Introduction Functions Development Structure Nasal cavity Nasal septum Lateral wall Applied anatomy and pathology – - danger area of nose - nose bleeding - foreign body in nose - developmental nasal deformities - nasal polyps - mouth breathing - rhinitis

1. LATERAL WALL OF
NOSE
By
- Dr Shefali Jaiswal

2. CONTENTS -
Introduction
Functions
Development
Structure
Nasal cavity
Nasal septum
Lateral wall
Applied anatomy and pathology –
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3. - danger area of nose
- nose bleeding
- foreign body in nose
- developmental nasal deformities
- nasal polyps
- mouth breathing
- rhinitis
Summary
Bibliography
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4. The nose is for breathing, the design of its cavity results
in warming and moistening the inspired air, since the
odors are air borne, the olfactory receptors are placed in
the nose.
 Nose consists of the external nose and nasal cavity,
which is divided into right and left halves by midline
nasal septum.
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INTRODUCTION

5. FUNCTIONS
Two main
functions
Respiratory
passage
Secretions of
mucous glands
trap dust and
other particles.
Highly vascular
and warms the
inspired air.
Nose acts as an air
conditioner where
the inspired air is
warmed,
moistened and
cleansed before
passed to lungs.
Organ of
smell
Olfactory mucosa
lines upper one-
third of nasal
cavity, contains
receptors for smell
called olfactory
cells.
It is thin and less
vascular than the
respiratory
mucosa.
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6. DEVELOPMENT
Development of nose starts at about 4th week of
gestational age.
It develops from frontonasal process which grows
between primitive forebrain and the stomatodaeum
(primitive oral cavity lined by ectoderm).
Frontonasal process gets divided into median nasal
process and two lateral process.
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Figure : Development of nose

8.  Primitive nasal cavities are closed at their posterior ends by
bucconasal membrane which ruptures and forms conchae.
 Olfactory placodes on the frontonasal process become
depressed to form olfactory pits which later form nasal
cavity.
 Rathke pouch, also known as hypophyseal diverticulum, is
an ectodermal outpouching of stomatodaeum which forms at
approximately 3-4 weeks gestation
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10. NOSE - STRUCTURE
 Nose consists of bony and
cartilaginous framework.
 Formed above by –
Nasal bones
Frontal process of maxillae
Nasal part of frontal bone
 Formed below by plates of hyaline
cartilage, which includes upper and
lower nasal cartilages and the septal
cartilage.
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11. NASAL CAVITY
 Extends from the external (anterior) nares to the posterior
nares (choanae).
 Divided into right and left halves by the nasal septum.
 Each half has a:
Floor
Roof
Lateral wall
Medial wall (septum)
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12.  Roof – 7cm long and 2mm wide
- Is narrow and formed (from behind forward) by the :
* Body of sphenoid
* Cribriform plate of ethmoid bone
* Frontal bone
* Nasal bone and cartilage
 Floor – 5cm long and 1.5cm wide
- Separates it from the oral cavity
- Formed by the hard (bony) palate
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14. MEDIAL WALL (NASAL SEPTUM)
 Median osseo-cartilaginous partition between the two halves
of the nasal cavity.
 Covered by the mucoperiosteum.
 Cuticular part is formed by-
i) fibro-fatty tissue covered by skin
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Bony part -
Vomer
Perpendicular
plate of the
ethmoid
Cartilaginous
part-
Septal cartilage
Septal
processes of
the inferior
nasal cartilages

16.  The septum has-
 Superior, inferior, anterior and posterior borders
 Right and left surfaces
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17. ARTERIAL SUPPLY – NASAL SEPTUM
Anteroinferior part of septum contains anastomoses
between septal ramus of superior labial branch of facial
artery, branch of sphenopalatine artery and anterior
ethmoidal artery.
These form a large capillary network called
KIESSELBACH’S plexus
 This is a common site of bleeding from nose or
epistaxis and known as Little’s area.
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19. VENOUS DRAINAGE – NASAL SEPTUM
From Little’s area plexus drains anteriorly into the facial
vein.
Posteriorly through the sphenopalatine vein to pterygoid
plexus.
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20. NERVE SUPPLY – NASAL SEPTUM
 General sensory nerves, arises from trigeminal nerve,
and distributed to whole of the septum.
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• Internal nasal branch of the anterior
ethmoidal nerve.
Antero-superior
part
• Nasopalatine branch of the pterygopalatine
ganglion.
Postero-inferior
part
• Medial posterior superior nasal branches
of the pterygopalatine ganglion
Postero-superior
part

21. Special sensory nerve or olfactory nerve are confined to
the upper part or olfactory area.
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22. LYMPHATIC DRAINAGE – NASAL
SEPTUM
 Anterior half drains to submandibular nodes.
 Posterior half drains to retropharyngeal and deep
cervical nodes .
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23. LATERAL WALL
The lateral wall of the nose is irregular owing to the
presence of three shelf like bony projections called
conchae.
The conchae increase the surface area of the nose for
effective air-conditioning of the inspired air.
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24. The lateral wall separates the nose :
 from above, the ethmoidal air sinuses.
 from the maxillary sinus below.
 from the lacrimal groove and nasolacrimal canal in
front.
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25. Lateral wall sub divided into three parts:
 A small depressed area in the anterior part is called
the vestibule, which is lined by modified skin
containing short, stiff, curved hairs called vibrissae.
 The middle part is known as atrium of the middle
meatus.
 The posterior part contains the conchae.
(spaces separating the conchae are called meatuses)
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26. The small space above the superior concha is called the
sphenoethmoidal recess.
The middle meatus is continous infront with a depression
called the atrium.
Atrium is limited above by a ridge called agar nasi.
The skeleton of the lateral wall is partly bony, partly
cartilaginous and partly made up of soft tissues.
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27. Bony part formed by :
 Nasal bone
 Frontal process of maxilla
 Lacrimal bone
 Labrininth of ethmoid with superior and middle
concha
 Inferior nasal concha
 Perpendicular plate of palatine bone
 Medial pterygoid plate
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29. Cartilaginous part formed by:
 Superior nasal cartilage
 Inferior nasal cartilage
 Small cartilages of ala
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30. CONCHAE AND MEATUSES
 Nasal conchae are curved bony projections directed
downwards and medially.
 Inferior concha is an independent bone.
 Middle concha is a projection from the medial surface of
the ethmoidal labryrinth.
 Superior concha is also a projection from the medial
surface of the ethmoidal labryrinth. It is the smallest
concha.
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32. Meatus of nose are passages beneath the overhanging
conchae. Each meatus communicates freely with nasal
cavity proper.
1. The inferior meatus lies underneath the inferior concha
and is the largest of the three meatuses. The
nasolacrimal duct opens into it at the junction of its
anterior one-third and posterior two-thirds. The
opening is guarded by the lacrimal fold or Hasner’s
valve.
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33. 2. The middle meatus lies underneath the middle concha. It
has following features –
a) the ethmoidal bulla – rounded elevation
b) the hiatus semilunaris – a deep semicircular sulcus
below the bulla.
c) the infundibulum – a short passage at the anterior end
of the hiatus.
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34. d) the opening of the frontal air sinus at anterior part of
the hiatus semilunaris.
f) the opening of the maxillary sinus at posterior part of
the hiatus semilunaris.
g) the opening of the middle ethmoidal air sinus at the
upper margin of the bulla.
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36. 3) The superior meatus lies below the superior concha. It
is the shortest and shallowest of the three meatuses. It
has openings of the posterior ethmoidal air sinuses.
The spenoethmoidal recess is a triangular fossa just
above the superior concha. It has openings of the
sphenoidal air sinus.
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37. The atrium of the middle meatus is shallow depression
just in front of the middle meatus and above the
vestibule of the nose.
It is limited above by a faint ridge of mucus membrane,
the agar nasi, running forwards and downwards from
the upper end of the anterior border of the middle
concha.
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38. OSTEOMEATAL
COMPLEX
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Osteomeatal complex,
is a common channel
that links the frontal
sinus, anterior and
middle ethmoid sinuses
and the maxillary sinus
to the middle meatus
that allows air flow and
mucociliary drainage.

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40. ARTERIAL SUPPLY - LATERAL WALL
• Anterior ethmoidal artery assisted by the
posterior ethmoidal and facial arteries.
The antero-
superior quadrant
• Branches from the facial and greater
palatine arteries.
The antero-
inferior quadrant
• Sphenopalatine artery.
The postero-
superior quadrant
• Branches from the greater palatine artery,
which pierce the perpendicular plate of the
palatine bone
The postero-
inferior quadrant
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42. VENOUS DRAINAGE - LATERAL WALL
The veins form a plexus which drains anteriorly into the
facial vein.
Posteriorly into the pharyngeal plexus of veins.
From middle part to the pterygoid plexus of veins.
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43. NERVE SUPPLY - LATERAL WALL
General sensory nerves derived from the branches of
trigeminal nerve.
- Anterior ethmoidal nerve branch of opthalmic nerve.
- Anterior superior alveolar nerve, branch of maxillary
nerve.
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44. - Posterior superior lateral nasal branches from the
pterygopalatine ganglion suspended by the maxillary
nerve.
- Greater palatine branch from the pterygopalatine
ganglion suspended by the maxillary nerve.
Special sensory nerves or olfactory – upper part of the
lateral wall just below the cribriform plate of the
ethmoid up to the superior concha.
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46. LYMPHATIC DRAINAGE - LATERAL WALL
Anterior half of the lateral wall pass to the
submandibular nodes.
The posterior half , to the retropharyngeal and upper
deep cervical nodes.
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47. APPLIED ANATOMY AND PATHOLOGY
Danger area of face:-
 Infections from the face can spread in a retrograde
direction and cause thrombosis of cavernous sinus.
This likely to occur in presence of infection in upper lip
and in the lower part of nose.
 Facial vein of nose communicates with cavernous sinus.
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49. Nose bleeding:-
A nose bleed is usually caused by a damaged blood vessel
that leaks blood. Nose bleeding can affect all ages, but
they are twice as common in children as in adults.
 Trauma or injury to the nose
 Nasal or sinus infection
 High blood pressure
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50.  Bleeding or clotting problem
 Tumor
 Cocaine use
 Use of topical nasal steroid medicines
 Dry mucous membranes in the nose due to low humidity
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51. FIRST AID FOR NOSE BLEEDING
Ask person breathe slowly through the mouth.
Direct the person to either sit or stand upright and lean
forward slightly.
 Stop blood flow by pinching the nose with the thumb
and index finger while breathing through the mouth.
apply this direct pressure for 5 to 10 minutes.
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52. Topical anesthesia packing may be given.
If the person's nose continues to bleed 15 minutes after
changing the person's position and applying direct
pressure, get medical help.
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53. FORGEIN BODY IN NOSE
Causes
 Deliberately inserting a small object, into the
nostril commonly seen in childrens.
 Having the airway packed in a healthcare setting.
First aid
 Encourage the person to breathe slowly through the
mouth.
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54.  Gently press the other nostril closed and have the
person blow through the affected nostril.
 Do not try to get the object using tweezers, Doing so can
push the object further up the nose.
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55. DEVELOPMENTAL NASAL DEFORMITIES
Losee et al (2004) classified Congenital nasal
deformities into the 4 categories:
Type I : Hypoplasia and atrophy
Type II - Hyperplasia and duplications
Type III – Clefts
Type IV - Neoplasms and vascular anomalies
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56. TYPE – I HYPOPLASIA AND ATROPY
The severity of the deformity may be a function of how
early in development the normal processes are
interrupted and whether the tissues required to form the
individual nasal parts are developed , partially
developed, or present but displaced.
It is associated with dwarfism and other genetic
conditions.
The nasal dorsum may be very low because of a lack of
growth of the nasal bones.
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58. TYPE – II HYPERPLASIA AND
DUPLICATIONS
Nasal dermoids- the presence of a frontonasal dermoid
may be noted at birth or in early infancy as a midline
pore, possibly with protruding hair and possibly with
widening of the nasal dorsum.
Nasal gliomas- heterotrophic neural tissue secondary to
deficient regression of neurologic tissue in embryonic
development. Seen at extranasal location may still
penetrate the bone in the frontonasal suture area and
boradening of the nasal root and increased intercanthal
distance.
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NASAL GLIOMA

60. Frontonasal encephaloceles- present as midline or
paramedian nasal masses, usually at the nasofrontal area
seen at birth and can attain enormous proportions.
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61. TYPE- III CLEFTS
Deranged development of the frontonasal process, and
/or faliure of adjacent processes to merge successfully,
results in coherent series of malformations.
Failure of the two nasomedial processes to merge in the
midline procedure the more rare, true midline cleft lip
and palate with hypertelorism.
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63. TYPE- IV NEOPLASMS AND VASCULAR
ABNORMALITIES
Nasal heamgiomas are one of the most common
pediatric nasal masses.
They may be present as an external red or purple mass,
but occasionally they can be entirely subcutaneous,
presenting as a swollen nasal tip.
They may have an intranasal component that can
compromise nasal airway function.
Usually present at birth.
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65. NASAL POLYPS
Nasal polyps are growths in the nasal cavity. They often
look like grapes or small balloons within the structures of
the nasal cavity.
Causes
• Asthma
• Sinusitis
• Cystic fibrosis
• Sensitivity to asprin
Treatment
Steroid therapy
Surgical excision
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66. MOUTH BREATHING
Increased resistance to the flow of air through the nasal
passages may be considered to be primary cause of
mouth breathing.
This could alter the equilibrium of pressures on the jaws
and affect both jaw growth and tooth position.
Etiology
 Deviated septum and other nasopharyngeal deformities
 Nasal polyps
 Enlarged adenoids or tonsils
 Enlarged turbinate's
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67. Effect on dento-facial structures.
 Facial form
Large face height
Increased mandibular plane angle
Retrognathic mandible and maxilla
Adenoid facies- long narrow face with narrow nose &
nasal passages.
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70. - Buccal segment of maxilla collapsed leading to ‘V’
shape and high palatal vault.
- Presence of open bite and posterior cross bite
Treatment -
• Elimination of cause
• Oral screen
• Lip exercises
• Maxillothorax myotherapy
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71. RHINITIS / COMMON COLD
Rhinitis known as a stuffy nose, It is the irritation and
inflammation of some internal areas of the Nose. The
inflammation results in the generating of excessive
amounts of mucus.
Cause- rhinovirus, corona virus, bacterial infection
Symptoms- rhinorrhea. sore throat (pharyngitis),
cough, congestion, headache.
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72. SUMMARY -
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Medial wall
Arterial supply -
-Capillary network -
Kiesselbach’s plexus.
-Common site of bleeding nose
Little’s area.
Venous drainage –
-Anteriorly - facial vein.
-Posteriorly-sphenopalatine
vein pterygoid plexus.
Lateral wall
Arterial supply-
-Anterior ethmoidal artery .
-Facial and greater palatine arteries.
-Sphenopalatine artery.
-Greater palatine artery.
Venous drainage-
-Anteriorly - facial vein.
-Posteriorly-pharyngeal plexus of veins.
-Middle part-pterygoid plexus of veins.

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Medial wall-
Nerve supply-
Antero-superior part-
anterior ethmoidal nerve.
Postero-inferior part-
Nasopalatine branch of the
pterygopalatine ganglion.
Postero-superior part-
Medial posterior superior nasal
branches of the pterygopalatine
ganglion.
Lateral wall-
Nerve supply-
-Anterior ethmoidal nerve branch
of opthalmic nerve.
-Anterior superior alveolar nerve.
-Posterior superior lateral nasal
branches from the pterygopalatine
ganglion.
-Greater palatine branch from the
pterygopalatine ganglion.

74. BIBLIOGRAPHY
1. BD Chaurasia : Human Anatomy, Regional and Applied, Vol.3,
Head, Neck & Brain- 4th edition,2004.
2. Inderbir Singh: Human Embryology, 6th edition,1996.
3. GJ Romanes: Cunningham’s Manual of Practical Anatomy,
Vol.3: Head & Neck& Brain, 15th edition,1993.
4. Warren.H.Lewis: Gray’s Anatomy of The Human Body-20th
edition, Online volume, 2000.
5. Losee, Joseph E., et al. Congenital nasal anomalies: a
classification scheme. Plastic and reconstructive surgery 113.2
(2004): 676-689.
6. Atlas of Human Anatomy, Fourth Edition, by Frank H. Netter
and edited by Jennifer K. Brueckner, et al.
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