ANATOMY OF NOSE AND PNS

1. ANATOMY OF NOSE AND PARA NASAL
SINUSES
By:
Dr. Rajesh Kumar Kundu

2. THE NOSE
 The nose consists of
the external nose and
the nasal cavity,
 Both are divided by a
septum into right and
left halves.

3. EXTERNAL NOSE
 The external nose has
two elliptical orifices
called the naris
(nostrils), which are
separated from each
other by the nasal
septum.
 The lateral margin, the
ala nasi, is rounded
and mobile.

4. ANATOMICAL LANDMARKS
 Nasion : midline point at which nasal bones join
the frontal bone.
 Rhinion : inferior point of the midline suture
between nasal bones where they meet the upper
lateral cartilages.
 Dorsum of nose: ridge formed by the union of
lateral surfaces of nose in the midline.
 Bridge of nose: anterior surface of nose formed by
the nasal bones.
 Columella: midline nasal soft tissue anterior to
septum separating the two nares.
 Alae nasi: wings of nose,(rounded eminences)at
the inferior ends of the lateral nasal surfaces of
nose.

5. EXTERNAL NOSE

7. EXTERNAL NOSE
 The framework of the
external nose is made
up above by the nasal
bones, the frontal
processes of the
maxillae, and the
nasal part of the
frontal bone.
 Below, the framework
is formed of plates of
hyaline cartilage

8. EXTERNAL NOSE

9. CONT.
 Nasal bones(two) articulate with the nasal process
of frontal bone superiorly & with the ascending
processes of maxilla laterally.
 These bones are thicker superiorly than inferiorly.

10. CONT..
 Their medial articular
surfaces are wider &
extend poster inferiorly into
nasal cavity to form crest.
This crest forms part of
septum & articulates with :
 spine of nasal process of
frontal bone
 perpendicular plate of
ethmoid
 septal cartilage of nose

11. CONT..
 The pyriform aperture is bounded by these
bones and the alveolar processes of maxilla.
The alveolar processes merge in midline to
form the anterior nasal spine to which
cartilaginous septum is attached.

12. NASAL CARTILAGES
 Upper lateral cartilage
 Lower lateral cartilage
 Accessory cartilage
Upper lateral
(triangular)
cartilage:
∆ in shape
boundaries

13. CONT..
Lower lateral cartilage
(greater alar or lobular
cartilage)
forms the shape of nasal tip &
maintains patency of nostrils.
Each comprises
Medial crus
Lateral crus

14. MUSCLES OF THE NOSE
 Are arranged in two overlapping layers.
 All innervated by facial nerve.
Dilators…
procerus
dilator naris
Constrictors…
nasalis
depressor septi

15. CONT..
Procerus: (Pyramidalis nasi)
 Is continuation of frontal
muscle onto the nose
 Is attached to nasal bones
& upper lat.cartilage
 Action…shortens
or elevates nose
Dilator naris:
(Levator labii superioris)
 Ant/post part
 Dilates nostrils/pulls
upper lip

16. CONT..
Depressor septi:
• Inserted into septum
& back part of ala
•Arise from incisive
fossa of maxilla
•Action… draws ala of
nose downwards
constricts nares

17.  The Nasalis (Compressor naris)
transverse part
alar part

18. BLOOD SUPPLY OF EXTERNAL NOSE
origin.. lateral nasal
branch
from angular
(upper part of
facial or
ext maxillary).
 dorsal nasal
artery
 infraorbital
artery
 external nasal
artery

19. NERVE SUPPLY OF EXTERNAL NOSE
 Supratrochlear & infratrochlear branches of the
ophthalmic nerve supply the skin of root,bridge,upper
portion of side of nose
 Infraorbital branch of the
maxillary nerve supply
the skin on side of
nearly the lower half
of nose
 Ext.nasal branch of
Ant. Ethmoidal nerve
skin over dorsum to
tip

20. LYMPHATIC DRAINAGE
 Main Submandibular/Submental nodes
 Bilateral drainage & flow to the parotid
nodes

21. INTERNAL NOSE
 Nasal cavity
 Paired cavities
separated by nasal
septum
 Ant .nares or nostrils
are oval shaped
 Post nares or choanae
is oval shaped
nasopharyngeal
opening of the cavity.

22. NASAL VESTIBULE
 Ant. & inf part of nasal cavity.
 Lined by skin & contains sebaceous
glands ,
hair follicles .
 Hair follicles is called vibrissae.
 Upper limit is limen nasai.
 Medial wall is formed by the collumella &
the lower part of the nasal septum upto its
mucocutaneous juction.

23. NASAL CAVITY
 The nasal cavity has
 a floor,
 a roof,
 a lateral wall,
 a medial or septal
wall.

24. THE FLOOR OF NASAL CAVITY
 Floor…ant 3/4th
palatal process of
maxillary bone.
post 1/4th
horizontal process of
the palatine bone

25. THE ROOF OF NASAL CAVITY
 Narrow
 It is formed
 anteriorly beneath the bridge
of the nose by the nasal and
frontal bones,
 in the middle by the
cribriform plate of the
ethmoid,
 located beneath the anterior
cranial fossa,
 posteriorly by the downward
sloping body of the sphenoid

26. THE MEDIAL WALL OF NASAL CAVITY
 The Nasal Septum
 Divides the nasal cavity into right and left halves
 It consists of 3 parts:
 1.Collumellar septum
 2.Membranous septum
 3.Septum proper
 A)SEPTUM PROPER
 It has osseous and cartilaginous part
 post.sup: per. plate of ethmoid.
 Anteriorly:
septal cartilage.
 Post. Inferiorly:
vomer
crest of maxillary bone
crest of palatine bone
Perpendicul
ar Plate
(ethmoid)Septal
Cartilag
e Vome
r

27. CONT..
Perpendicular plate of
ethmoid…
 forms upper 1/3 or more of
the nasal septum
 Unites sup. with cribrifom
plate of ethmoid.
 Articulates with
ant.sup…frontal/nasal bone
post…crest of sphenoid
bone
post.inf…vomer
ant.inf…septal cartilage
Perpendic
ular Plate
(ethmoid)

28. Vomer…
 Post inf portion of nasal septum
 Articulates with…

29. COTN..
Septal (or quadrangular) cartilage
 Is continuous with upper lateral cartilage
towards bridge of nose.
B)Columellar septum
-Containg medial crura and fibrous tissue
-Covered either side by skin.
C) Membranous septum
-Consists of double layer of skin
- No bony or cartilaginous support
-Lies between columellar & caudal border of
septal
Cartilage.

30. THE NASAL SEPTUM

31. BLOOD SUPPLY OF SEPTUM
•Sphenopalatine artery
•Ant & post ethmoidal
artery
•Facial artery
•Superior labial artery
branch
LITTLE’S AREA
WOODRUFF’S
PLEXUS

32. Nerve supply of septum
 Anterior ethmoidal nerve.(ant sup)
 Ant sup alveolar(ant inf)
 Nasal branch of ant palatine nerve

33. LYMPHATIC DRAINAGE
 The anterior septum drains with the external
nose to the submandibular nose.
 The posterior part of septum drains to the
retropharyngeal and anterior deep cervical
nodes.

34. THE LATERAL WALLS OF NASAL CAVITY
Marked by 3
projections:
 Superior concha
 Middle concha
 Inferior concha
>The space below each
concha is called a
meatus.
>Named from below
inferior,middle,superi
or,supreme conchae.

35. THE LATERAL WALLS OF NASAL CAVITY

36. CONT..
Inferior
turbinate/meatus
 Largest turbinate.
 Separate bone
covered by thick
mucous membrane
 Nasolacrimal opening
in anterior portion of
lateral wall of inferior
meatus
 Slit like opening is
protected by fold of
mucous membrane,
the plica lacrimalis or
valve of Hasner
LACRIMAL
PROCESS ETHMOIDAL
PROCESS
MAXILLARY
PROCESS

37. CONT..
Middle turbinate/meatus
 Portion of ethmoid bone
 Consists of two parts
Lateral lamina/lamina
basilaris
Medial lamina/lamina ta
Lateral lamina:
 Post part of middle
turbinate
 Downwards/backwards
from
Ant ethmoidal roof to a
small
crest of Palatine bone.

38. CONT..
Medial lamina :
 ant part of middle turbinate
 Ascends upwards lining ethmoid air cells
 Attached to roof of ethmoid at junction of fovea with
cribrifom.
 Most superior portion of middle meatus is inferior to
genu known as frontal recess..Ostia of frontal sinus
and some ant ethmoidal cells are located here.
 Rest of middle meatus posteroinferiorly contains
ethmoidal bulla
uncinate process
semilunar hiatus

39. CONT..
Uncinate process:
 Crescent shaped bone curved
downward/backwards
 Variation of attachment
lamina papyracea
base of skull
middle turbinate
UC BE

40. CONT..

41. CONT..
 INFUNDIBULUM
Infundibulum

42. CONT..
FRONTAL RECESS

43. CONT…
Concha bullosa:(36%)
 Aerated middle turbinate/unilateral or
bilateral
 May obstruct middle meatus osteomeatal
complex(sinusitis)
 May get infected form mucocele

44. CONT..

45. CONT..
Paradoxical middle turbinate:
 Greater curvature of middle turbinate is
concave to middle meatus
Double middle turbinate:
 Anteriorly bent UP may come in contact
with middle turbinate
 Narrows middle meatus & appear as
additional turb

46. CONT..
Superior turbinate/meatus
 Is appx. ½ length of middle turbinate
 Starts about midde of lower turbinate & becomes
continous with them
 Number 1 to 5
 Onodi cells – post. Ethmoidal cell
 Sur.imp.- optic nerve related to lat. wall
 Sphenoethmoidal recess lies between superior &
supreme turbinate
supreme turbinate
 Unilaterally or bilaterally in 60% of individuals
 Ostia of pos. ethmoidal cells open into supreme
meatus(75%)

47. LINING MEMBRANE OF INTERNAL NOSE
 1.Vestibule- lined by skin containing hair, hair
follicles & sebeseous gland.
 2. Olfactory region
 3.Respiratory region
2. olfactory region:-comprises superior nasal
concha &
corresponding opp.septum
(olfactory slit).
Features ..
 less vascular (yellow in colour)
 nerve cell bodies that give rise to olfactory
nerve fiber(nonmylinated)
 Serous glands( of bowman)

48. CONT..
3. Respiratory region
 Remainder of nasal cavity(lower two-third)
 Covered by mucous
membrane(exp.vestibule)
 Highly vascular with mucous & serous
glands
 Covered by pseudo stratified columnar
ciliated epithelium
 Contains plenty of goblet cells
 In submucous layer ..serous & mucous
gland.

49. OPENINGS INTO THE NASAL CAVITY
Nasolacrimal Canal drains
into Inferior Meatus
Sphenoid sinus opens into
sphenoethmoidal recess
Posterior ethmoidal air
cells open into superior
meatus
Anterior & middle ethmoid
air cells, maxillary and
frontal sinuses open into
middle meatus

50. BLOOD SUPPLY TO THE NASAL CAVITY
 From branches of the maxillary artery, one of the
terminal branches of the external carotid artery.
 The most important branch is the sphenopalatine
artery.
 The sphenopalatine artery anastomoses with the
septal branch of the superior labial branch of the
facial artery in the region of the vestibule.
 The submucous venous plexus is drained by veins
that accompany the arteries.

51. BLOOD SUPPLY TO THE NASAL CAVITY
Sphenopalatine a.
Maxillary a.
Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.

52. NERVE SUPPLY OF THE NASAL CAVITY
 The olfactory nerves from the olfactory
mucous membrane ascend through the
cribriform plate of the ethmoid bone to the
olfactory bulbs .
 The nerves of ordinary sensation are
branches of the
1.Anterior ethmoidal nerve.
2.Branches from sphenopaltine
ganglion.
3.Branches from the infra-orbital
nerve.

53. NERVE SUPPLY OF THE NASAL CAVITY
CN I – Olfactory Nerves (SVA)
Anterior ethmoidal
branch of V1
Posterior nasal
branches of V2
Cut nasopalatine
branch of V2 to
septum

54. LYMPHATIC DRAINAGE OF THE NASAL CAVITY
 The lymph vessels draining the vestibule end
in the submandibular nodes.
 The remainder of the nasal cavity is drained
by vessels that pass to the upper deep
cervical nodes,retropharygeal and lateral
pharyngeal.

55. THE PARANASAL SINUSES

56. THE PARANASAL SINUSES
 The paranasal sinuses
are cavities found in the
interior of the maxilla,
frontal, sphenoid, and
ethmoid bones .
 They are lined with
mucoperiosteum and
filled with air.
 They communicate with
the nasal cavity through
relatively small
apertures.

57. DRAINAGE OF MUCUS AND FUNCTION OF
PARANASAL SINUSES
 The mucus produced by the mucous membrane is
moved into the nose by ciliary action of the
columnar cells.
 Drainage of the mucus is also achieved by the
siphon action created during the blowing of the
nose.
 Functions:
1. Resonators of the voice
2. They also reduce the skulls weight
3. Help warm and moisten inhaled air
4. Act as shock absorbers in trauma

58. MAXILLARY SINUS
 Pyramidal in shape
 Paired & symmetric
 Located within the body of the
maxilla behind the skin of the
cheek. Antrum of Highmore
 Largest pns/ pyramidal cavity in
maxillary bone
 Dimensions :
height(3.3cm)
width(2-3cm)
ant.post(3-4cm)
volume(15ml)

59. CONT..
Boundries
 Ant..surface of
maxilla
 Post…infratempor
al fossa
 Med…lat.wall of
nasal cavity
 Sup…floor of
orbital cavity
 Inferior…alveolar
& palatineprocess
of maxilla

60. CONT..
 Maxillary Ostia
 3-4mm in diameter
 Post part of medial wall
 Drains into middle meatus through ethmoidal
infundibulum

61. CONT..
Accessory ostium:
 when present seen post to natural ostia
 Almost always circular
 Easily seen during endoscpy
HISTOLOGY
.Ciliated columnar epithelium
.Highest density of goblet cells (9700/mm²)

62. BLOOD SUPPLY
 Facial artery
 Infraorbital artery
 Greater palatine artery
 Sphenopalatine artery
Nerve supply
 Greater palatine nerve
 Post lateral nasal nerves
 Superior alveolar (infraorbital nerve)

63. CONT..
 Lymphatic drainage
Lymphatic drainage is relatively
poor,butfollows predominantly into
thepterygopalatine fossa and to
thesubmandibular nodes.
RELATIONS
 Superior : infraorbital and neve,orbit
 Inferior: upper dention and hard palate
 Posterior: pterygopalatine and infratemporal
fossa
 Anterior: cheek with skin ,fat, & facial ms

64. FRONTAL SINUS
 Seen in frontal bone
 Two sinuses are rarely
symmetrical
 Dimensions…height(28-
32mm)
width(24-26mm)
depth(18-20mm)
volume(6-7ml)
 May have septa which
partially
subdivide the cavity & interfere
with
drainage.

65. CONT..
Bent and Kuhn classification of frontal
cells.
 TypeI…single frontal recess cell above the
agger nasi cell, but below the frontal sinus
 TypeII…tier of more than one cell in frontal
recess above the agger nasi cell, but
below the frontal sinus
 TypeIII…large single cell pneumatizing
cephaloid into frontal sinus
 TypeIV…single isolated cell within the
frontal sinus

66. CONT..
Opening of the frontal sinus
 Drainage into frontal recess anterior to the
infundibulum(55%)
 Drainage above but not into the
infundibulum(30%)
 Drainage into infundibulum(15%)
 Drainage above the bulla(1%)

67. CONT..
Blood supply of frontal sinus
 Supraorbital artery
 Supratrochlear artery
Venous drainage
 Small vein that unites the
Supraorbital and Superior
ophthalmic veins.
Nerve supply
 Supraorbital nerve(ophthalmic
nerve)
 Supratrochlear nerve(ophthalmic
nerve)
Lymphatic drainage
 Submandibular nodes

68. ETHMOIDAL SINUSES
 Ethmoid means sieve like
 Ethmoid is trapezoid box
narrow/taller anteriorly
wide posteriorly(4-5cm AP
2-3cm high width 0.5cm
ant/1.5cm p)
 Multiple air containing cells
situated
in ethmoidal labyrinth(3-18)
 Boundaries of ethmoidal
sinus

69. CLASSIFICATION OF ANT ETHMOIDAL CELLS
 Anterior group-(drains –middle meatus)
 Middle group(drains-middle meatus)
 Posterior group(drains-superior meatus)

70. Bagatella et al classification of
ant. group of cells
 pre infundibular group(0-
1)agger nasi cells
 Lateral infundibular group(0-2)
 Post infundibular group(0-2)
 Bullar cells(2-5)
Posterior ethmoidal cells
 Intramural cells
 Extramural cells
Onadi cells… posterior
ethmoidal cells seen just in
front of sphenoid
Haller cell..ant ethmoidal cells
seen anteriorly & below the

71. BLOOD SUPPLY OF ETHMOID SINUS
 Anterior ethmoidal artery(ophthalmic artery)
 Post. Ethmoidal artery
 Sphenoidal artery(maxillary artery)
Venous drainage
 Nasal veins
 Ant. Ethmoidal vein
 Post. Ethmoidal vein

72. NERVE SUPPLY
 Ant ethmoidal nerve
 Post etmoidal nerve
 Maxillary branch of trigeminal nerve
Lymphatics
 ant.& middle ethmoidal cells-submandibular
group
 Post ethmoidal –retropharyngeal nodes

73. SPHENOIDAL SINUS
 Sphenoid means
wedged(frotal,temporal,occipital)
 Right & left are rarely symmetrical in shape
 Pneumatization may extend
into body of sphenoid bone
pterygoid process
basilar portion of occipital bone
nasal septum/perpendicular plate of
ethmoid
 Dimensions … (L..4-44mm)( w..25-34mm)(h..
5-33mm)
volume (7.5ml)

74. Boundries
Sup…pituitary/optic chisma
Lat…ICA/optic nerve/venous cavernosis
Post…brain stem/basilar artery
Floor…vidian nerve

75. TYPES ON BASIS OF PNEUMATISATION
1. conchal…(3%)
2. Presellar(11%)

76. CONT..
 Postsellar(86%)

77. BLOOD SUPPLY
 Posterior ethmoidal artery(roof of sinus)
 Sphenopalatine artery(floor of sinus)
Nerve supply
 Trigeminal (1/11 div)
Lymphatics
 Retropharyngeal nodes

78. EMBRYOLOGY IN BRIEF

79. DEVOLOPMENT OF NOSE
 The development of NOSE starts at about
4th week of gestational age.
 Three prominences appear around
stomatodaeum(future mouth)….
FRONTONASAL PROCESS…mesoderm
covering the developing forebrain
proliferates,& forms downward projection that
overlaps upper part of stomatodaeum.
MANDIBULAR ARCHES(Rt & Lt)….arising
from 1st pharyngeal arch.
Mandibular arch divides into maxillary and
mandibular process.

81. CONT..
 The Nose is derived from frontonasal process in
4th fetal week.
 5th fetal week ectodermal plaques develop on lateral
aspect of FNP & become paired NASAL
PLACODES,early precursors of nares.
 End of 5th week these convex placodes develop into
concave nasal grooves, the medial & lateral sides
of placodes protrudes forwards to become Medial &
Lateral Nasal Process.
 6th fetal week nasal grooves become blind-ending
Nasal Pits with forward &downward growth of
maxillary process.
 7th fetal week nasal pit deepens forms Nasal Sac
which forms future nasal cavity.

84. CONT..
 7th-8th fetal week lateral wall of nasal capsule
begins to form series of ridges of mesenchymal
tissue.
1st ridge, the maxilloturbinal(7th
week)…INFERIOR TURBINATE.
5 to 6 ridges appear superior to 1st (8th
week)…through regression & fusion, these ridges
3 to 4 ethmoturbinals.
1st ethmoturbinal (nasoturbinal)…aggar
nasi(ascending portion)…..uncinate
process(descending portion).
2nd ethmoturbinal ….MIDDLE TURBINATE.
3rd forms …SUPERIOR TURBINATE, rest
regress or join supreme turbinate.

85. CONT.
8th week

86. SUMMARY OF EMRYONIC PRECURSORS

87. PARANASAL SINUSES
 Appear as outgrowths from nasal cavity.
 Frontal ,maxillary,& ethmoidal sinuses arise from
evaginations of lateral nasal wall.
 Sphenoid sinus arises from a posterior
evagination of nasal capsule.
 The sinuses begin to develop in 3rd fetal month &
only ethmoidal & maxillary sinus, are present at
birth.
 Maxillary sinus begins as an outpounching of
lateral nasal wall at 10th fetal week.
 Ethmoidal sinus begins at 3rd month of fetal life.

88. CONT..

89. CONT..
 Frontal sinus develops during 4th fetal
months as an outpounching medial the
most superior aspect of uncinate process.
 Sphenoid sinus are unique in that they
arise from within the nasal capsule of
embryonic nose.
undeveloped until 3 yrs
by 7 yrs pneumatization reaches sella
tursica
by age 9 to 12 it is generally complete

90. SINUS DRAINAGE SCHEMA