1. The Nose

2. Nose
• The nose is the part of the respiratory tract superior
to the hard palate and contains the peripheral
organ of smell.
• It includes the external nose and nasal cavity,
which is divided into right and left cavities by the
nasal septum.

3. The functions of the nose are :
–olfaction (smelling),
–respiration (breathing),
–filtration of dust,
–humidification of inspired air, and
– reception and elimination of secretions
from the paranasal sinuses and
nasolacrimal ducts

4. External Nose
• The external nose is the visible portion that projects from
the face; its skeleton is mainly cartilaginous .
• Noses vary considerably in size and shape, mainly because
of differences in these cartilages.
• The dorsum of the nose extends from the root of the nose
to the apex (tip) of the nose.
• The inferior surface of the nose is pierced by two piriform (L.
pear-shaped) openings, the nares (nostrils, anterior nasal
apertures), which are bound laterally by the alae (wings) of
the nose.

5. Skin of nose
• The superior bony part of the nose, including its root, is covered by
thin skin.
• The skin over the cartilaginous part of the nose is covered with
thicker skin, which contains many sebaceous glands.
• The skin extends into the vestibule of the nose, where it has a
variable number of stiff hairs (vibrissae).
• Because they are usually moist, these hairs filter dust particles
from air entering the nasal cavity.
• The junction of the skin and mucous membrane is beyond the
hair-bearing area.

6. Skeleton of the External Nose
• The supporting skeleton of the nose is composed of bone and hyaline
cartilage.
• The bony part of the nose consists of:
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•
•
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the nasal bones,
frontal processes of the maxillae,
the nasal part of the frontal bone and its nasal spine, and
the bony parts of the nasal septum
•
• The cartilaginous part of the nose consists of five main cartilages:
• two lateral cartilages,
• two alar cartilages, and
• one septal cartilage.
• The U-shaped alar cartilages are free and movable; they dilate or constrict
the nares when the muscles acting on the nose contract.

8. Nasal Septum
• The nasal septum divides the chamber of the nose into two nasal cavities and has :
• a bony part and
• a soft mobile cartilaginous part
• The main components of the nasal septum are :
• the perpendicular plate of the ethmoid,
• the vomer, and
• the septal cartilage
• The thin perpendicular plate of :
• the ethmoid bone,
• forming the superior part of the nasal septum,
• descends from the cribriform plate and is continued superior to this plate as the crista galli .
• The vomer, a thin flat bone, forms the posteroinferior part of the nasal septum,
with some contribution from the nasal crests of the maxillary and palatine bones.
• The septal cartilage has a tongue-and-groove articulation with the edges of the
bony septum.

10. Nasal Cavity
•
The term nasal cavity, divided into right and left halves by the nasal septum, refers to either the entire cavity or
one of its halves, depending on the context.
•
The nasal cavity is entered anteriorly through the nares.
•
It opens posteriorly into the nasopharynx through the choanae.
•
Mucosa lines the nasal cavity, except for the nasal vestibule, which is lined with skin.
•
The nasal mucosa is firmly bound to the periosteum and perichondrium of the supporting bones and cartilages
of the nose.
•
The mucosa is continuous with the lining of all the chambers with which the nasal cavities communicate:
•
•
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the nasopharynx posteriorly,
the paranasal sinuses superiorly and laterally, and
the lacrimal sac and conjunctiva superiorly.
•
The inferior two thirds of the nasal mucosa is the respiratory area and the superior one third is the olfactory
area.
•
Air passing over the respiratory area is warmed and moistened before it passes through the rest of the upper
respiratory tract to the lungs.
•
The olfactory area contains the peripheral organ of smell; sniffing draws air to the area.

11. Boundaries of the Nasal Cavity
• The nasal cavity has a roof, floor, and medial and lateral walls.
• The roof of the nasal cavity is curved and narrow, except at its
posterior end; it is divided into three parts (frontonasal,
ethmoidal, and sphenoidal) named from the bones forming
each part .
• The floor of the nasal cavity is wider than the roof and is
formed by the palatine processes of the maxilla and the
horizontal plates of the palatine bone.
• The medial wall of the nasal cavity is formed by the nasal
septum.
• The lateral walls of the nasal cavity are irregular owing to
three bony plates, the nasal conchae, which project inferiorly,
somewhat like louvers.

12. Features of the Nasal Cavity
• The nasal conchae (superior, middle, and inferior) curve inferomedially, hanging like
louvers or short curtains.
• The conchae (L. shells) or turbinates of many mammals (especially running
mammals and those existing in extreme environments) are highly convoluted,
scroll-like structures that offer a vast surface area for heat exchange.
•
In both humans with simple nasal conchae and animals with complex turbinates, a
recess or meatus (singular and plural; passage(s) in the nasal cavity) underlies each
of the bony formations.
• The nasal cavity is thus divided into five passages:
• a posterosuperiorly placed sphenoethmoidal recess,
• three laterally located nasal meatus (superior, middle, and inferior), and
• a medially placed common nasal meatus into which the four lateral passages open.
• The inferior concha is the longest and broadest and is formed by an independent
bone (of the same name, inferior concha) covered by a mucous membrane that
contains large vascular spaces that can enlarge to control the caliber of the nasal
cavity.
• When infected or irritated, the mucosa may swell rapidly, blocking the nasal
passage(s) on that side.

13. sphenoethmoidal recess
• The sphenoethmoidal recess, lying superoposterior
to the superior concha, receives the opening of the
sphenoidal sinus, an air-filled cavity in the body of
the sphenoid.

14. superior nasal meatus
• The superior nasal meatus is a narrow passage
between the superior and the middle nasal
conchae into which the posterior ethmoidal
sinuses open by one or more orifices.

15. middle nasal meatus
• The middle nasal meatus is longer and deeper than the superior one.
• The anterosuperior part of this passage leads into a funnel-shaped opening,
the ethmoidal infundibulum, through which it communicates with the
frontal sinus.
• The passage that leads inferiorly from each frontal sinus to the
infundibulum is the frontonasal duct.
•
The semilunar hiatus (L. hiatus semilunaris) is a semicircular groove into
which the frontal sinus opens.
•
The ethmoidal bulla (L. bubble), a rounded elevation located superior to
the hiatus, is visible when the middle concha is removed.
• The bulla is formed by middle ethmoidal cells that form the ethmoidal
sinuses.

16. inferior nasal meatus
• The inferior nasal meatus is a horizontal passage
inferolateral to the inferior nasal concha.
• The nasolacrimal duct, which drains tears from the
lacrimal sac, opens into the anterior part of this
meatus.
•

17. common nasal meatus
• The common nasal meatus is the medial part of
the nasal cavity between the conchae and the
nasal septum, into which the lateral recesses and
meatus open.

18. Vasculature and Innervation of the Nose
• The arterial supply of the medial and lateral walls of
the nasal cavity is from five sources:
• Anterior ethmoidal artery (from the ophthalmic
artery).
• Posterior ethmoidal artery (from the ophthalmic
artery).
• Sphenopalatine artery (from the maxillary artery).
• Greater palatine artery (from the maxillary artery).
• Septal branch of the superior labial artery (from the
facial artery).

19. • The first three arteries divide into lateral and medial
(septal) branches.
• The greater palatine artery reaches the septum via the
incisive canal through the anterior hard palate.
• The anterior part of the nasal septum is the site
(Kiesselbach area) of an anastomotic arterial plexus
involving all five arteries supplying the septum.
• The external nose also receives blood from first and
fifth arteries listed above plus nasal branches of the
infraorbital artery and the lateral nasal branches of the
facial artery.

20. Arterial supply of nasal cavity

22. Observe the relationship of the orbit,
nasal cavity, and paranasal sinuses.
The orbital contents, including the four
recti and the fascia uniting them, form a
circle (a cone when viewed in three
dimensions) around the posterior part
(fundus) of the eyeball.
M. 1, 1st molar; R.I., rectus inferior, or
inferior rectus; R.M., rectus medius, or
medial rectus.

23. • A rich submucosal venous plexus deep to the nasal
mucosa drains into the sphenopalatine, facial, and
ophthalmic veins.
• This venous plexus is an important part of the
body's thermoregulatory system, exchanging heat
and warming air before it enters the lungs.
• Venous blood from the external nose drains mostly
into the facial vein via the angular and lateral nasal
veins. However, recall that it lies within the “danger
area”• of the face because of communications with
the cavernous (dural venous) sinus .

24. LYMPHATICS
• 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.

25. LYMPHATICS OF THE NOSE

26. Innervation
•
Regarding its nerve supply, the nasal mucosa can be divided into:
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•
posteroinferior and
anterosuperior portions
–
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by an oblique line passing approximately through the apex of the nose and the sphenoethmoidal recess.
The nerve supply of the posteroinferior portion of the nasal mucosa is chiefly from the maxillary nerve, by
way of the:
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•
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nasopalatine nerve to the nasal septum, and
posterior superior lateral nasal and
Posterior inferior lateral nasal
branches of the greater palatine nerve to the lateral wall .
•
The nerve supply of the anterosuperior portion is from the ophthalmic nerve (CN V1) by way of the anterior
and posterior ethmoidal nerves, branches of the nasociliary nerve.
•
Most of the external nose (dorsum and apex) is also supplied by CN V1 (via the infratrochlear nerve and the
external nasal branch of the anterior ethmoidal nerve), but the alae are supplied by the nasal branches of the
infraorbital nerve (CN V2).
•
The olfactory nerves, concerned with smell, arise from cells in the olfactory epithelium in the superior part of
the lateral and septal walls of the nasal cavity.
•
The central processes of these cells (forming the olfactory nerve) pass through the cribriform plate and end in
the olfactory bulb, the rostral expansion of the olfactory tract.

28. Rhinitis
• The nasal mucosa becomes swollen and inflamed
(rhinitis) during severe upper respiratory infections
and allergic reactions (e.g., hayfever).
•
• Swelling of the mucosa occurs readily because of
its vascularity.
• Infections of the nasal cavities may spread to the:
» Anterior cranial fossa through the cribriform plate.
» Nasopharynx and retropharyngeal soft tissues.
» Middle ear through the pharyngotympanic tube (auditory tube)

29. Epistaxis
• Epistaxis (nosebleed) is relatively common because of
the rich blood supply to the nasal mucosa.
• In most cases, the cause is trauma and the bleeding is
from an area in the anterior third of the nose
(Kiesselbach area).
• Epistaxis is also associated with infections and
hypertension. Spurting of blood from the nose results
from rupture of arteries.
• Mild epistaxis may also result from nose picking, which
tears veins in the vestibule of the nose.

30. Paranasal Sinuses
• The paranasal sinuses are air-filled extensions of the
respiratory part of the nasal cavity into the following
cranial bones:
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frontal,
ethmoid,
sphenoid, and
maxilla.
• They are named according to the bones in which they
are located.
• The sinuses continue to invade the surrounding bone,
and marked extensions are common in the crania of
older individuals.

31. Frontal Sinuses
• The frontal sinuses are between the outer and the
inner tables of the frontal bone, posterior to the
superciliary arches and the root of the nose .
• Frontal sinuses are usually detectable in children by
7 years of age.
• Each sinus drains through a frontonasal duct into
the ethmoidal infundibulum, which opens into the
semilunar hiatus of the middle nasal meatus.
• The frontal sinuses are innervated by branches of
the supraorbital nerves (CN V1).

32. Ethmoidal Cells
• The ethmoidal cells (sinuses) are small invaginations of the mucous
membrane of the middle and superior nasal meatus into the ethmoid
bone between the nasal cavity and the orbit .
• The ethmoidal cells usually are not visible in plain radiographs before 2
years of age but are recognizable in CT scans.
• The anterior ethmoidal cells drain directly or indirectly into the middle
nasal meatus through the ethmoidal infundibulum.
• The middle ethmoidal cells open directly into the middle meatus and are
sometimes called “bullar cells― because they form the ethmoidal
bulla, a swelling on the superior border of the semilunar hiatus .
• The posterior ethmoidal cells open directly into the superior meatus.
•
The ethmoidal cells are supplied by the anterior and posterior ethmoidal
branches of the nasociliary nerves (CN V1) .

33. Sphenoidal Sinuses
• The sphenoidal sinuses are located in the body of the sphenoid and may extend
into the wings of this bone . They are unevenly divided and separated by a bony
septum.
•
Because of this extensive pneumatization (formation of air cells or sinuses), the
body of the sphenoid is fragile.
• Only thin plates of bone separate the sinuses from several important structures:
the optic nerves and optic chiasm, the pituitary gland, the internal carotid arteries,
and the cavernous sinuses.
• The sphenoidal sinuses are derived from a posterior ethmoidal cell that begins to
invade the sphenoid at approximately 2 years of age.
• In some people, several posterior ethmoidal cells invade the sphenoid, giving rise
to multiple sphenoidal sinuses that open separately into the sphenoethmoidal
recess.
• The posterior ethmoidal arteries and posterior ethmoidal nerve supply the
sphenoidal sinuses.

36. Maxillary Sinuses
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The maxillary sinuses are the largest of the paranasal sinuses.
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They occupy the bodies of the maxillae and communicate with the middle nasal meatus .
The apex of the maxillary sinus extends toward and often into the zygomatic bone.
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The base of the maxillary sinus forms the inferior part of the lateral wall of the nasal cavity.
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The roof of the maxillary sinus is formed by the floor of the orbit.
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The floor of the maxillary sinus is formed by the alveolar part of the maxilla.
The roots of the maxillary teeth, particularly the first two molars, often produce conical
elevations in the floor of the sinus.
Each maxillary sinus drains by one or more openings, the maxillary ostium (ostia), into the
middle nasal meatus of the nasal cavity by way of the semilunar hiatus.
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The arterial supply of the maxillary sinus is mainly from superior alveolar branches of the
maxillary artery ; however, branches of the descending and greater palatine arteries supply
the floor of the sinus.
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Innervation of the maxillary sinus is from the anterior, middle, and posterior superior
alveolar nerves, which are branches of the maxillary nerve.