Lect 13: Nose cavity &paranasal sinuses

22.3.2011

Done by: roshaliyana jaafar, amar adam, nur nuha

Today’s lecture is about the nose and the nasal cavity and paranasal
sinuses...

So this is the nose, as you know it consists of the external nose and then the
nasal cavity

The external nose has three parts which are: apex/tip of the nose and then
there is dorsum of the nose and bridge/roof of the nose. You know about
the anterior nasal apertures, you saw the posterior nasal aperture (choana)
on the skull. Now the anterior nasal apertures are bounded medially by the
nasal septum and laterally by the ala of the nose.

The external nose is made up by bones and cartilages and those nasal
bones articulate with nasal part of the frontal bone above andthe frontal
process of maxilla laterally.

In the middle or midline, you have the two nasal bones articulate forming a
crest and that crest articulate with the perpendicular plate of the ethmoid
bone and the central cartilage forming the nasal septum, the lateral nasal
cartilage articulates with the maxilla and the nasal bone.

Remember there are three cartilages, three major cartilages forming the
external nose and there are several minor or small ones. The first major
one is called the lateral nasal cartilage and it articulates with both maxilla
and nasal bones and it continues from one side to the other then you have
great alar cartilages I will show you those cartilages on a figure in a
moment, so the great articular cartilages surround the nasal apertures, the
anterior ones and they hold them open. Then you have the septal cartilage
as the name indicates so it forms part of the nasal septum, so here, these
are the bones that forms the external nose, you have the nasal bone, this is
one, this is the other one they meet and articulate in the middle here and
then u have this is the frontal process of the maxilla, it forms the part of the
external nose.
Then the cartilages of the external nose are this is the lateral nasal
cartilage, continues from one side to the other and then you have the great
alar cartilage consisting of the lateral grooves and medial grooves. Finally
you have the septal cartilage here in the middle forming part of the nasal
septum.

Remember that the external nose is innervated by branches of the

ophthalmic division that branches the infratrochlear nerve …………and then
branch of maxillary division of trigeminal nerve which is the infraorbital
nerve and finally another branch of ophthalmic division of the trigeminal
nerve is the external nasal nerve.

The external nose is supplied by branches of the ophthalmic artery, you

have the dorsal nasal artery and the external nasal artery and then there is
the septal branch from the facial artery, so here this is supratrochlear
nerve, branch of the ophthalmic division then here is the infratrochlear
nerve then you have the external nasal nerve.

Regarding the artery………if you remember, this is the facial artery, here is
the angular artery, you have the dorsal nasal artery, branch of the
ophthalmic artery and then there is external nasal artery accompanying the
external nasal nerve.

There is the nasal cavity; you have two nasal cavities divided by nasal
septum. Again there are the anterior nasal apertures also called nostrils or
naris and posterior nasal apertures…….and the nasal cavity is that part
between those pairs of apertures.

Now remember that the nasal cavity is separated from the oral cavity by
the palate and that it opens posteriorly into the nasopharynx

If you remember this is here, the ala of the nose, that portion of the nasal
cavity underlying the ala of the nose is called vestibule and if you
remember from histology the vestibule is lined by modified skin and it has
the vibrancy? And the vibrancy?*not sure.... {C.T couldn’t find it in the
book!}* are those hairs in that modified skin lining the vestibules.

Now you have 3 kinds of lining, we said there is the vestibule, there is if you
remember the superior conchae here on the lateral wall, middle conchae
and inferior conchae.

Now the lower half of the nasal cavity is lined by the respiratory
epithelium, the constituent is the pseudostratified or the ciliated columnar
cells, and then there is the olfactory epithelium or mucosa covering the
superior concha, both superior choncha on the lateral wall and the upper
part of the medial wall which is the nasal septum.

Now as any cavity or compartment there are floor, roof, medial and lateral
walls. Now the floor of nasal cavity is formed by the superior surface of the
hard palate which is composed of the palatine processes of the maxilla
bone and the horizontal plate of palatine bone.

Then we have the roof which is formed by the nasal and frontal bone
anteriorly, and then the cribiform plate of ethmoid bone in the middle and
finally posteriorly by the body of sphenoid bone. Now the median wall
again is formed by the nasal septum which is formed by septal nasal
cartilage anteriorly and bones posteriorly (those bones are perpendicular
plate of ethmoid bone and the vomer). The vomer forms the posterior-
inferior part of the nasal septum.

Remember that the nasal septum is usually deviated in adult and that’s
why the nasal cavities are usually unequal on the right and the left sides. So
this is here the median bone which is the nasal septum, you can see septal
cartilage, perpendicular plate of the ethmoid bone. Posteriorinferiorly the
nasal septum is formed by the vomer.
 Now the lateral wall of the nasal cavity is formed by many bones, which
are nasal bone, frontal process of the maxillary bone, lacrimal bone, the
conchae of ethmoid bone (Superior & Middle), inferior nasal concha, and
the perpendicular plate of palatine bone and medial pterygoid plate. Now
remember that the lateral wall of the nasal bone is complicated and
uneven. It has projection/ swollen. These are called conchae (single-
concha), there are three pairs of them (Superior, Middle and Inferior).
Again the Superior and Middle conchae are formed from the ethmoid bone,
whereas the Inferior concha is just a bone itself. So below here
demonstrated the lateral wall of the nasal cavity.

Now the conchae are just a projection so there are spaces underlying those
conchae. Those spaces are called meatuses. There is space underlying the
Superior concha called Superior meatus, then one underlying Middle
concha called Middle meatus and lastly underlying the Inferior concha
called Inferior meatus. In addition to that, there are extra spaces or
passageway. Those spaces are important as they receive the openings of
paranasal sinuses. Now there is something called sphenoethmoidal recess
which lies superior and posterior to Superior concha.

In the lateral wall of middle meatus there is a rounded swelling\elevation

ethmoidal bulla, it is formed by the middle ethmoidal cells and also
receives the opening of these cells. There is also hiatus semilunaris
(semi=half, lunaris=lunar/ moon) located below the ethmoidal bulla. Then
there’s a ridge located below this hiatus semilunaris and it is called the
uncinate process of ethmoid bone. Finally, there is ethmoidal infundibulum,
which is, like a passageway that acts as a forward extension from the hiatus
semilunaris.
So, here, you have, this is the superior concha, this is the middle concha. It
has been partially removed and this is the inferior concha. Now, above and
behind the superior concha, you have the sphenoethmoidal recess.

Here, this is middle concha and so, underlying middle concha is a space
called middle meatus. This middle meatus has this swelling called bulla
ethmoidalis and then hiatus semilunaris. You have the infundibulum here,
which is just an upward forward extension of hiatus semilunaris.

Then, you have inferior concha and underlying it, is the inferior meatus.
Now, underlying the superior concha is the superior meatus.

Now, here, you remember, this is frontal bone and here is the frontal sinus.
Remember, when we said sinus, it’s just a cavity within the bones. So, there
are many paranasal sinuses.

You have the frontal sinus here; this is the body of the sphenoid bone.
Within the body of sphenoid bone, there are the sphenoid sinuses. In fact,
although there is one frontal bone, there are 2 frontal sinuses and although
there is 1 sphenoid bone, there are 2 sphenoid sinuses. Those paranasal
sinuses are separated by a bony septum.

Now, this is just to show the nerves within the nasal cavity. You have here,
is the olfactory nerve. If you remember, here is the olfactory mucosa,
olfactory epithelium; you have olfactory neurons which are bipolar
neurons. All the neurons (special senses) are bipolar.

Axons of those bipolar neurons form the olfactory nerve which travel in the
olfactory tract and synapse on the 2nd order of the neurons present on the
olfactory bulb. Then, you have, this is the nasal branch of anterior
ethmoidal nerve. It is a branch of the ophthalmic nerve or division of
trigeminal nerve.

You have nasopalatine nerve. I’m not asking you to know the names of the
nerves. Just know there are olfactory nerves, internal nerves in nasal
nerves and there are branches of maxillary division of trigeminal nerve.

Regarding the nasal cavity blood supply. There are branches of maxillary
artery. You have simple branches of a branch of maxillary artery called the
sphenopalatine artery. Those branches anastomose with septal branches of
facial artery which come off the superior labia l artery.

Remember, there is the venous plexus which is present in the submucosa.

Due to this plexus (something) occurs whenever there is injury. So this is
just the blood supply of the nasal cavity. Since you do not really know the
real name of those branches, so, just know, this is the septal branch of the
sphenopalatine artery which is a branch of maxillary artery and it
anastomoses with the septal branch of facial artery which you can’t see
here.

This is the lymphatic drainage. Of course, I will talk to you about lymphatic
drainage of the head and neck, later in this course. But just for now, know
that this cell that drains the vestibule go to the submandibular nodes
whereas those remainder of the nasal cavity go to the deep cervical
nodes.

Now, remember that the paranasal sinuses arise from invaginations of the
mucous membrane of the nasal cavity. So, they drain into the nasal cavity.
So, you have many paranasal sinuses which are in the maxilla, frontal,
sphenoid and ethmoid bones.

The frontal sinus, again, there are 2 frontal sinuses within the frontal bone,
which are separated by bony septum and they drain into the middle meatus
to the infundibulum. They are separated from the orbit by a thin bone.

The ethmoid sinus there are 3 groups of ethmoid sinuses named according
to their locations within the ethmoid bone. Now, remember that the
ethmoid sinuses are present between the nose and the orbit.

1) Anterior ethmoid sinuses

- Opens into infundibulum in middle meatus

2) Middle ethmoid sinuses

- Also called ethmoid air cells
- Opens into middle meatus or above the bulla ethmoidalis

3) Posterior ethmoid sinuses

- Opens into the superior meatus

The orbital plate of the ethmoid bone separates the ethmoidal air cells from
the orbit. You have to remember this because it is important in cases of
injury. So, whenever, for example, ethmoidal air cells are injured or
something, this can lead to blindness by influencing the optic canal.

The maxillary sinuses are the largest sinuses, similar to the other paranasal
sinuses; they are located within the body of the bone, that they hold their
name. So, within the body of maxilla, they open into the hiatus semilunaris
or onto the uncinate process in the middle meatus.

The roof of maxillary sinus is thin. That’s why, in the fractures, the eyeball
can fall into the maxillary sinus O_o. It’s a strong one. Now, the floor of
maxillary sinus is very closely related to the root of premolars and molars
(the upper one), especially molars. That’s why; the infection of the
maxillary molars can extend into maxillary sinuses.

Finally, the sphenoid sinuses are located within the body of sphenoid bone
separated from each other by bony septum and they open into the
sphenoethmoidal recess. Here, you have frontal sinus, this is another one.
Here are the ethmoidal air cells or ethmoid sinuses and then, the maxillary
sinuses. Here, just to see the sphenoid sinuses. End.