Anatomy of the Nose and Sinuses
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Questions and Answers

What is Kieselbach's area commonly known for?

  • A location of the frontal sinus
  • A site of nasal infections
  • A common site of epistaxis (correct)
  • An area for olfactory nerve function

    • Which vein is NOT involved in the venous drainage of the external nose?

  • Cavernous sinus
  • Maxillary vein (correct)
  • Facial vein
  • Sphenopalatine vein

    • Where is Kieselbach's area located?

  • Anterior-inferior part of nasal septum (correct)
  • Posterior part of the nasal cavity
  • Superior part of the nasal cavity
  • Inferior nasal concha

    • What does the submucosal venous plexus drain into?

    <p>Maxillary, sphenopalatine, and facial veins</p> Signup and view all the answers

    Which paranasal sinus is located directly anterior to the ethmoid sinus?

    <p>Frontal sinus</p> Signup and view all the answers

    Which of the following statements is true about the paranasal sinuses?

    <p>They communicate with the nasal cavity.</p> Signup and view all the answers

    Which structure is involved in the drainage of the frontal sinus?

    <p>Frontonasal duct opening</p> Signup and view all the answers

    What is the origin of the blood supply to Kieselbach's area?

    <p>Maxillary artery</p> Signup and view all the answers

    What forms the roof of the nasal cavity?

    <p>Sphenoid</p> Signup and view all the answers

    Which structures contribute to the lateral wall of the nasal cavity?

    <p>Maxillary sinus openings</p> Signup and view all the answers

    In which region of the nasal cavity is the respiratory epithelium found?

    <p>Lower 2/3 of cavity</p> Signup and view all the answers

    What is the primary function of the vestibule of the nasal cavity?

    <p>Traps/removes particles</p> Signup and view all the answers

    What types of nerves are associated with the olfactory region of the nasal cavity?

    <p>Olfactory and Trigeminal nerves</p> Signup and view all the answers

    Which arteries supply blood to the nasal cavity?

    <p>Sphenopalatine artery</p> Signup and view all the answers

    What is a consequence of a fracture in the nasal cavity that involves CSF rhinorrhea?

    <p>Leakage of cerebrospinal fluid</p> Signup and view all the answers

    Which structure is NOT part of the medial wall boundaries of the nasal cavity?

    <p>Maxillary bone</p> Signup and view all the answers

    Which cranial nerve is responsible for the afferent limb of the swallowing reflex?

    <p>Glossopharyngeal (IX)</p> Signup and view all the answers

    What happens to the larynx during swallowing?

    <p>The larynx is lifted up while the epiglottis falls down.</p> Signup and view all the answers

    What muscle is primarily responsible for opening the pharyngotympanic tube?

    <p>Levator palati</p> Signup and view all the answers

    Which structure is located cranial to the trachea?

    <p>Upper margin of the larynx</p> Signup and view all the answers

    What is Killian's dehiscence?

    <p>A junction between the cricopharyngeus and thyropharyngeus muscles.</p> Signup and view all the answers

    What structure does the tendon of tensor tympani insert into?

    <p>Handle of the malleus</p> Signup and view all the answers

    Which nerve crosses the medial surface of the neck of the malleus?

    <p>Chorda tympani nerve</p> Signup and view all the answers

    Which of the following muscles is responsible for dampening movements of both the ossicles and the tympanic membrane?

    <p>Tensor tympani</p> Signup and view all the answers

    What separates the middle ear from the scala tympani?

    <p>Round window</p> Signup and view all the answers

    Which of the following is NOT a component of the bony labyrinth?

    <p>Endolymphatic duct</p> Signup and view all the answers

    What structure is the maxillary sinus ostium associated with for drainage?

    <p>Inferior meatus</p> Signup and view all the answers

    Which anatomical feature is the roof of the maxillary sinus related to?

    <p>Orbit</p> Signup and view all the answers

    Which muscle of the tongue is supplied by the Vagus nerve?

    <p>Palatoglossus</p> Signup and view all the answers

    What can posterior ethmoid group sinusitis potentially affect?

    <p>Optic nerve</p> Signup and view all the answers

    What is the primary action of the genioglossus muscle?

    <p>Protrusion of the tongue</p> Signup and view all the answers

    Which part of the pharynx is attached to the Eustachian tube?

    <p>Nasopharynx</p> Signup and view all the answers

    Which artery is the main blood supply to the tongue?

    <p>Lingual branch of external carotid</p> Signup and view all the answers

    How do the constrictor muscles of the pharynx function?

    <p>Meet at the midline raphe</p> Signup and view all the answers

    Which nerve is responsible for taste sensation in the anterior two-thirds of the tongue?

    <p>Facial nerve</p> Signup and view all the answers

    What is the main function of the salpingopharyngeal fold?

    <p>Facilitating ear ventilation</p> Signup and view all the answers

    Which nerve supplies all the intrinsic muscles of the tongue?

    <p>Hypoglossal nerve</p> Signup and view all the answers

    Which term describes the potential impact of maxillary sinus inflammation?

    <p>Pressure on upper molars</p> Signup and view all the answers

    Which statement correctly describes the relationship of the maxillary sinus ostium?

    <p>It is located higher than the sinus floor.</p> Signup and view all the answers

    What action is primarily performed by the styloglossus muscle?

    <p>Elevation and retraction of the tongue</p> Signup and view all the answers

    Which of the following functions is NOT performed by the hyoglossus muscle?

    <p>Protrusion of the tongue</p> Signup and view all the answers

    Which nerve provides general sensory innervation to the posterior one-third of the tongue?

    <p>Glossopharyngeal nerve</p> Signup and view all the answers

    What type of cartilage contributes to the skeletal framework of the external nose?

    <p>Hyaline cartilage</p> Signup and view all the answers

    Which structure serves as the boundary of the nasal cavity?

    <p>Medial wall</p> Signup and view all the answers

    Which muscle is primarily responsible for elevating the soft palate during swallowing?

    <p>Levator palati</p> Signup and view all the answers

    What is the primary role of the uvular muscles during swallowing?

    <p>To thicken and shorten the uvula</p> Signup and view all the answers

    Which nerve is responsible for the motor innervation of most muscles of the soft palate?

    <p>Vagus nerve</p> Signup and view all the answers

    What action triggers the gag reflex?

    <p>Touching the soft palate</p> Signup and view all the answers

    During swallowing, which muscle assists in sealing off the mouth from the oropharynx?

    <p>Palatoglossus</p> Signup and view all the answers

    What is the primary function of the paranasal sinuses?

    <p>To enhance vocal resonance and lighten the skull</p> Signup and view all the answers

    Which group of ethmoidal sinuses drains into the middle meatus?

    <p>Middle group</p> Signup and view all the answers

    What anatomical feature separates the sphenoidal sinus from adjacent structures?

    <p>Ethmoid bone</p> Signup and view all the answers

    Which sinus drains into the superior meatus?

    <p>Posterior group of ethmoidal sinuses</p> Signup and view all the answers

    Which condition may result from the extension of a dental abscess?

    <p>Sinusitis</p> Signup and view all the answers

    Where does the frontal sinus primarily drain?

    <p>Middle meatus through the frontonasal duct</p> Signup and view all the answers

    Which paranasal sinus is described as pyramidal-shaped?

    <p>Maxillary sinus</p> Signup and view all the answers

    What is the drainage pathway for the maxillary sinus?

    <p>Middle meatus through hiatus semilunaris</p> Signup and view all the answers

    What is Kieselbach's area commonly associated with?

    <p>Common site of epistaxis</p> Signup and view all the answers

    Which of the following veins is involved in the venous drainage of the external nose?

    <p>Facial vein</p> Signup and view all the answers

    What is the main function of the ciliated epithelium lining the paranasal sinuses?

    <p>Movement of mucus toward the nasal cavity</p> Signup and view all the answers

    Which sinus is located posterior to the frontal sinus?

    <p>Sphenoidal sinus</p> Signup and view all the answers

    What anatomical feature is primarily at risk of erosion due to the expansion of the maxillary sinus?

    <p>Maxillary tuberosity</p> Signup and view all the answers

    Which area is referred to as the 'dangerous area' of the face in relation to venous drainage?

    <p>Area around the nose</p> Signup and view all the answers

    Which paranasal sinus communicates most directly with the nasal cavity?

    <p>Maxillary sinus</p> Signup and view all the answers

    What typically occurs during childhood and early adulthood regarding the paranasal sinuses?

    <p>Erosion into surrounding bones</p> Signup and view all the answers

    What is the primary role of the tensor tympani muscle?

    <p>To dampen vibrations of the tympanic membrane</p> Signup and view all the answers

    Which structure separates the middle ear from the cochlear duct?

    <p>Round window</p> Signup and view all the answers

    What are the two components of the labyrinth found in the internal ear?

    <p>Bony labyrinth and membranous labyrinth</p> Signup and view all the answers

    Which of the following structures is located within the bony labyrinth?

    <p>Utricle</p> Signup and view all the answers

    Which nerve is responsible for transmitting taste sensations from the anterior two-thirds of the tongue?

    <p>Facial nerve</p> Signup and view all the answers

    Which of the following intrinsic tongue muscles is not involved in elevation?

    <p>Inferior longitudinal</p> Signup and view all the answers

    What is the primary nerve that supplies all the extrinsic muscles of the tongue, except for one?

    <p>Hypoglossal nerve (XII)</p> Signup and view all the answers

    Which muscle is primarily responsible for the retraction of the tongue?

    <p>Styloglossus</p> Signup and view all the answers

    Which of the following arteries is not typically associated with the blood supply of the tongue?

    <p>Facial artery</p> Signup and view all the answers

    What role does the chorda tympani play in tongue innervation?

    <p>Taste sensation for the anterior two-thirds of the tongue</p> Signup and view all the answers

    Which nerve carries taste and general sensory information for the posterior one-third of the tongue?

    <p>Glossopharyngeal nerve (IX)</p> Signup and view all the answers

    Which of the following extrinsic tongue muscles is primarily involved in the action of protrusion?

    <p>Genioglossus</p> Signup and view all the answers

    What are the sensory nerves responsible for general sensation in the anterior two-thirds of the tongue?

    <p>Lingual branch of mandibular nerve and chorda tympani</p> Signup and view all the answers

    Which muscle of the tongue is specifically supplied by the vagus nerve?

    <p>Palatoglossus</p> Signup and view all the answers

    What is the primary function of the posterior cricoarytenoid muscle?

    <p>Abduction of the vocal folds</p> Signup and view all the answers

    Which nerve is responsible for the motor supply of the cricothyroid muscle?

    <p>External laryngeal nerve</p> Signup and view all the answers

    Which is responsible for the sensory innervation of the mucous membrane above the vocal fold level?

    <p>Superior laryngeal nerve</p> Signup and view all the answers

    The lateral cricoarytenoid muscle primarily functions in which action?

    <p>Adduction of the vocal folds</p> Signup and view all the answers

    What structure separates the right and left vocal folds?

    <p>The glottis</p> Signup and view all the answers

    Which artery supplies the upper half of the larynx?

    <p>Superior thyroid artery</p> Signup and view all the answers

    The intrinsic muscles of the larynx receive their motor supply primarily from which nerve?

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    What is the role of the transverse arytenoid muscle?

    <p>Adduction of the inter-cartilaginous part</p> Signup and view all the answers

    Which structure is involved in the venous drainage of the upper half of the larynx?

    <p>Superior laryngeal vein</p> Signup and view all the answers

    What function does the thyroarytenoid muscle perform?

    <p>Relaxes and shortens the vocal cords</p> Signup and view all the answers

    The lymphatic drainage of the larynx primarily involves which group of nodes for the lower half?

    <p>Lower deep cervical nodes</p> Signup and view all the answers

    Which of the following intrinsic laryngeal muscles is the main antagonist to the posterior cricoarytenoid?

    <p>Lateral cricoarytenoid</p> Signup and view all the answers

    What is the primary action performed by the cricothyroid muscle?

    <p>Tensioning the vocal cords</p> Signup and view all the answers

    Which phrase accurately describes the role of the larynx during respiration?

    <p>Regulates airflow through opening and closing</p> Signup and view all the answers

    Study Notes

    Upper Airways

    • The lecture was delivered on 25-11-2024, during Year 2, Semester 1, by Dr. Vijayalakshmi S B.
    • The lecturer's email address is [email protected].
    • The lecturer's department is Anatomy.
    • The learning outcomes covered oral cavity, gingivae, tongue structure, blood vessels, nerves, pharynx, palate, tonsils, gag reflex, nose (turbinates, meatuses, and sinuses), nasal septum and its blood supply, external/middle ear including auditory canal & tympanic membrane's structure, ossicles, muscles & relations, cartilages, ligaments, and muscles of the larynx, anatomy and movements of vocal cords, nerve supply & injuries, comparing and contrasting laryngotomy and tracheostomy.

    Oral Cavity

    • The oral cavity proper is the space within the oral vestibule.
    • Anatomical structures including the tongue, lingual gingivae, molar tooth, oral vestibule, buccinator muscles, bolus of food, buccal gingiva and mandible are part of the oral cavity
    • The oral cavity skeleton includes the frontal, temporal, parietal, occipital, ethmoid, maxillary, sphenoid, palatine, zygomatic, and vomer bones. -Also, mandibular bones
    • Bud development for permanent teeth occurs between 8-12 weeks.
    • Permanent teeth erupt from 6 years of age onwards with 32 teeth total.
    • Central and lateral incisors are included. There's 1 canine tooth.
    • 2 premolar teeth.
    • 3 molar teeth, with the third molar, or wisdom teeth erupting around age 20.

    Oral Cavity Boundaries

    • The oral cavity is bordered by the hard palate, soft palate, oropharynx and laryngopharynx.
    • The visual cranium is bordered by structures including the frontal sinus, nasal cavity, hard palate, oral cavity proper, genioglossus, mylohyoid, nasopharynx, oropharynx, laryngopharynx, esophagus. -Visual cranium includes viscerocranium and the mandible and hyoid bone..

    Oral Cavity - Palatine Tonsils

    • The palatine tonsils are located within the oral cavity.
    • The palatopharyngeal and palatoglossal arches surround the tonsils.

    Oral Cavity - Tongue

    • The tongue is the principal organ for taste, speech, and swallowing and is situated in the mouth floor.
    • It curves around the body of the mandible.
    • It comprises root, apex, inferior surface, and dorsum.
    • Tongue is connected to the hyoid bone, mandible, epiglottis and soft palate.
    • It includes hyoglossus, genioglossus and the glossoepiglottic fold which connect the root of the tongue to the epiglottis and 2 lateral glossoepiglottic folds (binding vallecula). There are palatoglossal folds which connect to the soft palate

    Oral Cavity- Tongue - Surface

    • Superior surface includes filiform, fungiform, foliate and vallate papillae.
    • Foramen caecum, sulcus terminalis, lingual papillae and lingual tonsil are also related to the tongue. -Vallate papillae, filiform papillae, fungiform papillae, and foliate papillae.
    • Inferior surface includes fimbriated fold, frenulum of tongue, sublingual fold, and sublingual caruncle, greater and lesser lingual ducts.

    Tongue Muscles

    • The extrinsic muscles of the tongue connect it to the skeleton.
    • These include palatoglossus, hyoglossus, styloglossus, and genioglossus..
    • All supplied by hypoglossal nerve (XII)
    • Intrinsic muscles stay within the tongue and are supplied by the hypoglossal nerve (XII).
    • Includes superior, inferior, transverse and vertical muscles.

    Tongue Movements

    • Protrusion is achieved by action of the genioglossus muscles.
    • Retraction and depression are achieved by simultaneous action of the styloglossus and hyoglossus muscles.
    • Elevation is achieved by simultaneous action of the styloglossus and palatoglossus.

    Tongue Blood Supply

    • The lingual branch of the external carotid is the primary artery supplying the tongue, but the tonsillar branch of the facial artery and ascending pharyngeal also contribute.
    • Deep and dorsal lingual veins empty into the internal jugular vein.

    Tongue Nerve Supply

    • All the intrinsic muscles of the tongue are supplied by the hypoglossal nerve (CN XII), except the palatoglossus, which is supplied by the vagus nerve (CN X).
    • The sensory nerves of the tongue include the lingual branch of the mandibular nerve (for the anterior 2/3), chorda tympani branch of the facial nerve (for taste in the anterior 2/3), and the glossopharyngeal nerve (for the posterior 1/3).
    • The superior laryngeal branch of the vagus nerve contributes sensory input to the root of the tongue (and taste).

    Lingual Nerve

    • The lingual nerve originates from the mandibular nerve (CN V3).
    • The lingual nerve is characterized by postganglionic parasympathetic fibers from the submandibular ganglion.
    • The lingual nerve also contains chorda tympani (from facial nerve (VII)) fibers which carry taste sensation.
    • The lingual artery branches into several smaller arteries.
      • The lingual nerve supplies sensory fibers to the tongue.
    • The preganglionic secretomotor fibers originate from the superior salivatory nucleus in the pons. These fibers travel through sensory components of the chorda tympani and lingual nerve, and to reach submandibular ganglion. Postganglionic fibers supply directly the submandibular and sublingual glands through the lingual nerve

    Oral Cavity - Innervation

    • Motor nerves involved: Mandibular, Vagus, Hypoglossal, Anterior ramus of C1.
    • Facial nerves carry taste to the anterior tongue, while glossopharyngeal nerves carry sensory and taste from most of the posterior tongue, and the vagus nerves carry these sensory functions from a small part of the posterior tongue.

    External Nose

    • Parts include: root, bridge, apex, ala, nostril.
    • It has a skeletal framework of nasal, maxillary, and the nasal part of the frontal bone, with both bones and hyaline cartilage.
    • The lateral, alar and septal cartilages are important anatomical component of the external nose.

    Nasal Cavity

    • Has 3 regions: vestible (internal to nostril, lined with skin, filters air), respiratory (main cavity, lined with pseudostratified ciliated columnar epithelium, with olfactory area), and olfactory (lined with olfactory epithelium allowing sense of smell)
    • The medial wall/septum involves the perpendicular plate of the ethmoid and the vomer. The anterior part of the septum is cartilage.
      • The roof of the nasal cavity connects to the frontal bone, cribriform plate, and sphenoid bone.
    • The floor is the hard palate.
    • The lateral walls contain nasal conchae (turbinates).

    Nasal Cavity Lateral Wall Openings

    • The openings include superior, middle, and inferior meatuses.
    • The superior meatus has groups of posterior ethmoidal openings.
    • The middle meatus contains the middle ethmoidal groups, frontal sinus, and anterior ethmoidal group openings, and the maxillary sinus opening.
    • The inferior meatus has the nasolacrimal duct opening.

    Paranasal Sinuses

    • Extensions of the nasal cavity.
    • Lined with cilia epithelium.
    • Communicate with the nasal cavity through channels.
    • Located within the frontal, sphenoid, and ethmoid bones and within the maxilla.
    • Functions include resonating sound, lightening the skull, warming and moistening inspired air.

    Relevance to Clinical Practice

    • Paranasal sinus infections (sinusitis) can be caused by nasal infections or dental abscesses.
    • Ethmoid sinusitis can also spread to the orbit or affect the optic nerve.

    Pharynx

    • A funnel-shaped muscular organ.
    • Covered by mucosa, forms a pathway for air and food.
    • Divided into nasopharynx, oropharynx, and laryngopharynx.
    • Three constrictor muscles (superior, middle, inferior) connect posteriorly to form raphe.
    • Three elevator muscles (salpingopharyngeus, stylopharyngeus, palatopharyngeus) attach to the eustachian tube, styloid process, soft palate, and merge with the constrictor muscles.

    Palatine

    • Forms the roof of the oral cavity and floor of nasal cavities.
    • The hard palate is anteriorly.
    • The soft palate is posteriorly.
      • Covered with periosteum and oral mucosa (inferiorly).
      • Covered with respiratory mucosa (superiorly) -Contains two parts; hard and soft palate. -The hard palate is anteriorly, the soft palate posteriorly.

    Ear

    • The ear is comprised of external, middle, and internal portions.
    • External ear parts - include the helix, antehelix, concha, tragus, antriagrus, lobule. They are made of elastic cartilage.
    • Middle ear parts include malleus, incus, and stapes (auditory ossicles).
    • Internal ear structures include cochlear duct, semicircular canals.

    Ear Canal

    • Adult canal is comprised of lateral 2/5 cartilaginous and medial 3/5 bone.
    • Child canal is 2/5 cartilaginous and 3/5 bone.
    • Lining includes the epithelium, ceruminous glands which secrete cerumen that prevents maceration of skin by water. Cerumen then migrates laterally in a spiral path.

    Tympanic Membrane

    • Consists of 3 layers including skin, fibrous tissue and respiratory epithelium.
      • It is circular about 1 cm in size, with the apex or umbo pointed medially and angled at approximately 55 degrees.

    Auditory Ossicles

    • Small bones (malleus, incus, stapes) form a mobile chain from the tympanic membrane to the oval window.

    Middle Ear

    • An air-filled cavity in the petrous temporal bone.
    • Lined with mucous membrane - Respiratory epithelium.
    • Connects to nasopharynx via eustachian tube for pressure relief (equalization).

    Internal Ear

    • A bony and membranous maze within the petrous temporal bone.
    • Bony labyrinth has 3 semicircular canals, vestibule, and cochlea.
    • Membranous labyrinth consists of cochlear duct and 3 semicircular ducts suspended in the bony labyrinth and contain saccule, utricle, and endolymphatic ducts).

    Larynx

    • A cartilaginous structure with a lining of mucosa.
    • Located in the neck below the hyoid bone connecting to it through the hyoid ligament, and in front of the trachea via the cricotracheal ligament.
    • Cartilages include the thyroid, cricoid, arytenoid and epiglottis.

    Larynx Muscles

    • Extrinsic (connect to the skeleton): Geniohyoid, stylohyoid, digastric, stylopharyngeus, salpingopharyngeus, palatopharyngeus.
    • Intrinsic (within the larynx wall): Oblique arytenoid, transverse arytenoid, posterior cricoarytenoid, lateral cricoarytenoid, cricothyroid, thyroarytenoid, vocalis.
      • The posterior cricoarytenoid is a life saving muscle.

    Larynx: Nerve Supply

    • Sensory (mucous membrane): Internal and external laryngeal branches of the vagus nerve. (Sensory above the vocal cords supplied by the internal, below the vocal cords supplied by the recurrent laryngeal nerve)
    • Motor (intrinsic muscles): Recurrent laryngeal nerve branch of the vagus nerve; external laryngeal branch of the superior laryngeal nerve (Critothyroid).

    Larynx Blood Supply

    • Branches of the Superior Laryngeal artery ( from superior thyroid artery ); Internal branch.
    • Branches of the Inferior laryngeal artery (from inferior thyroid artery).
    • The upper one-half of the larynx is supplied primarily by the superior thyroid arteries, and the lower one-half by the inferior thyroid arteries.

    Larynx: Drains Lymphatically

    • Lymph nodes above the vocal fold—upper deep cervical nodes.
    • Lymph nodes below the vocal fold—lower deep cervical nodes.

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    Upper Airways Presentation PDF - RCSI

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    Test your knowledge of the anatomy related to Kieselbach's area, venous drainage of the external nose, and the paranasal sinuses. This quiz covers key structures, their functions, and anatomical locations crucial for understanding nasal and sinus health.

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