It is a introductory ppt for rhinology in ent.

1. Anatomy
of Nose
DR T. K. MANDAL
RMO cum CT
BMC&H

2. Anatomy of Nose:(chapter inculdes)
(I) External Nose:
A) Osteocartilaginous framework
a)Bony part,
b)Cartilaginoes part( i)Upper lateral cartilage ii)Lower lat iii)Lesser
alar c& iv) Septal c .
B)Nasal musculature
C)Nasal skin
(II)Internal nose:
A) Vestibule of nose
B)Nasal cavity propera) Lateral nasal wall (L.Q.) [i)IT & meatus,ii)MT
& meatus,iii)ST & meatus, iv) Sp-ethmoidal recess v)supreme tur]
b)Medial wall c)Floor d)Roof.
C) Lining membrane of internal nosea)Vestibule b)Olfactory region
c)Respiratory region.
(III) Nerve supply, Blood supply, Lymphatic drainage.

3. Various parts of nose & related fascial
stcrs:
Front view: i)Philtrum ii)Columella
iii)Naris iv)Alar groove v)Dorsum
Lateral view: i) Root of nose
ii)Nasolabial angle.
Philtrum
Columella
Naris
Dorsum
Alar groove
Root of nose
Nasolabial
angle

4. (I) External Nose:
A) Osteocartilaginous framework
a)Bony part, b)Cartilaginoes part(i)Upper lateral cartilage ii)Lower lat
iii)Lesser alar c& iv) Septal c .
Lateral view: Basal view:
Nasal bone
rocess of
maxilla
ULC
LLC
ser alar
rtilage
Septal
cartilage
Lat crus
Med cru
Caudal border of
septal cartilage
Fibrofatty tisue

5. (I) External Nose(cont):
A) Osteocartilaginous framework
a)Bony part,
b)Cartilaginoes part( i)Upper lateral cartilage
ii)Lower lat iii)Lesser alar c& iv) Septal c .
B)Nasal musculature:1)Procerus 2)Nasalis 3)Levator labii
superioris alaque nasi 4)Ant & post dilator nares & 5)
Depressor septi w/ bring about movements of nasal tip, ala
the overlying skin.
C)Nasal skin: Skin over nasal bones & upper lateral cartilages
is thin and freely mobile. Covering the alar cartilages is
thick and adherent, & contains many sebaceous glands.
Hypertrophy of these sebaceous glands, gives rise to
lobulated tumour k/a rhinophyma.

6. Rhinophyma/ Potato tumor (S.Q.)
i)Slow-growing benign Tumour often seen in cases of long-standing acne rosacea. ii)It
presents pink, lobulated mass over the nose with superficial vascular dilation. Iii) Patient
seeks advice because of the unsightly appearance. Iv) Tt: paring down the bulk of tumour
with sharp knife or carbon dioxide laser area allowed to re-epithelialise.

7. (II)Internal nose:
Divided into rt & lt nasal cavities by n septum. Each n cavity consists of
a skin-lined portion—the vestibule & a mucosa-lined portion the
n cavity proper.
A) Vestibule of nose Ant & inf part of n cavity is k/a vestibule. It is
lined by skin & contains sebaceous glands, hair follicles. The hair k/a
vibrissae. Its upper limit on the lateral wall is marked by limen nasi
(also k/a n valve (S.Q.), formed by the lower border of upper lateral
cartilage ,fibrofatty tissue & ant end of IT. Medially by the
cartilaginous n septum upto its mucocutaneous junction.
B)Nasal cavity propera) Lateral nasal wall (L.Q.) b)Medial wall
c)Floor d)Roof.

8. Internal nose(saggital view):
Vestibule
Nasal cavity
proper

9. (II)Internal nose:
A) Vestibule of nose
B)Nasal cavity propera) Lateral nasal wall (L.Q.) [i)IT & meatus,ii)MT &
meatus,iii)ST & meatus, iv) Sp-ethmoidal recess v)supreme tur] b)Medial wall c)Floor
d)Roof.
3 & occasionally 4 turbinates /conchae mark
lateral wall of nose.Turbinates are scroll like
bony projections covered by mucous
membrane. The spaces below the turbinates
are k/a meatuses.
Consists of (i) IT & meatus (S.Q.) (ii) MT (iii)M
meatus(S.Q.) (iv) ST & meatus (v)
Spenoethmoidal recess (v) supreme
turbinate.

10. Structures on lateral wall of nose:
Vestibule
Agger
nasi
Atrium
ST & meatus
MT & meatus
IT & meatus

11. i)Inferior turbinate(S.Q.)
 It is a separate scrolllike bone.
 Unlike the MT & ST it runs a fairly staight course
from ant to post.
 Inf margin free & overhangs I meatus.
 Sup margin attached to, maxilla ant-ly & palatine
bone post-ly.
 Approximately 1cm behind of its ant end shows a
peak/apex w/ can be recognized in live pt. The
NLD opens into IM at this peak, is guarded at its
terminal end by a mucosal valve k/a Hasner’s
valve

12. MAXI. OSTIUM RELATIONS
WITH L. PAPYRACEA &NLD:
where IT trimmed:
NLD canal dissected & split(show nld
duct, hasners valve & lacrimal sac)
5mm ant to N max sinus.

13. ii) M turbinate(S.Q.):
 A convoluted stctre bending in different planes similar to a dried
leaf. It is attached to the lateral wall by a bony lamella in its middle
1/3rd w/ stabilizes the MT, k/a ground /basal lamella. Its
attachment is not straight but in an S-shaped manner & orientation
in 3 dimensional space.
 Ant 1/3rd lies in sagittal plane & attached to lateral edge of
cribriform plate.
 Middle 1/3rd lies in frontal plane & attached to lamina papyracea .
 While post 1/3rd runs horizontally & forms roof of the m meatus &
attached to lamina papyracea & medial wall of maxillary sinus.
 The ostia of various sinuses draining anterior to basal lamella form
anterior group of paranasal sinuses while those which open
posterior & superior to it form the posterior group.

14. MT
ATTACHMENTS:
i)Convoluted bendig
strctr-simiar to dried leaf.
ii)Divided into 3 parts-
ant,middle & post 1/3rd.
iii)May pneumatised with
eth cells, k/a concha
bullaso.

15. (iii)Middle meatusShows several important strctrs w/ are important in
ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F Recess 4) Atrium 5)Agger
nasi cells 6)Conchae bullosa 7)Haller cells.
(1)Uncinate process: (S.Q.)
 A hook-like structure running from ant-superior to post-inferior
direction.
 Its post-superior border is sharp & runs parallel to ant border of
bulla ethmoidalis; the gap b/w the 2 is k/a hiatus semilunaris
(inferior). It is a 2-D space of 1–2 mm width w/ leads into a 3D
space k/a the infundibulum.
 The ant-inferior border of UP is attached to the lateral wall.
 Post-inferior end of UP is attached to IT dividing membranous part
of lower m meatus into ant & post fontanelle. The fontanel area is
devoid of bone & consists of membrane only w/ leads into maxillary
sinus when perforated.
 Upper attachment of UP shows great variation .May be inserted
into lateral nasal wall, upwards into base of skull or medially into
the MT. This also accounts for variations in drainage of frontal sinus.

16. (iii)Middle meatusShows several important strctrs w/ are
important in ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F
Recess 3)Atrium 5)Agger nasi cells 6)Conchae bullosa 7)Haller
cells.
(1)Uncinate process:(cont.) 
 The space limited medially by UP & frontal process of
maxilla & sometimes lacrimal bone, and laterally by the
lamina papyracea is k/a the infundibulum.(S.Q)
 Natural ostium of maxillary sinus is situated in the
lower part of infundibulum. Accessory ostium or ostia
of maxillary sinus are sometimes seen in the anterior
or posterior fontanel.
 The UP, the bulla & the intervening infundibulum form
the key area/osteomeatal unit or complex (S.Q.)into
w/ the frontal, maxillary & ant ethmoidal sinuses drain.

17. MT
WINDOW
CUT-
showing
OM-unit:
i) U process
ii) Eth bulla
iii) HS

18. Lateral wall of nose with turbinates removed
showing openings of various sinuses.

19. (iii)Middle meatusShows several important strctrs w/ are
important in ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F
Recess 4) Atrium 5)Agger nasi cells 6)Conchae bullosa 7)Haller
cells.
(2)Bulla ethmoidalis (S.Q.)
• An ethmoidal cell situated behind the UP.
• Ant surface of bulla forms the posterior boundary of HS.
• Depending on pneumatization, bulla may be a pneumatized cell/ a solid
bony prominence. It may extend sup-ly to the skull base & post-ly to fuse
with ground lamella. When there is a space above or behind bulla, it is k/a
suprabullar or retrobullar recesses, respectively .
• Suprabullar & retrobullar recesses together form the lateral sinus (sinus
lateralis of Grunwald).(S.Q.) The lateral sinus is thus bounded superiorly
by the skull base, laterally by lamina papyracea, medially by middle
turbinate and inferiorly by the bulla ethmoidalis. Posteriorly the sinus
lateralis may extend up to basal lamella of middle turbinate.
• The cleft-like communication between the bulla and skull base and
opening into middle meatus is also called hiatus semilunaris superior in
contrast to hiatus semilunaris inferior referred to before.

20. M TURBINATE
TRIMMED-
obvius view
within m
meatus:
UPvertical up end to
lacrimal bone.
Horizontal part attached
to IT & perpendi palatine
bone.
8% rudimentary/absent,
hence A/L nomenclature is
torus lateralis/lateral
bulge.
Sinus lateralis
boundaries

21. (iii)Middle meatusShows several important strctrs w/ are
important in ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F
Recess 4) Atrium 5)Agger nasi cells 6)Conchae bullosa 7)Haller
cells.
(3) Frontal recess:
 The infundibulum leads directly/indirectly into frontal
recess w/ bounded ant-ly by agger nasi cell(ant wall of
AG cell), post-ly by bulla ethmoidalis, lat-ly L papyracea
& medial wall formed by MT.
 Sup-ly the F recess opens via F ostium into F sinus w/ is
seen from above as funnel shaped & is placed at the
post & medial end of the floor of the F sinus.This
funnel shaped region is k/a F infundibulum.
 In saggital cross section the F infundibulum, the F
ostium & F recess together form Hour-glass
configuration.

22. F recess & its boundaries;
& HOUR-GLASS
CONFIGURRATION
i)U Process ,up end anatomy variation:
• mcly 80% to L papy in form of dome
( inverted egg cup & recess within it k/a
recessus terminalis)
• extend upto base of skull
• attach to middle m tur.
• to the insertion of m tur.
• lie free in m meatus.
• may pneumatised
ii)Contents of F recess variation:
• AG cell small/large/single/multiple/rarely abs
• Bulla small/large/upto skull base/stopping at
suprabuller recess.
iii)Diff types frontal cells (ant eth cell
migration into F recess):kuhn
classification(S.Q.)
T-Isingle cell above AG cell
T-II2/>
T-IIIlarge cell(frontal bulla, mimicking F
sinus itself)
T-IVisolated loner cell

25. (iii)Middle meatusShows several important strctrs w/ are important in
ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F Recess 4)Atrium 5)Agger
nasi cells 6)Conchae bullosa 7)Haller cells.
(4)Atrium of the middle meatus It is a shallow
depression lying in front of middle turbinate and
above the nasal vestibule.
(5)Agger nasi 
• It is an elevation just anterior to the attachment
of middle turbinate.
• When pneumatized it contains air cells, the agger
nasi cells, which communicate with the frontal
recess. An enlarged agger nasi cell may encroach
on frontal recess area, constricting it and causing
mechanical obstruction to frontal sinus drainage.

26. LATERAL NASAL WALL-view
on saggital section
•:
•Series of elevation & depressions,
•Ridge extending agger nasi to IT-
NLD
•3 turbinates & meatuses

27. Agger nasi cell

28. (6)Conchae bullosa
• Pneumatization of middle turbinate leads to an
enlarged ballooned out middle turbinate called concha
bullosa.
• It drains into frontal recess directly or through agger
nasi cells.
(7) Haller cells
• Situated in the roof of maxillary sinus. They are
pneumatized from anterior or posterior ethmoid cells.
• Enlargement of Haller cells encroaches on ethmoid
infundibulum, impeding draining of maxillary sinus.
(iii)Middle meatusShows several important strctrs w/ are important
in ESS(Surgical imp.) (S.Q.)1) UP 2) Bulla eth 3)F Recess 4)Atrium
5)Agger nasi cells 6)Conchae bullosa 7)Haller cells.

30. (iv)Superior turbinate & meatus:
• It is situated post & sup to MT. It may also get pneumatized by one or
more cells.
• It forms an important landmark to identify ostium of sphenoid sinus w/
lies medial to it w/ can be located endoscopically about 1 cm above the
upper margin of posterior choana close to the posterior border of the
septum
• Superior meatus is a space below the ST. Posterior ethmoid cells open
into it. Number of posterior ethmoid cells varies from 1 to 5.
Onodi cell(S.Q.) is a posterior ethmoidal cell w/ may grow post-ly by the
side of sphenoid sinus /superior to it for as much distance as 1.5 cm from
anterior surface of sphenoid. Onodi cell is surgically important as the optic
nerve may be related to its lateral wall.
(v)Sphenoethmoidal recess
• Situated above the ST. Sphenoid sinus opens into it.
vi)Supreme turbinate.
• Sometimes present above the ST & has a narrow meatus beneath it.

32. Surgical importance of lat N wall:
• During ESS the surgeon has to traverse 4 main
barriers in the coronal plane as he proceeds
deeper into the operative field.
• These from ant to post are the UP, the ant
wall of bulla, the ground lamella & the ant
wall of SS.
• The surgeon may also encounter the ground
lamella of ST if present & if he dissects
superolaterally.

33. A &P ETH CELL
DISSECTED TO
SHOW 4 LAMELLAE:
SS ostium lies high on its
ant wall,1-1.5 cm above
the roof of choana & 2-3
mm away froms eptum.
The Stur may overlie the ss
ostium.
Reltion of SS & post eth
cells so ss lie post,inf &
medial to post eth cells.

34. B)Nasal cavity propera) Lateral nasal wall (L.Q.)
b)Medial wall c)Floor d)Roof.
b)MEDIAL WALL:
• Nasal septum forms the medial wall.(described later)
c)ROOF:
• Anterior sloping part of the roof is formed by nasal bones.
• Posterior sloping part is formed by the body of sphenoid bone.
• The middle horizontal part is formed by the cribriform plate of
ethmoid through w/ the olfactory nerves enter the nasal cavity.
d)FLOOR:
• It is formed by palatine process of the maxilla in its ant 3/4th &
horizontal part of the palatine bone in its posterior 1/4th.

35. (C)LINING MEMBRANE OF INTERNAL NOSE:
• 1. Vestibule Lined by skin, containing hair, hair follicles &
sebaceous glands.
• 2. Olfactory region Upper 1/3rd of lateral wall (up to ST) ,
corresponding part of nasal septum & roof of nasal cavity form the
olfactory region. Here, mucous membrane is paler in colour.
• 3. Respiratory region
• Lower 2/3rd of the nasal cavity form the respiratory region. Here
mucous membrane shows variable thickness being thickest over
nasal conchae especially at their ends, quite thick over the nasal
septum but very thin in the meatuses and floor of the nose.
• It is highly vascular and also contains erectile tissue.
• Its surface is lined by pseudostratified ciliated columnar epithelium
which contains plenty of goblet cells.

36. 1. Olfactory nerves
• They carry sense of smell & supply olfactory region of nose.
• They are central filaments olfactory cells & arranged into 12–20 nerves w/ pass
through the cribriform plate & end in the olfactory bulb.
• It can carry sheaths of dura, arachnoid & pia /w them into the nose. Injury to these
nerves can open CSF space leading to CSF rhinorrhoea /meningitis.
2. Nerves of common sensation. They are:
• (a) Anterior ethmoidal nerve Supplies ant & sup part of nasal cavity (lateral wall
and septum).
• (b) Branches of sphenopalatine ganglionMost of the post 2/3rd of nasal cavity
(both septum and lateral wall) are supplied by branches of sphenopalatine
ganglion. ( w/ can be blocked by placing a pledget of cotton soaked in anaesthetic
solution near the sphenopalatine foramen situated at the posterior extremity of
middle turbinate.)
• (c) Branches of infraorbital nerve Supply vestibule of nose both on its medial
and lateral side.
NERVE SUPPLY:

37. Nerve supply of lateral wall: Nerve supply of septum:
2,a)Ant
ethmoidal
nerve
1)Olfactory
nerves
2,b)Branches of
sphenopalatine
ganglion
2,c)Infaorbi
tal nerve
Greater
palatine
nerve

38. 3. Autonomic nerves
Parasympathetic nerve fibres Supply nasal glands and control nasal
secretion. They come from greater superficial petrosal nerve, travel in the
nerve of pterygoid canal (vidian nerve) and reach the sphenopalatine
ganglion where they relay before reaching the nasal cavity. They also
supply the blood vessels of nose and cause vasodilation.
Sympathetic nerve fibres Come from upper 2 thoracic segments of spinal
cord, pass through superior cervical ganglion, travel in deep petrosal nerve
and join the parasympathetic fibres of greater petrosal nerve to form the
nerve of pterygoid canal (vidian nerve). They reach the nasal cavity
without relay in the sphenopalatine ganglion. Their stimulation causes
vasoconstriction.
• Excessive rhinorrhoea in cases of vasomotor and allergic rhinitis can be
controlled by section of the vidian nerve.
NERVE SUPPLY:

39. Blood supply:
LATERAL WALL:
(a)INTERNAL CAROTID SYSTEM
1. Anterior ethmoidal
2. Posterior ethmoidal } Branches of ophthalmic artery
(b)EXTERNAL CAROTID SYSTEM
1. Posterior lateral nasal branches → From sphenopalatine artery.
2. Greater palatine artery → From maxillary artery.
3. Nasal branch of anterior superior dental → From infraorbital branch of maxillary artery.
4. Branches of facial artery to nasal vestibule.
NASAL SEPTUM:
(a)INTERNAL CAROTID SYSTEM
1. Anterior ethmoidal artery
2. Posterior ethmoidal artery } Branches of ophthalmic artery
(b)EXTERNAL CAROTID SYSTEM
1. Sphenopalatine artery (branch of maxillary artery) gives nasopalatine and posterior medial nasal
branches.
2. Septal branch of greater palatine artery (branch of maxillary artery).
3. Septal branch of superior labial artery (branch of facial artery).

40. Blood supply of lat n wall: Blood supply of septum:
Internal carotid artery
Ophthalmic artery
Ant.
Eth. art
Post.
Eth. art
Facial art ECA Maxillary art
Superior
labial art
Brs of
sphenopalatine
art(post-lat n br)
Greater &
lesser
palatine art

41. LYMPHATIC DRAINAGE:
• Lymphatics from the external nose and anterior
part of nasal cavity drain into submandibular
lymph nodes.
• Those from the rest of nasal cavity drain into
upper jugular nodes either directly or through the
retropharyngeal nodes.
• Lymphatics of the upper part of nasal cavity
communicate with subarachnoid space along the
olfactory nerves.
• )

42. • **Denger area of face: is lower part of nose & upper
lip, since deep facial vein & sup orbital vein can spread
infection to pterigoid venous plexus, then to cavernous
sinus l/t cavernous sinus thrombosis( a life threatening
conditon, a bl clot blocks a vein) Symp severe
headache, high fever, redness around1/both eyes,
drooping eyelids, vision loss, seizures. Inv CT/MRI of
brain. Tt High dose IV Abs, Corticosteroid
medication.
• **Denger area of neck: A potential space behind the
true retropharyngeal space which spread infection
from pharynx(eg retrophx abscess) to the
mediastinum(chest

43. THANK YOU