Nose & Paranasal Sinuses Anatomy PDF

Nose & Paranasal Sinuses CREATED BY TINKER TEETH  01 DESCRIBE THE EXTERNAL NOSE 02 DESCRIBE THE NASAL CAVITY LEARNING Outcome (MEDIAL WALL, LATERAL WALL, AND FLOOR OF NASAL CA...

Nose & Paranasal Sinuses CREATED BY TINKER TEETH  01 DESCRIBE THE EXTERNAL NOSE 02 DESCRIBE THE NASAL CAVITY LEARNING Outcome (MEDIAL WALL, LATERAL WALL, AND FLOOR OF NASAL CAVITY) DESCRIBE THE ARTERIAL AND 03 NERVE SUPPLY OF THE NASAL SEPTUM AND ITS CLINICAL IMPORTANCE 04 DESCRIBE BRIEFLY THE PARANASAL SINUSES, ITS CLOSELY RELATED STRUCTURES, AND ITS OPENINGS INTO THE NOSE  01 NOSE  features External Nose ROOT OF NOSE (ATTACHED TO FOREHEAD) APEX/TIP OF NOSE DORSUM (PART BETWEEN ROOT AND APEX) ALA OF NOSE NASAL SEPTUM (SEPERATE NOSTRILS) NOSTRILS/NARIS (BOUNDED BY ALA AND NASAL SEPTUM) PHILTRUM  framewook External Nose CARTILAGINOUS PARTS Lateral nasal process of frontal bone Septal Greater Alar and Lesser Alar BONY PARTS (UPPER 1/3 OF NOSE) Nasal bones Frontal processes of the maxillae Nasal processes of the frontal bone and its nasal spine  02 NASAL CAVITY  Nasal cavity 01 NASAL VESTIBULES supported by nose cartilage lined with tissues contain hair 02 NASAL CAVITY PROPER lined by mucosa functions 1. olfactory area - smell 2. respiratory area - breathing  Nasal cavity ROOF Narrow Formed by : 1. MIDDLE PART - Cribriform plate of ethmoid bone 2. ANTERIORLY : Nasal part of frontal bone Nasal bone Cartilages 3. POSTERIORLY - Inferior surface of body of sphenoid bone  Nasal cavity LATERAL WALL Separates the nasal cavity from : Orbit Maxillary sinus Features : Inferiorly : vestibules (anterior portion lined by skin with soft hair) Posteriorly - choanae (opening between nasal cavity & nasopharynx) Medially - 3 bony projections > conchae/turbinates  Nasal cavity FLOOR Formed by : Palatine process of maxilla Horizontal plate of palatine bone  Nasal cavity MEDIAL WALL ( NASAL SEPTUM) 1. divides nasal cavity into half 2. Consists of Bony part : vomer & perpendicular plate of ethmoid cartilaginous part : septal cartilage  03 ARTERY AND NERVE  ARTERIAL SUPPLY TO NASAL CAVITY Anterior INTERNAL CAROTID ARTERY MIDDLE WALL: ethmoidal arteries Anterior posterior Posterior ethmoidal arteries ethmoidal arteries ethmoidal arteries FROM OPTHALMIC FROM OPTHALMIC ARTERY Kiesselbach’s ARTERY SUPPLY : area SUPPLY: ETHMOIDAL CELL ANTEROSUPERIOR PART & NASAL CAVITY EXTERNAL CAROTID ARTERY Sphenopalatine Superior labial Greater palatine Sphenopalatine artery artery artery artery FROM : FACIAL FROM : MAXILLARY FROM : MAXILLARY ARTERY ARTERY ARTERY SUPPLIES : SUPPLIES : Greater palatine SUPPLIES : POSTERIOR Superior labial artery ANTEROINFERIOR POSTEROINFERIOR PART OF NASAL SEPTUM artery PART PART  ARTERIAL SUPPLY TO NASAL CAVITY Lateral wall: Anterior INTERNAL CAROTID ARTERY ethmoidal arteries Anterior Superior Posterior ethmoidal arteries ethmoidal arteries ethmoidal arteries FROM OPTHALMIC FROM OPTHALMIC ARTERY ARTERY Lateral SUPPLY :ETHMOIDAL SUPPLY : nasal CELL & NASAL CAVITY ANTEROSUPERIOR PART arteries EXTERNAL CAROTID ARTERY Sphenopalatine Superior labial Lateral nasal artery artery arteries FROM : MAXILLARY FROM : FACIAL ARTERY FROM : FACIAL ARTERY ARTERY Superior labial SUPPLY : SUPPLY : SUPPLY : VESTIBULES artery ANTEROINFERIOR PART POSTEROSUPERIOR & Sphenopalatine POSTEROINFERIOR PART Greater artery palatine artery  CLINICAL IMPORTANCE (EPISTAXIS) A.K.A NOSEBLEED MOST COMMON SITE = ANTERIOR THIRD OF NOSE KNOWN AS KIESSELBACH’S PLEXUS / LITTLE’S AREA ANASTOMOSED VASCULAR NETWORK THAT SUPPLIES OXYGENATED BLOOD TO NASAL SEPTUM DUE TO MUCOSAL DRYNESS  CLINICAL IMPORTANCE (RHINITIS) NASAL MUCOSA BECOMES SWOLLEN & INFLAMED LEAD TO CONGESTION, MUCUS DRAINAGE & NOSEBLEED CAUSES ; 1) UPPER RESPIRATORY INFECTIONS 2) ALLERGIC REACTIONS (HAY FEVER) TYPES ; 1) VASOMOTOR RHINITIS : BLOOD VESSELS TOO SENSITIVE & DILATE CAUSED BY ENVIRONMENT 2) ALLERGIC RHINITIS : ALLERGENS IN THE AIR TRIGGER HISTAMINE TO BE RELEASED IN BODY  NERVE SUPPLY (NASAL SEPTUM) Internal nasal branch of anterior Internal nasal branch of anterior ethmoidal nerve ( branch of V1) ethmoidal nerve ( branch of V1) Olfactory nerve (cn 1) ORIGIN : TRIGEMINAL GANGLION EXIT : SUPERIOR ORBITAL FISSURE PROVIDE GENERAL SENSORY TO ANTEROSUPERIOR OF NASAL SEPTUM Nasopalatine nerve (branch V2) ORIGIN : TRIGEMINAL GANGLION EXIT : FORAMEN ROTUNDUM PROVIDE GENERAL SENSORY TO POSTEROINFERIOR PART Olfactory nerve (cn 1) ORIGIN : OLFACTORY MUCOSA EXIT : OPTIC TRACT PROVIDE SMELL SENSATION (SPECIAL SENSORY) Nasopalatine nerve (branch V2)  NERVE SUPPLY (LATERAL WALL OF NASAL CAVITY) Anterior ethmoidal nerve ( branch V1) ORIGIN : TRIGEMINAL GANGLION Anterior ethmoidal EXIT : SUPERIOR ORBITAL FISSURE nerve ( branch V1) PROVIDE GENERAL SENSORY TO ANTEROSUPERIOR PART Olfactory nerve (cn 1) Anterior superior alveolar nerve (branch V2) ORIGIN : TRIGEMINAL GANGLION EXIT : FORAMEN ROTUNDUM PROVIDE GENERAL SENSORY TO ANTEROINFERIOR PART Posterior lateral nasal nerve Posterior lateral nasal nerve ( branch v2) ( branch v2) ORIGIN : TRIGEMINAL GANGLION EXIT : FORAMEN ROTUNDUM Greater palatine PROVIDE GENERAL SENSORY TO POSTEROSUPERIOR PART Anterior superior nerve (branch V2) alveolar nerve Greater palatine nerve (branch V2) (branch V2) ORIGIN : TRIGEMINAL GANGLION EXIT : FORAMEN ROTUNDUM PROVIDE GENERAL SENSORY TO POSTEROINFERIOR PART  NERVE SUPPLY (LATERAL WALL OF NASAL CAVITY) Anterior ethmoidal nerve ( branch V1) Olfactory nerve (cn 1) Secremotor innervation of glands Pterygopalatine in mucosa by : ganglion PREGANGLIONIC FIBRES FROM SUPERIOR CERVICAL Posterior lateral nasal nerve GANGLION ( branch v2) POSTGANGLIONIC FIBRES FROM PTERYGOPALATINE GANGLION Greater palatine Anterior superior nerve (branch V2) alveolar nerve (branch V2)  04 PARANASAL SINUSES Paranasal Sinuses + AIR-FILLED CAVITIES WITHIN + BONES INVOLVED: THE NASAL CAVITY FRONTAL MAXILLA SPHENOID + PAIRED BUT ASSYMETRICAL ETHMOID + LINED WITH RESPIRATORY EPITHELIUM + FUNCTIONS: RESONATING VOICE ENHANCE THE RESONANCE OF SPEECH REDUCE WEIGHT OF SKULL AIR-CONDITIONING CHAMBERS  Sphenoid Sinus PAIRED, ASYMMETRIC CAVITIES LOCATED INSIDE THE SPHENOID BODY SEPARATED BY A BONY SEPTUM RELATIONS SUPERIORLY: - OPTIC CHIASMA - PITUITARY GLAND LATERALLY: - CAVERNOUS SINUS - INTERNAL CAROTID ARTERY BEHIND: -PONS & MEDULLA OBLONGATA ARTERIAL SUPPLY: POSTERIOR ETHMOIDAL ARTERY ( BRANCHES OF OPTHALMIC ARTERY )  Sphenoid Sinus At 6 years old,size of a small pea pneumatization =  Relations of Sphenoid Sinus  Ethmoidal Sinus 3-18 SMALL INTERCONNECTED AIR SPACES CONTAINED WITHIN THE ETHMOID BONE, BETWEEN NOSE AND ORBIT 3 GROUPS: ANTERIOR, MIDDLE & POSTERIOR SEPARATED FROM ORBIT BY A THIN BONE PLATE > SO THAT INFECTION CAN READILY SPREAD FROM SINUSES INTO THE ORBIT RELATIONS: LATERALLY —>ORBITAL PLATE OF ETHMOID ARTERIAL SUPPLY: ANTERIOR & POSTERIOR ETHMOIDAL BRANCHES OF OPHTHALMIC A.  Ethmoidal Sinus DRAINED INTO THE MIDDLE NASAL MEATUS. THE MIDDLE CELLS ARE ALSO DRAINED TO THE KNOWN AS “BULLAR MIDDLE NASAL CELLS” FROM A BULGE THEY MEATUS VIA THE FORM ON THE MIDDLE ETHMOIDAL NASAL MEATUS INFUNDIBULUM. (ETHMOIDAL BULLA) DRAINED INTO THE SUPERIOR NASAL MEATUS Ethmoidal Sinus Ethmoidal Sinus  Relations of Ethmoidal Sinus CORONAL SECTION OF HEAD CORONAL CT SCAN  Relations of Ethmoidal Sinus TRANSVERSE SECTION SAGITTAL SECTION OF HEAD OF HEAD  Relations of Ethmoidal Sinus ANTERIOR ETHMOIDAL ARTERY POSTERIOR ETHMOIDAL ARTERY  Frontal Sinus THERE ARE TWO ABSENT AT BIRTH, APPEAR DURING THE 2ND YEAR OF LIFE CONTAINED WITHIN THE FRONTAL BONE, SEPARATED BY A BONY SEPTUM ROUGHLY TRIANGULAR EXTENDS INTO: + UPWARD AND ABOVE THE MEDIAL END OF THE EYEBROW + BACKWARD INTO THE MEDIAL PART OF THE ROOF OF THE ORBIT ARTERIAL SUPPLY: SUPRAORBITAL VESSELS NERVE SUPPLY: SUPRAORBITAL NERVE Relations of Frontal Sinus  Relations of Frontal Sinus MEDIAL VIEW OF NASAL CAVITY ARTERY & NERVE SUPPLY  Maxillary Sinus LARGEST SINUS & 1ST TO FORMED PYRAMIDAL SHAPED BOUNDARIES : 1. ROOF - ORBITAL SURFACE OF MAXILLA (TRANSVERSE BY INFRAORBITAL NERVE & VESSEL 2. FLOOR - ALVEOLAR PROCESS OF MAXILLA (CLOSELY RELATED TO ROOT OF PREMOLAR & MOLAR) 3. POSTERIOR - ANTERIOR WALL OF INFRATEMPORAL FOSSA (PIERCED BY POSTERIOR SUPERIOR ALVEOLAR VESSELS & NERVE)  Maxillary Sinus ARTERIAL SUPPLY - ANTERIOR, MIDDLE & POSTERIOR SUPERIOR ALVEOLAR VESSELS OF MAXILLARY ARTERY NERVE SUPPLY - ANTERIOR, MIDDLE & POSTERIOR SUPERIOR ALVEOLAR NERVE  Relations of Maxillary Sinus 1. Superior Orbit Infraorbital nerve & vessels 2. Inferior Roots of molars & premolars 3. Medially Nasal cavity 4. Laterally Cheek  Relations of Maxillary Sinus Coronal section of head Coronal CT scan  Reduction of large maxillary hiatus to small ostium 1. Maxillary hiatus: It is a large, irregular opening in the lateral wall of the nasal cavity that connects to the maxillary sinus. 2. Maxillary ostium: It is the functional opening of the maxillary sinus into the nasal cavity, allowing air to flow and mucus to drain The large maxillary hiatus becomes a small ostium because it is partially covered by surrounding bones and soft tissue 1.Uncinate process of the ethmoid bone 2. Inferior concha 3. Perpendicular plate of the palatine bone 4. Lacrimal bone Opening of the paranasal sinus Meatus : space beneath the concha shortest lies beneath the superior concha above superior concha lies beneath middle concha largest lies beneath the inferior concha Opening of the paranasal sinus Applied Anatomy sinusitis MAXILLARY OCCURS WHEN THE MAXILLARY SINUSES BECOME INFLAMED OR INFECTED SYMPTOMS: PAIN IN THE CHEEK, NEAR THE UPPER TEETH, OR AROUND THE EYES CONGESTION REDUCED SENSE OF SMELL HEADACHES TYPES: ACUTE MAXILLARY SINUSITIS— USUALLY LASTS LESS THAN FOUR WEEKS CHRONIC MAXILLARY SINUSITIS— LASTS 12 WEEKS OR MORE, EVEN WITH TREATMENT ODONTOGENIC MAXILLARY SINUSITIS— A TYPE OF SINUSITIS THAT'S CAUSED BY DENTAL OR DENTOALVEOLAR DISEASES  Applied Anatomy SINUSITIS AN INFLAMMATION OF THE TISSUES IN YOUR SINUSES IT CAUSES FACIAL PAIN, A STUFFY OR RUNNY NOSE, AND SOMETIMES A FEVER AND OTHER SYMPTOMS IT’S USUALLY CAUSED BY THE COMMON COLD, BUT OTHER VIRUSES, BACTERIA, FUNGI AND ALLERGIES CAN ALSO CAUSE SINUSITIS Applied Anatomy ENDOSCOPIC SINUS SURGERY FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS) A PROCEDURE TO REMOVE BLOCKAGES AND TREAT OTHER PROBLEMS IN THE SINUSES USING AN ENDOSCOPE — A THIN, RIGID TUBE WITH A CAMERA AND A LIGHT THIS TYPE OF SURGERY DOES NOT INCLUDE CUTTING THE SKIN BECAUSE IT IS PERFORMED ENTIRELY THROUGH THE NOSTRILS Applied Anatomy ENDOSCOPIC SINUS SURGERY  That's A wrap THANK YOU FOR PARTICIPATING