Nasal cavity, paranasal sinuses,
pterygopalatine fossa
James E. Schwob, M.D., Ph.D.
What are noses
good for?
•  Aesthetics
•  Respiratory function
(protective)
•  Sensory function
And you can clone from them!
Although their identity remains
controversial …
Broadly potent
neurocompetent stem
cells are found in
olfactory mucosa
•  Recent work from
Mackay-Sim has
demonstrated that OE
cells (including
human) can generate
many non-olfactory
types after
transplantation. Clinical significance
•  Well over $2 billion spent on nasal
nostrums per year for treating colds,
sinusitis
•  Loss of olfactory sensory function can be
life-threatening, and is certainly a quality of
life issue
What do we mean by the nose and
paranasal sinuses
•  External nose and
internal nose (nasal
cavity)
•  Both have bony and
cartilaginous parts
•  Both are richly
innervated and
vascularized
•  Paranasal sinuses flank
the nasal cavity
•  Pterygopalatine ganglion
and fossa are intimately
involved with both
“Surface”
anatomy of the
nasal cavity
•  Boundaries: roof, walls,
floor, inlet, outlet
•  Recesses: 4 passages
defined by nasal conchae
•  Ostia: only sphenoid is
visible
Recesses along lateral wall
•  Removal of middle and inferior nasal conchae reveals
numerous ostia
Bony skeleton
•  External nose: bones and cartilage
Bony skeleton II
•  Medial wall: nasal septum
Bony skeleton III
•  Lateral wall: with and without conchae
•  Note openings into sinus and pterygopalatine fossa
Bony skeleton IV
•  Pterygopalatine fossa is entryway into nasal cavity
for nerves and vessels
Vasculature of nasal cavity I
•  Maxillary artery (3rd part) enters via the
pterygopalatine fossa and supplies posterior half
of nasal cavity and maxillary sinus
Vasculature II
•  Branches from
maxillary artery to
posterior-ventral half
of medial and lateral
walls
•  From ophthalmic to
anterior-dorsal
•  From facial to
vestibule
•  Epistaxis (no picking
and grinning)
Innervation of
the nasal cavity
and paranasal
sinuses
•  General sensory from
Trigeminal (CN V)
–  Ophthalmic division (V1)
–  Maxillary division (V2)
Innervation II
•  Autonomics:
–  Preganglionic
parasympathetic via
greater petrosal branch
of facial nerve to
pterygopalatine
ganglion.
Postganglionics
distribute with
branches of maxillary
nerve
–  Postganglionic
sympathetics via the
carotid plexus and
deep petrosal nerve
Innervation III
V
IX
X
VII
•  Special sensory:
–  Olfactory -- CN I
–  Taste -- via greater petrosal to palatine
Paranasal sinuses
•  What are they?
•  What are they good
for?
Three views
Imaging the sinuses
Maxillary sinus
drainage
Surgical approach
to maxillary
sinusitis
Imaging the sinuses
The trouble
with sphenoids
•  Many important structures
are near the sphenoid and
vulnerable
•  Including the optic nerve
Paranasal sinuses are late to grow
“Surface”
anatomy of the
nasal cavity
•  Boundaries: roof, walls,
floor, inlet, outlet
•  Recesses: 4 passages
defined by nasal conchae
•  Ostia: only sphenoid is
visible
Endoscopic tour of the nasal cavity
What can go wrong and how to fix it
“Surface”
anatomy of the
nasal cavity
•  Boundaries: roof, walls,
floor, inlet, outlet
•  Recesses: 4 passages
defined by nasal conchae
•  Ostia: only sphenoid is
visible