Nose & Para nasal sinuses
Dr. Ashraf Hussain
Had Cleopatra's nose been shorter, the
whole face of the world would have
changed.
(Blaise Pascal
(1623 - 1662) French philosopher, mathematician, and physicist)
NOSE
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External nose
Bones
Nasal cavity
Mucous membrane
Olfactory portion
Respiratory portion
Communications of nasal cavity
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Floor
Roof
Lateral wall
Medial wall
Olfactory membrane Located on the roof of the nasal cavity. Contains cells/receptors which are in
contact with the Olfactory bulb and nerve to provide sense of smell. (5% of nasal cavity area)
Relations of nasal cavity
Important in the spread of infection
Direct continuity with
(i) the anterior cranial
fossa (via the cribriform plate of the ethmoid bone)
(ii) the nasopharynx and, through the pharyngotympanic
tube, the middle ear
(iii) the paranasal air sinuses
(iv) the lacrimal apparatus and conjunctiva.
Nasal Mucosa
Cross section of nasal mucosal layer. Cilia is
beating
Functions of Nose
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Olfaction
Respiration
Filtration of dust
Humidification
Elimination of secretions from paranasal
sinuses and nasolacrimal ducts
Arteries supplying the Nose
• External Carotid Artery
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-Sphenopalatine artery
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-Greater palatine artery
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-Ascending pharyngeal artery
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-Posterior nasal artery
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-Superior Labial artery
• Internal Carotid Artery
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-Anterior Ethmoid artery
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-Posterior Ethmoid artery
Blood supply
• The upper part of the nasal cavity receives its
arterial supply from the ethmoidal branches
of the ophthalmic artery, a branch of the
internal carotid.
• The sphenopalatine branch of the maxillary
artery, a terminal of the external carotid,
supplies the lower part of the cavity.
• Just within the vestibule of the nose, on the
anteroinferior part of the septum, it links with
a septal branch of the facial artery and it is
from this zone, Little’s area, that 90% of nosebleeds occur.
BLOOD SUPPLY OF MEDIAL WALL OF NOSE
BLOOD SUPPLY OF LATERAL WALL OF NOSE
Kesselbach’s
Plexus/Little’s Area:
-Anterior Ethmoid (Opth)
-Superior Labial A (Facial)
-Sphenopalatine A (IMAX)
-Greater Palatine (IMAX)
Woodruff’s Plexus:
-Pharyngeal & Post. Nasal
AA of Sphenopalatine A
(IMAX)
Epistaxis
venous drainage
• Veins accompany the arteries
• The veins drain downwards into the facial vein
and upwards to the ethmoidal tributaries of
the ophthalmic veins.
Innervation
• Sense of smell is via the olfactory nerve, which
sends microscopic fibers from the olfactory bulb
through the cribiform plate to reach the top of
the nasal cavity.
• General sensory innervation is by branches of
the
• Trigeminal nerve (V1 & V2)
• Nasociliary nerve (V1)
• Nasopalatine nerve (V2)
• Posterior nasal branches of Maxillary nerve (V2)
• The entire nasal cavity is innervated by
autonomic fibers.
• Sympathetic innervation to the blood vessels
of the mucosa causes them to constrict, while
the control of secretion by the mucous glands
is carried on postganglionic parasympathetic
nerve fibers originating from the facial nerve.
Lymphatics
• Lymph from anterior regions of the nasal cavities
drains forward onto the face by passing around
the margins of the nares. These lymphatics
ultimately connect with the submandibular
nodes.
• Lymph from posterior regions of the nasal cavity
and the paranasal sinuses drains into upper deep
cervical nodes. Some of this lymph passes first
through the retropharyngeal nodes.
Clinical features
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Nasal Fractures
Epistaxis
Rhinitis
Deviated nasal septum
Nasal polyps
Boil on nose
Danger area of the face
The skin of the external nose and its surrounds contains
many sebaceous glands and hair follicles which may
become blocked and infected
Facial veins, which may become
secondarily infected, communicate directly with the
ophthalmic veins and hence with the cavernous sinus.
For this reason, this zone is often known as
the ‘danger area of the face’.
Deviated Nasal Septum
• The septum is frequently deviated to one or
other side, interfering both with inspiration
and with drainage of the nose and accessory
sinuses.
Pathology
• Deviation
– Usually in cartilagenous
part
– Different shapes
• C shaped
• S shaped
• Spur
– At junction of cartilage
and bone
Symptoms
• Nasal obstruction
• Nasal deformity
• Sense of smell and taste
are disturbed
• Recurrent epistaxis
Nasal Polyp
– Smooth glistening grape
like masses
• Pale but Protruding polyp
may appear pink
• Insensitive to probing
• Do not bleed on touch
– Multiple and bilateral
– Broadening of nose
– Increased intercanthal
distance
Paranasal air sinuses
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Air filled spaces in bones
Frontal
Ethmoidal
Sphenoidal
Maxillary
Sinuses
Functions of sinuses
• Warm and humidify inspired air
• Resonance of voice
• Reduce the weight of skull
Guess what?
Guess what?