ANATOMY OF NOSE AND PARA NASAL SINUSES BY DR. MD. KHURSHID PERVEJ GOVT. MEDICAL COLLEGE, PATIALA. PUNJAB

1. Anatomy of Nose &
Paranasal sinuses
Dr. Khurshid Pervej
Junior resident
Department of ENT
GMC Patiala

2. NOSE - ANATOMY
DEVELOPMENT
 Nose develops from frontonasal process
which grows between primitive forebrain
and the stomodaeum.
 Frontonasal process gets divided into
median nasal process and two lateral
process.
 Primitive nasal cavities are closed at their
posterior ends by bucconasal membrane
which ruptures and forms choanae.
Clinical significance: choanal atresia

3.  Olfactory placodes on the frontonasal
process become depressed to form
olfactory pits which later form nasal
cavity.
DEVELOPMENT

4. External nose showing surface
anatomy

5. Bony & Cartilaginous Anatomy of
nose
 Osteocartilagenous framework:
Upper 1/3rd - bony
Lower 2/3rd – cartilagenous
 Bony framework
a) Nasal bones
b) Nasal processes of frontal bone
c) Frontal processes of maxilla

6. Cartilages of the external nose and
columella
 The nasal cartilages are composed of
hyaline cartilage which may be ossified.
 The upper cartilages are triangular flat
expansions lying inferior to the nasal
bones and are overlapped by them, by the
adjacent frontal processes of the maxillae
and by the lower lateral cartilages.

7.  The lower lateral cartilage forms lower
one third of nose.
 Having medial and lateral crus meet at
the tip of the nose.
 Two medial crura attached in the
midline and form columella.
 The groove between the upper and
lower lateral cartilages is known as the
limen nasi, which is the site of
intercartilaginous incisions.

8. Bony nasal septum
 Upper one third is bony; mainly by 2
nasal bones with some contributions by
nasal spine of frontal bone and fronto-
nasal process of maxilla.
 Nasal bone:
Wedge shaped convex and smooth outer
surface ; concave and roughened inner
surface
United in midline with each other
superiorly attached to nasal frontal
suture, laterally with frontal process of
maxilla.

9. ANATOMY OF NOSE
EXTERNAL NOSE
 Nasal musculature:
a) Procerus
b) Nasalis (transverse and alar part)
c) Levator labi superioris alaque nasi
d) Anterior and posterior dialator naris
e) Depressor septi
Nasal skin: skin over nasal bone and upper lateral
cartilage is thin and freely mobile while that on
alar cartilages is thick and adherent and
contains sebaceous glands

10. ANATOMY OF NOSE
EXTERNAL NOSE
 Blood supply:
Facial artery- Alar region
Ophthalmic and maxillary artery- dorsum
and lateral wall of ext nose
Venous drainage- corresponds to arterial
supply in facial and ophthalmic vein.

11.  Lymphatic drainage: Submandibular
and Sub mental lymph nodes.
Sometimes in buccal nodes.
 Nerve supply:
Sensory- Upper two divisions of
trigeminal nerve, Ophthalmic and
maxillary nerve.
Motor- Facial nerve.

12. ANATOMY OF NOSE
INTERNAL NOSE
 It is divided into right and left nasal
cavities by nasal septum.
 Each nasal cavity consists of
a) Skin lined portion-vestibule (contains
sebaceous glands, hair follicles,
vibrissae)
b) Mucosa lined portion-nasal cavity
proper

13. Nasal Cavity
 Extends from nostrils to the post.
Choanae.
 Divided into two cavity by a septum.
 Each nasal cavity has
◦ a floor,
◦ a roof,
◦ a lateral wall,
◦ a medial or
septal wall.

14. ANATOMY OF NOSE
INTERNAL NOSE
 Nasal cavity posteriorly continues with
the naso pharynx and
 Narrower anteriorly than posteriorly.
 Floor: Formed by
a) Palatine process of maxilla (anterior
3/4th )
b) Horizontal process of palatine bone
(posterior 1/4th )

15. ANATOMY OF NOSE
INTERNAL NOSE
 Roof: formed by
a) Anterior sloping part by nasal bones
b) Posterior sloping part by body of
sphenoid
c) Middle horizontal part by cribriform
plate of ethmoid through which
olfactory nerves enter the nasal
cavity

16. ANATOMY OF NOSE
INTERNAL NOSE
 Nasal septum consists of three parts
a) Membranous septum (lies between
columella and caudal border of septal
cartilage)
b) Septum proper: consists of
osteocartilagenous framework covered
with nasal mucous membrane

17. ANATOMY OF NOSE
INTERNAL NOSE
 Septum proper: principal constituents
a) Perpendicular plate of ethmoid postero-
superiorly
b) Vomer infero-posteriorly
c) Septal cartilage (quadrilateral cartilage)
 These articulate with following bones to
complete the septum
a) Superiorly-frontal bone, nasal bone,
rostrum of sphenoid.
b) Inferiorly anterior nasal spine of maxilla,
nasal crest of maxilla and palatine bones

18. Cartilaginous and bony septum of
nose

19. Cartilaginous and bony septum of
nose
Perpendicular
Plate (ethmoid)
Septal
Cartilage
Vomer
Crest of maxilla Crest of
palatine
Membranou
s septum
Nasal
bone

20. BLOOD SUPPLY-NASAL
SEPTUM Little’s area: Situated in the antero-inferior
part of nasal septum just above the
vestibule. Four arteries-anterior
ethmoidal, septal branch of superior
labial, septal branch of sphenopalatine
and greater palatine anastamose here to
form kiesselbach’s plexus.
 Woodruff’s area: Venous plexus situated
in the posterior aspect of nasal septum.

21. BLOOD SUPPLY-NASAL
SEPTUM

22.  The anterior ethmoidal branch of the
nasociliary nerve and a smaller
anteroinferior portion receives a branch
from the anterior superior alveolar nerve.
 The posteroinferior septum also receives
a small supply from the nerve to the
pterygoid canal and a posterior inferior
nasal branchof the anterior palatine
nerve.
NERVE SUPPLY-NASAL SEPTUM

23. NERVE SUPPLY-NASAL SEPTUM

24. Nasal septum-LYMPHATIC
DRAINAGE
 The anterior septum drains with the
external nose to the submandibular
nodes while
 Posterior septum drains to the
retropharyngeal and anterior deep
cervical nodes.

25. ANATOMY-LATERAL WALL OF
NASAL CAVITY
 Lateral wall is formed by
a) Ascending process of maxilla
b) Nasal bone
c) Ethmoid
d) Medial part of maxilla
e) Inferior turbinate
f) Perpendicular plate of palatine bone
g) Medial pterygoid plate

26. ANATOMY-LATERAL WALL OF
NASAL CAVITY
 Lateral wall is marked by three bony
projections called turbinates or
conchae-superior (part of ethmoid),
middle (part of ethmoid), inferior
(separate bone).
 sometimes a fourth turbinate concha
suprema may also be present.
 Below and lateral to each turbinate is a
corresponding meatus.

27. Attachments- inferior & middle turbinates
 Inferior turbinate:
 having maxillary process which articulates with the
inferior margin of maxillary hiatus.
 Also articulates with ethmoid, palatine and lacrimal
bone completing the medial wall of naso-lacrimal
duct.
 Medial turbinate:
 Most anterior attachment in the sagittal plane to
the fronto-nasal process of maxilla and cribriform
plate.
 Then it turns it turns laterally and attached in
coronal plane in the lamina papyracea. (This is
called basal lamella or ground lamella).
 Most posterior attachment in the horizontal plane

28. The Lateral Walls of Nasal
Cavity

29. ANATOMY-LATERAL WALL OF
NASAL CAVITY
 Inferior meatus- nasolacrimal duct opens in
its anterior part.
 Middle meatus- consists of bulla
ethmoidalis, hiatus semilunaris,
infundibulum. Frontal, maxillary and anterior
ethmoidal sinuses open into middle meatus.
 Superior meatus- posterior ethmoidal
sinuses open into it.
 Sphenoethmoidal recess- triangular fossa
above the superior meatus. Sphenoidal
sinus opens into it.

30. OSTEOMEATAL COMPLEX
 The middle meatus is the space below
and lateral to the middle turbinate, and
is often functionally referred to as the
osteomeatal complex. It contains the
drainage pathways for the anterior
ethmoids, the maxillary and the frontal
sinuses.
 The middle meatus is the area that is
most commonly involved in the

31. OSTEOMEATAL COMPLEX-
RELATED STRUCTURES
 The Maxillary Hiatus:
It is bounded by:
• inferior: the maxillary process of the
inferior turbinate bone;
• posterior: the perpendicular plate of the
palatine bone;
• anterosuperior: a small portion of the
lacrimal bone;
• superior: the uncinate process and bulla
of the ethmoid.

32. OSTEOMEATAL COMPLEX-
RELATED STRUCTURES
The ethmoidal infundibulum:
 It is a cleft-like, three dimensional space
in the lateral wall of the nose that
belongs to the anterior ethmoid.
 Boundaries:
 Medially: Uncinate process
Laterally: Lamina papyracea of the orbit
Anteriorly: Uncinate process
Posteriorly: Anterior surface of
ethmoidal bulla

33. OSTEOMEATAL COMPLEX-
RELATED STRUCTURES
The 'hiatus semilunaris’:
(inferior hiatus semilunaris according to
Grunwald)
 lying between the free posterior margin of
the uncinate process and the anterior
surface of the ethmoidal bulla.
 Sickle-shaped two-dimensional space.
 The superior hiatus semilunaris :This cleft
between the ethmoidal bulla and the middle
nasal meatus exists, when there is a marked
recess posterior to the ethmoidal bulla

34. OSTEOMEATAL COMPLEX-
RELATED STRUCTURES
 Uncinate process-
It is superior extension of the ethmoid.
Anteriorly it fuses with the postero
medial wallof agger nasi cell and
postero medial wall of nasolacrimal
duct.
It has free superio-posterior edge.
floor and medial wall of infundibulum is
formed by the uncinate process.
It is approximately 3 to 4 mm wide and
1.5 to 2 cm in length.

36. Ethmoidal Bulla
 the largest anterior ethmoidal cell
 alternative nomenclature of torus
lateralis (lateral bulge).
 Sometimes a cleft is encountered
between the posterior wall of the bulla
and the basal lamella of the middle
turbinate, the retrobullar recess. The
space between it and the ethmoidal roof
is called the suprabullar recess).

37. THE AGGER NASI
 It is the most anterior part of the
ethmoid.
 It is represented by a small crest or
mound on the lateral wall just anterior
to the attachment of the middle
turbinate.
 It may be pneumatized.

38. Frontal recess
 Found in the most antero superior part
of the middle meatus.
 The frontal recess may be defined as
follows:
• medial: middle turbinate;
• lateral: lamina papyracea, lacrimal
bone;
• superior: skull base;
• inferior: dependent upon the attachment
of the uncinate process;
• pneumatization of agger nasi cells.

39. Anatomical Variations
 Concha bullosa
 Nasal septal deviation
 Paradoxic middle tubinate
 Variations in the uncinate process
 Haller or infraorbital cells
 Onodi or sphenoethmoidal cells
 Gaint ethmoidal bulla
 Extensive pneumatization of the
sphenoid sinus
 Aerated crista galli.

40.  Sphenoethmoidal recess- triangular fossa
above the superior meatus.
Lies medial to superior tubinate.
Sphenoidal sinus opens into it.
 Posterior Ethmoid Complex-
The clefts and cells posterior to the basal
lamella.
Drains into superior meatus.
The sphenoid sinus ostium opens into the
sphenoethmoidal recess medial to the
superior turbinate.
Lateral and posterior external of posterior
ethmoidal air cells are called Onodi or
Sphenoethmidal cells.

41. Blood Supply to the Nasal Cavity
Sphenopalatine a.
Maxillary a.
Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.

42. Roof of the ethmoid comlex
 Roof formed by the cribriform plate of
the ethmoid separtes the nose from
anterior cranial fossa.
 Cribriform plate shows horizontal
medial lamella and oblique or vertical
lateral lamella.
 Lateral lamella articulates with the
frontal bone.
 Thus the ethmoid fovea is formed
medially by the cribriform plate and
laterally by the frontal bone.

43.  The length of the latral lamella and
depth of the olfactory fossa are
classified by kero and Kainz into three
types-
Type I- 1-3 mm
Type II- 4-7 mm
Type III- 8-17 mm
Roof of the ethmoid comlex

44. Anterior ethmoidal artery
In nasal cavity cavity it divides into ant and post nasal branches
Reaches the nasal cavity through cribro ethmoidal foramen
Enters intracranially into the olfactory fossa through lateral lamella of
lamina cribrosa
Crosses the anterior ethmoid at the level of roof
Through ant ethmoidal foramen enter ant ethmoid complex
Passes between sup oblique and medial rectus muscle
Arises from the ophthalmic artery in the orbit

45. Blood Supply to the Nasal
Cavity From branches of the maxillary artery, one
of the terminal branches of the external
carotid artery.
 The most important branch is the
sphenopalatine artery.
 The sphenopalatine artery anastomoses
with the septal branch of the superior labial
branch of the facial artery in the region of
the vestibule.
 The submucous venous plexus is drained
by veins that accompany the arteries.

47. AUTONOMIC NERVE SUPPLY-
NASAL CAVITY
 Sympathetic supply- superior cervical
sympathetic ganglion -> internal carotid
plexus -> vidian nerve -> sphenopalatine
ganglion.
 Parasympathetic supply- facial nerve ->
greater superficial petrosal nerve -> vidian
nerve -> sphenopalatine ganglion.
 Nasal branches from sphenopalatine
ganglion supply the nasal cavity.

48. SENSORY NERVE SUPPLY-
NASAL CAVITY
 Trigeminal nerve carries the common
sensation via ophthalmic and maxillary
divisions.
 Special sensory (smell) carried via
olfactory nerves.

50. Nerve Supply of the Nasal Cavity
CN I – Olfactory Nerves (SVA)
Anterior ethmoidal
branch of V1
Posterior nasal
branches of V2
Cut nasopalatine
branch of V2 to
septum

51. LYMPHATIC DRAINAGE-NASAL
CAVITY
 Lateral wall drains into submandibular
lymph nodes anteriorly ; and posteriiorly
lateral pharyngeal, retro pharyngeal and
upper deep cervical lymph nodes.

52. The Paranasal Sinuses

53. Maxillary sinus
(Antrum of Highmore)
 Largest of the paranasal sinuses
 Pyramidal in shape
 Capacity- 10-20 ML
 boundaries-
a) Medial wall- lies between the sinus and nasal
cavity
b) Posterior wall- related to pterygopalatine and
infratemporal fossae
c) Anterior wall- related to soft tissue of cheek
d) Roof- formed by floor of orbit
e) Floor- formed by alveolar process and palate

54. Neurovascular supply
 Blood supply – Facial, Maxillary, Infra
orbital and greater palatine Artery
 Venous return – To the anterior facial and
pterygoid venous plexus.
 Lymphatic drainage - Submandibular
nodes.
 Nerve supply – Maxillary division of
trigeminal n. Via infraorbital superior

55. FRONTAL SINUS
 Situated in between inner
and outer table of frontal bone
 Pyramidal in shape with apex
upwards and base is formed by the floor
 Capacity- 5-10 ML
 Boundaries
a) Anterior wall-outer table of frontal bone
b) Posterior wall- inner table of frontal bone
separates the sinus from cranial cavity
c) Floor- formed by thin bone separating sinus
from orbit
d) Medial wall- forms the septum between two
frontal sinuses

56. Neurovascular supply
 Blood supply - Supra orbital artery
Anterior ethmoidal arteries.
 Venous return - Anastomotic veins in
supra orbital notch, connecting supra
orbital and supra ophthalmic veins.
 Lymphatic drainage - Submandibular
nodes.
 Nerve supply - Supra orbital nerve
traversing the floor of the sinus.

57. ETHMOIDAL SINUSES
 Thin walled air cavities in the
lateral masses of ethmoid bone.
 Clinically divided into anterior
and posterior group
 Ethmoidal labyrinth has following relations
a) Roof- ant. cranial fossa lateral to cribriform
plate
b) Lateral wall- orbit, optic nerve, nasolacrimal
duct separated by thin bone called lamina
papyracea
c) Inferior- maxillary sinus

58. Neurovascular
supply
 Blood supply : Sphenopalatine artery
Anterior and posterior ethmoidal
artery.
 Lymphatic drainage : Submandibular
nodes
Retropharyngeal nodes.
 Nerves : Anterior and posterior
ethmoidal nerves.
Orbital branches of pterygopalatine
ganglion..

59. SPHENOID SINUS
 There are 2 sinuses in
sphenoid bone divided
by a thin bony septum
 Relations-
a) Laterally- cavernous sinus containing
3,4,5,6th cranial nerves, internal
carotid artery, optic nerve
b) Superiorly- pituitary gland, optic
chiasma, olfactory bulb, frontal lobe
c) Inferiorly- nasopharynx and vidian
nerve

60.  Depending upon the pneumatization of
the sphenoid bone, This sinus is
classified as:
A. Conchal pneumatization, with only a
rudimentary sinus (2-3 percent) .
B. Presellar, in which the sinus is
pneumatized as far as the anterior
bony wall of the pituitary fossa ( 1 1
percent) .
C. Sellar, in which pneumatization
extends back beneath the pituitary
fossa ( 59 percent) .
SPHENOID SINUS

61.  Blood supply : Posterior ethmoidal
artery.
 Lymphatic drainage :
Retropharyngeal nodes.
 Nerve supply : Posterior ethmoidal
nerve.
Neurovascular
supply

62. Sinus Drainage Schema

63. Thank you