NOSE & PARANASAL SINUSES
• NASAL CAVITY REVIEW
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Boundaries
Concha
Regions
Innervation
Blood Supply
Paranasal Sinuses
– General features
– Clinical Relationships
• PTERYGOPALATINE FOSSA PREVIEW
Gordon L. Todd, Ph.D.
WH 2002
9-4241
gltodd@unmc.edu
Nasal Cavity
- Concha
• Superior
– Sphenoethmoidal recess – sphenoid sinus
– Superior meatus – post. ethmoid air cells
• Middle
– Ethmoid bulla – middle ethmoid air cells
– Hiatus semilunaris – frontal sinus, ant. ethmoid air
cells and maxillary sinus
Nasal Cavity - Boundaries
• Roof – nasal, frontal,
cribriform plate, sphenoid
• Floor – Maxillary & palatine
bones of hard palate
• Septum – Septal cart.,
perpendicular plate of
ethmoid, vomer (bottom)
• Post – Choana
• Lat – Nasal, lacrimal,
maxillary, ethmoid, palatine,
sphenoid and inf. concha
Nasal Cavity - Regions
• Vestibule
• Olfactory – sup.
concha & upper 1/3
of septum
• Respiratory
• Inferior
– Inferior meatus – nasolacrimal duct
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Nasal Cavity - Innervation
• Olfactory n.
• Ant. ethmoid n.
(nasociliary n.)
• Lat. nasal n. (greater
palatine) – parasym. to
glands & sensory
(maxillary)
• Nasopalatine (maxillary)
- septum
Nasal Cavity – Blood Supply
• Sphenopalatine (maxillary)*
• Ethmoids (ophthalmic)
• Sup. labial, ascending palatine and lat.
nasal (facial)
• Descending palatine (maxillary)
Greater & lesser palatine
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Epistaxis
• Epistaxis that “you can see” – septal brs. of sup.
Labial and sphenopalatine
• Epistaxis that “you cannot see” – post.
sphenopalatine or post. ethmoid a.
• Kiesselbach’s plexus – 90% of epistaxis
• Initial treatment – pack with cotton & pinch
• Extended treatment – gauze packing or balloon
occluders
• Severe recurrent epistaxis – ligate ext. carotid a.
Pterygopalatine Fossa
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Post. Med. – Pharyngeal canal
Post. – Pterygoid canal
Post. Lat. – Foramen rotundum
Lat. – Pterygomaxillary fissure
Ant. – Inf. Orbital fissure
Med. – Sphenopalatine foramen
Floor – Palatine canal
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Paranasal Sinuses - General
• 4 pairs of sinuses
• Lined by mucous membrane continuous
with nasal cavity
• Secrete more than 500 ml / day
• Cilia of respiratory epithelium clear mucus
• Sinusitis – Inflammation of mucous memb.
• “Useless products of human evolution.”
Paranasal Sinuses - General
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Maxillary Sinus
• Tetrahedra shape, largest, 1st to develop
• Aperture – middle meatus
• Relations
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Sup. – Infraorbital n. and orbit
Med. – Nasal cavity
Ant.& lat. – Cheek
Post. – Infratemporal fossa, pterygopalatine fossa
Inf. – Roots of premoloars & molars
• Nerve supply – infraorbital n.
• Blood supply – Maxillary a.
• Clinical – Pain in forehead, cheek, teeth
Frontal Sinus
• Flattened tetrahedral shape
• Aperture – Inferomed. angle of middle meatus
• Relations
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Sup. – Ant. Cranial fossa
Ant. – Forehead, supraorbital & supratrochlear n.
Med. – Other frontal sinuses
Inf. – Orbit, ant. ethmoid sinuses
Post. – Ant. cranial fossa
• Nerve supply – Ophthalmic via supraorbital
• Blood supply – Ophthalmic a.
• Clinical – Pain around eyes & discomfort in forehead
Ethmoid Sinus
• 3-18 irregular-shaped cells
• Aperture – middle meatus (Ant.), bulla (mid.),
superior meatus (post.)
• Relations
• Med. – nasal cavity
• Lat. – orbit
• Sup. – ant. Cranial fossa
• Nerve Supply – Ant. & post. ethmoids, nasal brs.
(maxillary)
• Blood Supply – Ant. & post. Ethmoids
• Clinical – Pain in retro-orbital area, between eyes
Sphenoid Sinus
• Cuboidal shape across the midline
• Aperture – Sphenoethmoidal recress
• Relations
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Med. – Sinus of opposite side
Sup. – Hypophyseal fossa, pituitary gland, optic n.
Lat. – Cavernous sinus, int. carotid a.
Ant. – Nasal cavity
Inf. – Nasopharynx, pterygoid canal
• Nerve Supply – Post. Ethmoid (ophthalmic) &
sphenopalatine (maxillary)
• Blood Supply – Post. Ethmoid & sphenopalatine a.
• Clinical – Pain at vertex, occipital, retro-orbital
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Clinical Relationships
Clinical Relationships
Clinical Relationships
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