maxillary sinus
 Articulates laterally with
zygoma via the zygomatic
BASIC ANATOMY OF THE NOSE, PARANASAL SINUSES, MAXILLA process
AND FACE  Upper part borders the nasal
NOSE bone
 Gateway to the respiratory tract  Frontal process projects
 Structural anatomy is important aesthetically and functionally upward to the frontal bone
 External shape and appearance affect overall appearance of the  Zygomatic bone
face and functional processes that take place internally  Frontal process connects
superiorly with the frontal bone
ZYGOMA
FACIAL SKIN AND SOFT TISSUES lateral to the orbit
 A highly conspicuous region in which the faulty or inadequate  Communicates posteriorly with
treatment of tissue changes will have obvious consequences the zygomatic arch
 Relaxed skin tension lines (RSTLs)
o Scars can be made less conspicuous by taking these
tension lines into account when suturing facial skin
injuries
 Aesthetic units of the face
o An important consideration in the treatment of larger
soft-tissue defects
o Failure to take these units into account will produce a
poor cosmetic result

The cranial bones

Skin tension lines and aesthetic units

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 NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
EXTERNAL NOSE PIRIFORM APERTURE
 Shape is defined by the following:  Anterior bony opening of the nasal cavity
o Nasal bones  Boundaries:
 Pair of rectangular bones in the upper nasal dorsum Lateral
o Paired lateral cartilages (Upper nasal cartilages) and Maxilla
Inferior
Alar cartilages (major alar cartilages) in the central and Superior Nasal bone
lower portions of the nose
 Lateral portions of the nasal alae also contain several NASAL SEPTUM
minor alar cartilages (small accessory cartilages)  Divides the interior of the nose behind the nasal valve into two
which are embedded in the lateral soft tissues of the main cavities
nose
 Composed of an Anterior cartilaginous part and two posterior
bony parts
ALAR CARTILAGE
 Abnormalities in septum shape which cause nasal airway
 Medial crus obstruction:
Components
 Lateral crus o Deviated septum
 Chiefly determine the appearance of o Tension septum
Functions nasal tip and shape of the nares o Spurs or ridges
 Maintain an effective nasal airway
CHOANAE
 Structures which stabilize the base of the nose:  Paired posterior openings through which the nasal cavities
o Medial crura communicate with the nasopharynx
o Inferior septal margin
o Columella (connective-tissue septum) LATERAL NASAL WALL
 Subluxation of the inferior septal margin can hamper nasal  Location of functionally important structures such as:
breathing by partially obstructing the nasal airway
o Nasal turbinates and their associated passages (meati)
o Sinus ostia
o Orifice of the nasolacrimal duct
 Located in the corresponding inferior meatus

Bony and cartilaginous structures that define the appearance

of the external nose

NASAL CAVITIES
 Begin anteriorly at the nasal vestibule, which is bordered
posteriorly by the limen nasi (internal nasal valve) located
between the posterior border of the alar cartilage and the
anterior border of the lateral cartilage
 Boundaries:
 Lateral nasal walls
Lateral Structure of the lateral nasal wall
o Formed by ethmoid bone and maxilla
 Palatine bone TURBINATES
Posterior
 Pterygoid process of sphenoid bone
SUPERIOR  Part of the ethmoid bone
Superior  Cribriform plate of the ethmoid bone TURBINATE
 Hard palate  Part of the ethmoid bone
o Formed by the two palatine processes
Floor  Has the greatest functional importance
of the maxilla and the horizontal MIDDLE
TURBINATE  Most of the drainage tracts from the
laminae of the palatine bone
surrounding paranasal sinuses open into
the middle meatus
ALAR CARTILAGE
INFERIOR  Consists of a separate bone that is attached
 Valve area TURBINATE to the medial wall of the maxillary sinus
 Narrowest portion of the upper respiratory tract SUPREME  Rudimentary
 Has a major bearing on the aerodynamics of nasal airflow TURBINATE  Present above the superior turbinate

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 NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
CRIBRIFORM PLATE PARANASAL SINUS DRAINAGE
 Thin bony plate of the ethmoid bone ANTERIOR SINUS
 Has numerous openings for the passage of the fila olfactoria FRONTAL (Forehead)
 Forms the boundary of the anterior cranial fossa MAXILLARY (Molar area) Middle meatus
ANTERIOR ETHMOID
NASOLACRIMAL DUCT (Midline)
 Part of the lacrimal apparatus, POSTERIOR SINUS
o Also includes:
 Lacrimal gland POSTERIOR ETHMOID Superior meatus
 Lacrimal ducts
 Lacrimal sac Anterior wall directly above
SPHENOID
 Runs in a bony canal between the medial canthus of the eye choanae
and the inferior nasal meatus
MAXILLARY SINUS
PARANASAL SINUSES  Present at birth but remains very small until the second
 Air-filled cavities that communicate with the nasal cavities dentition
 All (but the sphenoid sinus) are already present as o Presence of tooth germs in the maxilla limit the extent of
outpouchings of the mucosa during embryonic life, but except the sinuses
for the ethmoid air cells - do not develop into bony cavities  Borders the nasal cavity laterally
until after birth  Upper part of the sinus is separated from the orbit by the
 Frontal sinus and sphenoid sinus reach their definitive size in orbital floor
the first decade of life  Floor of the sinus is closely related to the roots of the second
premolar and first molar teeth
o Creates a potential route for the spread of dentogenic
infections
o Tooth extraction may create an oroantral fistula
(communication between the oral cavity and maxillary
sinus)

 Located behind the maxillary sinus

 Traversed by the maxillary artery
PTERYGOPALATINE
along with branches of the
FOSSA
trigeminal nerve and autonomic
nervous system
 labyrinthine system of small,
pneumatized sinus cavities
 superior and medial to the maxillary
sinus
 separated from one another by thin
bony walls
ETHMOID AIR CELLS
 extend posteriorly between the
medial border of the middle
turbinate and orbit to the sphenoid
sinus
 Posterior ethmoid cells
o Closely related to the optic nerve
 Orbital plate of the ethmoid bone
 Forms the lateral bony wall that
separates the ethmoid air cells from
the orbit
LAMINA PAPYRACEA
 Paranasal sinus inflammations can
spread through this lamina to
involve the orbit (orbital
complications)
 Form the bony boundary that
separates the ethmoid cells from the
anterior cranial fossa
Paranasal sinuses ETHMOID ROOF &
 Roof of the ethmoid labyrinth
CRIBRIFORM PLATE
o Formed mainly by the portion of
the frontal bone that covers and
closes the ethmoid cells

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superiorly
o Continuous medially with the
cribriform plate, the lateral
lamina of which represents the
continuation of the attachment of
the middle turbinate
o Very easily injured during
surgical manipulations in this
region
NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
 In close proximity to the orbit and cranial cavity
o Inflammations can give rise to serious complications such as:
 Orbital cellulitis
 Epidural or subdural abscess
 Meningitis
VASCULAR SUPPLY
 Detailed knowledge of the vascular supply is particularly
important in the management of intractable epistaxis
(nosebleed), which requires vascular ligation or
angiographic embolization as a last recourse

EXTERNAL NOSE
 Derives most of its blood supply from:
o Facial artery
 Arises from the external carotid artery
o Ophthalmic artery
 Springs from the internal carotid artery

INTERNAL NOSE
 Receives blood from the territories of the external and internal
carotid arteries:
o Terminal branches of the sphenopalatine artery
 Arises from the maxillary artery
o Anterior and posterior ethmoid arteries
 Arise from the ophthalmic artery

Ethmoid roof and anterior ethmoid KIESSELBACH'S PLEXUS

at the level of the crista galli  Located in Little's area
 Formed by the following arteries:
SPHENOID SINUS o Anterior ethmoid artery
 Located at the approximate center of the skull above the o Posterior ethmoid artery
nasopharynx o Sphenopalatine artery
 Very closely related to the optic canal o Superior labial artery
 Optic nerve and internal carotid artery may run directly o Greater palatine artery
beneath the mucosa of the lateral wall of the sphenoid sinus,  Significance: most common site of epistaxis (90%)
without a bony covering
 Develops at 10-12 years old

 Located in the anterior wall directly above

Ostium
the choanae
Posterior  Formed by the clivus
wall
Superior  Sella turcica and pituitary
borders  Anterior and middle cranial fossae
 Cavernous sinus
Lateral
 Internal carotid artery
borders
 Cranial nerves II–VI

FRONTAL SINUS
 Located in the frontal bone
 Extension of the ethmoid sinus
 Develops later at about 9 to 10 years old Kiesselbach's Plexus
VENOUS DRAINAGE
 Forms the medial portion of the orbital  Facial vein
Floor
roof  Retromandibular vein
Posterior  Anterior cranial fossa  Internal jugular vein
border

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 NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
LYMPHATIC DRAINAGE FUNCTIONALLY SIGNIFICANT ANATOMIC STRUCTURES OF
 Face and external nose THE OSTIOMEATAL UNIT
o Handled mainly by the submandibular lymph nodes  Thin fibrous or bony process on the
 Nasal cavity lateral nasal wall
o Retropharyngeal and deep cervical lymph nodes  Arises slightly behind the anterior border
NERVE SUPPLY Uncinate process of the middle turbinate
SENSORY  May narrow the passage from the nasal
 Terminal branches of the trigeminal nerve cavity to the ostiomeatal complex,
o Sensory innervation of the facial skin depending on its degree of development
o Enter the facial region through the following foramina:  Slitlike passage located between the
 Supraorbital posterior border of the uncinate process
Semilunar hiatus
 Infraorbital and the first ethmoid cell (the ethmoid
 Mental bulla)
 Great auricular nerve supplies the following:  Hourglass-like shape connecting the
Frontal recess
o Skin over the mandibular angle frontal sinus to the ostiomeatal unit
o Lower portions of the auricle Ethmoid bulla  First ethmoid cell
 The space between the uncinate process,
Ethmoid
MOTOR ethmoid bulla, and lamina papyracea of
infundibulum
 Facial muscles the ethmoid bone
o Classified as mimetic or masticatory Maxillary sinus
o Each of these groups receiving different motor innervation ostium
 Mimetic muscles
 Develop from the blastema of the second branchial CLINICAL SIGNIFICANCE
arch (hyoid arch)  Related to the sites of narrowing in the ostiomeatal unit
 Supplied by the facial nerve o Even minor changes (e.g. anatomical variants, mucosal
 Masticatory muscles swelling) can hamper ventilation in this region, leading to
 Trace their embryonic development to the first pathologic sequelae in the paranasal sinuses
branchial arch (mandibular arch) o Hyperemia and mucosal swelling in common cold 
 Supplied by mandibular nerve branches arising from obstruct of narrow passages in the ostiomeatal unit 
the trigeminal nerve prevent adequate ventilation of the dependent paranasal
sinus system  rhinogenic inflammation of the paranasal
ANATOMY OF THE OSTIOMEATAL COMPLEX sinuses (sinusitis)
 Nose and paranasal sinuses  Pathologies in the ostiomeatal complex that can block
o Regarded as a functional unit drainages of the sinuses and cause sinusitis:
 Collective term for various anatomical structures located about o Polyps
the middle meatus o Anatomical variations (e.g. bone spurs)
 Represents the region on the lateral nasal wall that receives o Tumors
drainage from the: o Inflamed nasal mucosa in the ostiomeatal complex
o Anterior ethmoid cells  Management
o Frontal sinus o Clean the ostiomeatal complex to alleviate the sinusitis
o Maxillary sinus o Functional endoscopic sinus surgery
 Many rhinologic disorders are transmitted from the nasal  Correct the problem by removing the obstruction and
cavity into the paranasal sinuses creating a wider opening of the sinuses

BOUNDARIES MORPHOLOGY OF THE NASAL MUCOSA

Medial  Middle turbinate  The anterior part of the nasal cavity (the nasal vestibule)
Lateral  Lamina papyracea o Covered by skin composed of a multilayer, keratinizing
squamous epithelium
 Anterior to the head of the inferior turbinate, this
keratinized epithelium gives way to a nonkeratinized
squamous epithelium, nonciliated columnar epithelium,
and finally, a ciliated respiratory epithelium
 Along with the submucous tissue, this ciliated
epithelium forms the typical mucosal lining of the
nasal cavity and paranasal sinuses

OLFACTORY REGION
 Small area on the upper nasal septum, superior turbinate, and
part of the middle turbinate
 Located adjacent to the cribriform plate
 Covered by olfactory mucosa

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RESPIRATORY MUCOSA
EPITHELIUM
 Composed of ciliary cells, goblet cells, and basal cells
 Provides an initial, mechanical barrier against infection
Scanning electron micrograph of cilia and microvilli
CILIARY CELL
 Dominates the surface of the respiratory epithelium
 Each has approximately 150-200 cilia which are composed of
microtubules and are interlinked by "dynein arms"
 The cytoskeleton of the ciliary cells and the activity of dynein, a
specialized protein, enable the typical, synchronous beating of
the cilia in the respiratory epithelium
 Ciliary action  propels a blanket of mucous secretions (from
the goblet cells) and serous secretions (from the nasal glands)
toward the nasopharynx  mechanical cleansing of inspired
air (mucociliary transport)
BASAL CELL
 Morphological connection between the columnar epithelium
and goblet cells on the one hand and the epithelial basement
membrane on the other
 Distinguished from the other epithelial cell types by:
o Increased expression of certain adhesion molecules e.g.
intracellular adhesion molecule-1 (ICAM-1)
o Increased cytokine synthesis e.g. interleukin 1
OTHER CELLS
 Immunocompetent cells
o Mostly CD8-positive T cells
o Smaller numbers of:
 Mast cells
 Macrophages
 MHC-II–bearing dendritic cells
 Function as antigen-presenting cells
LAMINA PROPRIA
Structure of the lamina propria in histologic section
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NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
 Separated from the epithelium by a basement membrane
 Some areas of the lamina propria, especially about the inferior
turbinate, show a marked preponderance of vascular
structures known as venous erectile tissue or sinusoids
o Consist of thin-walled and thick-walled venous capacitance
vessels, which are important not only in warming the
inspired air and producing secretions but also in
controlling the tumescence of the nasal mucosa
 Contains nasal glands
o Mainly produce a serous secretion
 Immunocompetent cells in the lamina propria consist of CD4-
positive T lymphocytes along with CD8-positive cytotoxic cells
and suppressor cells such as CD4-/CD8-negative T
lymphocytes, mature B lymphocytes, Ig-plasma cells, mast
cells, and macrophages
o These cellular elements demonstrate the importance of the
nasal mucosa, which acts in concert with local host
reactions to mediate inflammatory and allergic responses
in the nose
NERVE SUPPLY
 Trigeminal nerve (sensory innervation)
 Pterygopalatine ganglion (autonomic innervation)
o Parasympathetic fibers
 Induce vasodilation
 Stimulate the secretory activity of the nasal glands
o Sympathetic fibers
 Produce vasoconstriction
 Inhibit glandular secretions
OLFACTORY MUCOSA
TOPOGRAPHY
 Covers the olfactory region, which occupies the anterior
superior part of the nasal septum and adjacent areas of the
lateral nasal wall, and including the side of the superior
turbinate facing the septum and part of the middle turbinate
 The junction of the olfactory mucosa with the respiratory
mucosa is variable in its location
STIMULUS PROCESSING SYSTEM
 Contains between 10-20 million bipolar sensory cells
 Olfactory sensory cells have dendritic epithelial processes as
well as basal axons that pass through the basement membrane
between the supporting cells and basal cells and then join into
bundles (see fila olfactoria) that are ensheathed by Schwann
cells
FILA OLFACTORIA
 Pass through foramina in the cribriform plate of the ethmoid
bone and enter the cranial cavity where they unite to form the
olfactory nerve and pass to the olfactory bulb in the brain (see
primary olfactory center)
PRIMARY OLFACTORY CENTER
 Connected via the olfactory tract to the secondary olfactory
center (olfactory cortex) in the temporobasal cortex
SECONDARY OLFACTORY CENTER (OLFACTORY CORTEX)
 Responsible for the perception of smells and their association
with other sensory impressions

 Has projections to the limbic system that connect with the
autonomic centers in the thalamus and hypothalamus 
creates a pathway that mediates the emotional and affective
phenomena that are associated with smells
 Has connections with the tertiary olfactory centers which are
believed to have polysensory associative functions
TERTIARY OLFACTORY CENTER
 Hippocampus
 Anterior insular region
 Reticular formation
MICROSCOPIC ANATOMY OF THE OLFACTORY MUSCOA
 Besides receptor cells, the epithelium of the olfactory mucosa
is also composed of:
o Microvilli
o Supporting cells
o Basal cells
 The lamina propria additionally contains serous glands
(olfactory glands) and vessels
 The microvilli most likely represent extra chemoreceptors in
the olfactory epithelium, which perform their function along
with the classic receptor cells
 Olfactory glands, its secretions play a role in mediating the
olfactory sense; secretion layer on the epithelium contains a
specific protein that has a high affinity for most odorous
substances, and thus could facilitate or even mediate their
binding to the sensory cells
BASIC PHYSIOLOGY AND IMMUNOLOGY OF THE NOSE
PHYSICAL PRINCIPLES OF NASAL AIRFLOW
 Inspiration → air stream enters the nasal vestibule in an
oblique vertical direction in a state of laminar flow → reaches
the nasal valve located between the vestibule and nasal cavity
→ passes through limen nasi→ past the limen nasi, the airway
becomes greatly expanded → “diffuser effect” → transforms
most of the laminar flow into turbulent flow
Laminar flow - no mixing of the different air layers
Turbulent flow - different air layers are swirled together
Limen nasi – narrowest portion in the URT
 Besides the velocity of the air, the degree of change in airflow
characteristics at this stage is very strongly influenced by the
specialized anatomy of the nasal cavity, which is subject to
substantial individual differences
o e.g., septal deviation and cartilaginous or bony spurs on
the septum lead to turbinate hyperplasia or septal
perforation
 transition from laminar to turbulent flow within the nose →
slows the flow velocity of the inspired air → prolongs contact
with nasal mucosa, contributing to olfaction → easier for the
nose to clean, humidify, and warm the inspired air
NASAL CYCLE
 physiologic phenomenon marked by an alternation between
luminal narrowing and widening of the nasal cavities
 alternate congestion and decongestion of the nasal mucosa
 effected mainly through reactions of the venous capacitance
vessels of the inferior and middle turbinates
 regulated by the autonomic nervous system
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NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
CONDITIONING OF THE INSPIRED AIR
 inspired air is warmed and humidified in the nose before
reaching the lower airways
 conditions that promote the necessary contact of the inspired
air with the nasal mucosa:
o turbulent flow
o favorable relationship between the relatively small nasal
cavity and the comparatively large mucosal surface area,
which is further enlarged by the turbinates
HUMIDIFICATION
 accomplished by secretion and transudation from
o nasal glands
o epithelial goblet cells
o vessels of the lamina propria
TEMPERATURE REGULATION
 controlled by the intranasal vascular system and especially
the venous erectile tissue, which is particularly abundant in
the inferior turbinates
 temperature gradient
o temperature in the anterior portions of the nasal
cavity is lower than in the posterior regions
o inspiration → gradual warming of inspired air
o expiration → moisture and heat returned to the nose
through condensation
 disturbances in the conditioning function of the nose can
result from
o age-related drying of the mucosa due to involution of
the goblet cells and glands
o chronic inflammatory changes
o extensive resections of the mucosa during intranasal
surgery
PROTECTIVE FUNCTIONS OF THE NASAL MUCOSA
NON SPECIFIC DEFENSE MECHANISMS
MECHANICAL DEFENSES: MUCOCILIARY APPARATUS
 most important mechanical defense mechanism of the nasal
mucosa
 physically cleanses the inspired air
 mucociliary transport system consists of
o cilia of the respiratory epithelium
o 2 layers of mucous blanket
- sol layer – deeper, less viscid, in which ciliary
motion occurs
- gel layer – superficial, more viscid
 causes of disturbances of mucociliary transport
o ↑ viscosity and thickness of the periciliary sol layer
o hampering ciliary movements
o changes in the viscoelasticity of the gel layer resulting in
ineffectual mucus transport
o acute viral infection of the upper respiratory tract can
lead to desquamation of the epithelium, with a loss of
ciliated cells
o micro-organisms can directly affect ciliary motility by
reducing the beat frequency of the cilia
o ciliary dyskinesia syndromes
- congenital disorders based on morphologic changes
in the cilia such as absence of the dynein arms
- result in uncoordinated, dyskinetic ciliary
movements that prevent effective mucus transport
 NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
 the local, specific immune system of the nasal mucosa is
based on the actions of
o antibodies – responsible for the humoral immune
response
o immunocompetent cells – responsible for cellular
immune response

HUMORAL IMMUNE RESPONSE

 IgA, IgM and IgG antibodies are formed in the paraglandular
plasma cells
 IgA
o characteristic of the respiratory mucosa and therefore of
the nasal mucosa
o when released it is absorbed by the glandular cells of the
lamina propria, provided with a secretory component,
PHYSIOLOGY OF CILIARY MOTION and re-released as secretory antibodies (sIgA)
 ciliary motion consists of 3 phases
o initiated by ATP-splitting proteins, which cause a CELLULAR IMMUNE RESPONSE
movement of the filaments within the cilia (sliding  occur chiefly as dendritic (Langerhans)
Cells of RES
filament theory) cells in the nasal mucosa
 the superficial gel layer is propelled toward the nasopharynx  of special importance in the control and
by a coordinated but metachronous beating of the cilia T lymphocytes memory functions of the immune
 the dynamics of ciliary motion has been likened to a “field of response
grain swaying in the wind”  can differentiate into plasma cells
 the cilia beat at a frequency of 10–20 times per second, but  have a key role in the humoral immune
B lymphocytes
their motion is influenced by external factors such as response of the mucosa in connection with
temperature and humidity local antibody production
 found mainly in association with:
NONSPECIFIC PROTECTIVE FACTORS IN NASAL SECRETIONS o chronic sinusitis
Eosinophilic
SUBSTANCE GROUP EXAMPLE o nasal polyps
granulocytes
Interferon  their granules contain cytotoxic
 Cathepsin substances that can damage tissues by
 Elastase the lysis of cell membranes
Proteases Basophilic  involved in immediate allergic reactions
 Chymase
 Tryptase granulocytes (although the mast cells are by far the
most dominant cell type in this phase)
 α1-protease inhibitor
Protease inhibitors Mast cells  chiefly responsible for histamine release
 C1 activator
in the early phase of an allergic reaction
Lysozyme
 specific receptor of basophilic
 Catalase
granulocytes and mast cells for binding
Antioxidants  Glutathione
IgE
 Ascorbic acid FcεR  on contact with the corresponding
allergenic substance, this can incite a
CELLULAR DEFENSES
devastating allergic reaction that may
 predominant phagocytic cells: culminate in anaphylactic shock
o neutrophilic granulocytes
 adhesion molecule expressed by the
o monocytes
epithelial cells of nasal mucosa
o macrophages ICAM-1
 helps to prevent viral infections by acting
 NK cells
as a receptor for more than 90% of
o protect mainly against viral infections of the nasal
rhinoviruses
mucosa
 play an important role in the specific
immune responses of the nasal mucosa
SPECIFIC IMMUNE RESPONSE
Endothelial  activated by various inflammatory
 made up of cells of the mediators (e.g. IL- 1 and TNF-α)
o nasal mucosa blood vessels  regulate transendothelial diapedesis of
- purely an effector organ in which, for example, foreign
immunocompetent cells into the
material is phagocytized by immunocompetent cells
surrounding tissue through the
o lymphoepithelial tissue of Waldeyer’s ring
expression of various adhesion molecules
- includes the pharyngeal and palatine tonsils
- function as inductive components that are active in
Transendothelial migration of immunocompetent cells
the absorption, processing, and presentation of
*ICAM: intercellular adhesion molecule
antigens

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 NOSE AND PARANASAL SINUSES:
ANATOMY and PHYSIOLOGY
LFA: lymphocyte function-associated antigen 5. How many cilia does each ciliary cell have?
PECAM: platelet/endothelial cell adhesion molecule a. 200-250
b. 150-200
c. 100-150
d. 50-100
6. Instrument not used during posterior rhinoscopy
a. Tongue depressor
b. Nasal speculum
c. Nasopharyngeal mirror
d. Head mirror
7. Physiologic phenomenon marked by an alteration
between luminal narrowing and widening of the nasal
cavities, alternate congestion and decongestion
a. yawning
b. sneezing
c. nasal cycle
d. snoring
8. The following structures can be seen during posterior
The interaction between immunocompetent cells and endothelial rhinoscopy except:
cells in an inflammatory reaction is mediated by various adhesion a. Nasal Septum
molecules and proceeds in the following steps: b. Middle turbinates
1. Inflammatory mediators trigger the release of endothelial c. Superior turbinates
selectins. The interaction with their ligands initiates the d. Inferior turbinates
migration of cells along the endothelium.
2. Activated integrins on the cells allow firm binding to the Where do the ff drain into?
endothelial ligand, usually a member of the
1. Maxillary sinus a. Superior meatus
immunoglobulin supergene family. 2. Anterior Ethmoidal b. Middle Meatus
------------------------------------------------------------------------------------ c. Inferior Meatus
END OF TRANS
------------------------------------------------------------------------------------
REVIEW QUIZ:
1. The anatomical connections between the nasal cavity 1b2b3a4a5b
and paranasal sinuses that are functionally important 6b7d8c9b10b
and play a key role in the pathogenesis of many
rhinologic diseases that involve the paranasal sinuses.
a. Hiatus semilunaris
b. Ostiomeatal unit
c. Sphenoethmoid recess
d. Paranasal sinuses
2. The orbital plate of the ethmoid bone is otherwise
known a. Vomer
b. Lamina papyracaea
c. cribriform plate
d. Ethmoid bone
3. Not included in a paranasal sinus radiograph
a. Nose soft tissue, lateral
b. Water’s view
c. Lateral view
d. Paranasal sinuses
4. Also called the water projection radiograph
a. Occipitomental projection
b. Occipitofrontal projection
c. Occipitonasal projection
d. Temporomental projection

9 of 9 [Agcaoili, Aranda, Chua, Ocampo, and Sabado]