THE NOSE & PARANASAL

SINUSES

THE NOSE IS PRIMARILY MEANT FOR

BREATHING. THE LOWER 2/3 IS THE
WIDER RESPIRATORY PART.
SINCE ODOURS ARE AIRBORNE THE
OLFACTORY PART IS IN THE
NARROWER UPPER 1/3.
THE PARANASAL SINUSES ARE AIR
SACS IN THE BONES AROUND THE
NOSE, WHOSE SECRETIONS DRAIN
INTO IT

FUNCTIONS OF THE NOSE AND PARANASAL

SINUSES

NOSE

1. RESPIRATORY AIRWAY
2. AIR CONDITIONING BY
HEATING AND
HUMIDIFICATION
3. PROTECTIVE
FILTRATION AND
CILIARY MECHANISM
4. OLFACTION
5. VOCAL RESONANCE
6. NASAL CONSONANTS
7. NASAL REFLEX
FUNCTIONS

PARANASAL SINUSES
NUMEROUS FUNCTIONS
HAVE BEEN PROPOSED
BUT WITHOUT
EQUIVOCAL EVIDENCE.
SOME ARE 1. SUPPLEMENTARY AIR
CONDITIONING CHAMBER
2. VOCAL RESONANCE
3. VESTIGIAL OLFACTION
ESP. IN LOWER ANIMALS
4. THERMAL INSULATORS
5. AID TO BALANCE OF
HEAD

Extent and subdivisions of the nasal cavity

The nasal cavity is the space between the nares
(nostrils/anterior nasal orifice) in front and the
choanae (posterior nasal apertures) behind;
between the hard palate (roof of mouth)
below and anterior cranial base above.
The cavity is divided into the right and left
halves by the nasal septum.
Each is further into 1.Vestibule from nares to limen - skin
2.Respiratory below superior concha-resp
epith&
3.Olfactory regions olfactory neuroepthelium

The paranasal sinuses

These are diverticula (outpouchings) from both
nasal cavities.
The frontal sinus occupies the lower vertical
and orbital part of that bone.
The maxillary sinus occupies almost whole of
body of maxilla.
The sphenoid occupies the body of the
sphenoid bone
The ethmoid air cells comprise multiple small
inter- connected air sacs between the orbit
and nose. They are grouped as
Anterior (+/- 11 cells),
Middle (+/- 3 cells) &
Posterior ethmoidal (+/- 5 cells) sinuses

MEDIAL WALL OF NOSE

LATERAL WALL OF
NOSE

The skeleton of the medial

nasal wall

It is always a good idea to

learn the bones of a region
before proceeding further.
The bones of the nasal
septum and other
landmarks are:
1. nasal
2. frontal
3. ethmoid
4. sphenoid
5. vomer
6. perpendicular plate of
ethmoid
7. maxilla
8. horizontal process of
palatine bone
9. medial pterygoid plate
10.occipital condyle

Schema of Nasal Septum

Usually when the
head is bisected,
the nasal septum is
either destroyed or
left behind on one
side.
The nasal septum is
made up of the
following:
perpendicular plate
of ethmoid
vomer
maxilla
septal cartilage

Skeleton of external nose

Features of Lateral nasal wall

Be sure you know which is front

and back and up and down. Look
at the lateral wall of the nasal
cavity and identify:
sphenoethmoidal recess (arrow
above 1)
superior concha (1)
superior meatus (tip of arrow)
middle concha (2)
middle meatus (tip of arrow)
inferior concha (3)
inferior meatus (tip of arrow)
A meatus is a small space under
the concha.
The superior and middle conchae
are parts of the ethmoid bone.
The inferior concha is a separate
bone of the skull
Vestibule & vibrissae
Limen
atrium

Structures on lateral wall after excising middle and

inferior conchae
Once the most obvious
structures are
identified, removal of
the middle and inferior
conchae reveals other
items to be identified:
cut edges of middle and
inferior conchae (1 and
2)
hiatus semilunaris (3)
ethmoid bulla (bulge
formed by ethmoid air
cells (4)
small bulge formed by the
nasolacrimal duct (5)
(not always apparent)

Relation of nose to paranasal

sinuses

In order to get an idea as to the

relationship of the nasal cavity to the
air sinuses, a frontal section is
shown in the image. Again use
familiar structures to orient yourself,
like the orbits with the optic foramen
(black circle). Identify: right and left
nasal cavities on either side of the
nasal septum made up of the:
vomer (7) and
perpendicular plate of ethmoid (1)
superior, middle and inferior conchae
(3-5) with the meatus deep to them
large maxillary sinus
ethmoid sinuses
frontal sinus
Note that the roof of the nasal cavity
is made up of the cribriform plate
(not labeled) but on each side of (1).
Also note that the floor of the nasal
cavity is made up of the palatine
processes of the maxilla (6).

Where do sinuses drain

The paranasal sinuses are lined with a mucous
membrane that secretes a fluid to keep the
lining moist. Under normal conditions, the
sinuses drain into various parts of the nasal
cavity.
1. sphenoid sinus-->sphenoethmoid recess
2. frontal sinus-->infundibulum of middle
meatus
3. anterior ethmoid sinus-->middle meatus
4. middle ethmoid sinus-->ethmoid bulla of
middle meatus
5. maxillary sinus-->middle meatus
6. One other structure empties into the nasal
cavity and that is (6) the nasolacrimal duct.
You can see that this duct is close to the front
of the nasal cavity and therefore should
realize why your nose runs when you cry. This
duct carries away extra tears.
You should also realize that when the
drainage pores are closed off due to irritation,
the mucous can no longer drain out of the
sinuses, they fill up and cause pressure which
can then cause headaches (sinus headaches).
Sinus medication reduces the swelling so
that the mucous can drain.

Nerve and
blood supply
of lateral
wall
lat wall into
quadrants by a
simple + sign:

Posterosuperior quadrantPostrior superior lateral nasal

nerves
Sphenopalatine artery
Posteroinferior quadrantAnterior palatine nerve
Greater palatine artery
Anterosuperior quadrantAnterior ethmoidal nerve
Anterior ethmoidal artery
Anteroinferior quadrantAnterior superior alveolar nerve
Terminal branch > palatine a. &
superior labial br. of facial artery

Nerve supply of septum

Sensory innervation to
the nose is also
important in that it
provides reflexes
(such as the sneeze
reflex) to keep
foreign particles out
of the respiratory
system. The sensory
nerves to the septum
are:
1.anterior ethmoidal
(V1) (nasociliary)
2.nasopalatine (V2)
(maxillary)