Anatomy of nose and

paranasal sinuses

Dr. Lakshmi Menon R

ENT
Embryology

 Commences in the 3rd week of gestation

 Nose from cranial ectoderm
 Depression of Olfactory placodes due to
growth of medial and lateral nasal folds
 Frontonasal process
 Maxillary process of the 1st branchial
arch
Surface anatomy

 Root
 Dorsum
 Supra tip
 Tip of the nose
 Ala
 Columella
 External nares
 Nostril sill
Skin of the nose

 Thicker,adherent and sebaceous in the

tip
 Thinner and mobile in the upper part
 *Furuncle is painful in the tip
 *Rhinophyma affects the tip
 *Skin defects in the upper part easier to
close
 *Skin defects in the tip requires plastic
surgical procedures
Musculature of the nose

 Largely vestigeal
 Procerus, Lev lab sup,Nasalis, Dilator
naris and dep septi
 *Dilation of nostrils in deep
breathing,absence of this movement in
facial palsy
Vault of the nose

 Upper 1/3rd bony

 Lower 2/3rd cartilaginous
 Two nasal bones attached to the nasal
processes of maxilla and frontal bone
and fused in the midline
 Upper part of the nasal bones thick and
lower part thin
 *Fractures commonly involve the lower
part
Cartilaginous vault

 Upper lateral cartilage-Upper part overlapped

by the nasal bones,med part in continuity with
the septal cartilage
 Lower lateral cartilage(Alar cartilage)Consists of
lateral crus ,dome and medial crus
 Lesser alar cartilages- variable
 *Free lower border of upper lat cartilage and its
attachment with the septum acts as a valve
regulating the air flow (Int nasal valve)
Internal nose

 Vestibule of the nose

 Nasal cavity-med wall,lat wall,floor and
roof
 Vestibule
 Entrance to the nose
 Lined by skin and contains
sebaceous glands and hair
follicles.
 Contains vibrissae
Lateral wall of nose

 Three turbinates, rarely a fourth called

supreme turbinate
 Inferior turbinate is a separate bone,rest
parts of ethmoid
 Three meati
Turbinates

 Changes in size
 Thick mucous membrane
 *Hypertrophy in allergy
 *Compensatory hypertrophy in DNS
 *Atrophied in Atrophic rhinitis
Inferior turbinate & meatus
Middle meatus
 Clinically and surgically important
 Maxillary frontal and ethmoidal sinuses drain into this.
 Bulla ethmoidalis-Bulge formed by middle ethmoid air
cells
 Hiatus semilunaris
 Infundibulum- Funnel shaped space
 Uncinate- Floor and medial wall
 Frontal sinus-infundibulum/ posterior to aggernasi
 Anterior Ethmoids – Infundibulum
 Maxillary sinus – posterior part –Infundibulum
 *Area of most of the work in FESS
Osteomeatal complex
 Superior Meatus

 Posterior third lateral wall

 Posterior Ethmoids open into it

 Sphenoethmoidal Recess – Above

superior turbinate – Receives opening of
sphenoid sinus
Blood supply- lateral wall nose
Nerve supply – lateral wall
nose
Medial wall-The septum

 Bony part-Perpendicular plate of ethmoid and

vomer
 Septal cartilage-Quardrilateral ,renders support
to the external nose
 Membranous septum- Between columella and
caudal border of septal cartilage- Double layers
of skin
 *Septal haematoma and abscess leads to
collapse of the nose
 *Dev nasal septum common clinical problem
Roof

 Ant -nasal bones ,mid-cribriform

plate,post-body of sphenoid
 Lined by olfactory epithelium
 Cribriform plate pierced by olfactory
nerves
 *Dehiscence result in CSFleak
 *Air flow to the roof should be free for
olfaction
Floor

 Palatine process of the maxilla in ant

3/4th and horizontal part of palatine bone
in post 1/4th
Lining

 Respiratory epithelium
 Olfactory epithelium
 Skin
 *Mucosa has high absorbing
capacity.Topical application of drugs
effective(Local anaesthetics,nasal
drops,steroid sprays,intranasal
vasopressin,snuffs?)
Venous drainage

 Drains into cavernous sinus through

valve less tributaries
 *Cavernous sinus thrombosis is a
complication of acute sinusitis
Lymphatic drainage

 Ext nose to submandibular nodes

 Rest to upper jugular nodes
 Sinuses to retropharyngeal nodes
Clinical significance

 Epistaxis—common alarming condition

to the patient
 Ligation of int max ,ant ethmoidal
arteries as a last resort
Littles area
Woodruffs plexus

 Posterior part of MT
 Arterial( sphenopalatine+ pharyngeal)
 venous
Maxillary sinus

 The antrum
 Antrum of Highmore
 Largest
 Pyramidal in shape
 Capacity—15ml - one fluid ounze-28.5
ml
 Present at birth
 Encased within maxilla
 Post wall related to infra
temp,Pterygopalatine fossa
 Roof by floor of orbit
 Med wall inf and middle meatus
 Floor by alveolar and palatine process
and 1 cm below the floor of the nose
 Ostium opens into middle meatus
 Accessory ostium in 30%
Surgical anatomy

 Spread of infection from teeth

 Access through the lateral wall of nose
 Trans antral access to pterygopalatine
fossa
 Access for fractures of orbit
Frontal sinus

 Between two tables of frontal bone

 Varies in shape and size
 May be absent in one or both sides
 Drains by frontonasal duct into middle
meatus
 *frontal mucocele due to obstruction of
frontonasal duct
 *anterior wall depressed fractures
 Not present at birth
Ethmoid sinuses

 Thin walled cavities 3-18 in nos

 Ant,middle and post
 Post group drains into sup meatus
 Ethmoidal labyrinth is a single midline
bone
 *Lamina papyracea
 *Post ethmoid in close relationship with
optic nerve
 Present at birth
Sphenoid sinus

 Occupies the body of sphenoid

 Right and left are asymetrical
 *Trans sphenoidal access to pituitary
 Not present at birth
DANGEROUS AREA- FACE
DNAGEROUS AREA NOSE
 CANINE FOSSA

Superiorly- I-O
formamen
Medially- Pyriform
aperture
Inferiorly- alveolar
ridge
Laterally- canine
Cottles line
thank you