Nasal Cavity, Paranasal Sinuses, and Pterygopalantine Fossa April 16, 2010 1.

Describe the osteology of the nasal cavity and indicate sites of drainage for each paranasal sinus a. Lateral Wall

Frontal bone

Ethmoid bone

Frontal sinus Sphenoid sinus

Nasal

Palatine bone Maxilla

i. ii. Conchae/turbinates: scroll-like bony projections on each lateral wall 1. Each projects medially 2. Lined by a mucous membrane: increases SA of cavity for warming and humidifying inhaled air iii. Meatus: each concha has an air space below/lateral to it b. Drainage points in the nasal cavity

i. 1. Nasolacrimal duct: where excess tears drain into from the eyes 2. Middle meatus: frontal, maxillary, and anterior/middle ethmoids 3. Superior meatus: posterior ethmoids

4. Sphenothmoidal recess: where sphenoid sinus drains into

2. Indicate the relationships of the paranasal sinuses to other regions of the head
Ethmoid air cells ethmoid sinusitis may erode orbits Frontal sinus cause headache Sphenoid sinus most posterior

Maxillary sinus sinusitis causes pain/tenderness in cheek area

a.

3. Trace the course of the nerve and blood supply to the nasal cavity and indicate areas where nose bleeds are most common a. Blood supply i. External carotid artery maxillary artery enters pterygomaxillary fissure from the infratemporal fossa three pathways: 1. exits pterygomaxillary fossa on the medial side though the sphenopalatine foramen as the sphenopalatine artery 2. exits pterygomaxillary fossa on the superior side through the inferior orbital fissure as the infraorbital artery 3. exits pterygomaxillary fossa on the inferior side through the greater palatine canal as the descending palatine artery

Sphenopalatine artery

Maxillary artery

ii.

Descending palatine artery

b. Nerve supply

Trigeminal ganglion V2
Infraorbital nerve SS

Nerve of pterygoid canal para/pre (VII) Pterygopalatine ganglion SS, para Greater/lesser palatine nerves SS, para/post

Nasal mucosal branches SS, para/post

i. 4. Probe the six foramina leading into or out of the pterygopalatine fossa and list the structures passing through each opening

a. 5. Describe the nerve pathways related to parasympathetic innervations of the lacrimal gland and the nasal and palatine mucous glands a. Superior salivatory nucleus CN VII geniculate ganglion greater petrosal nerve nerve of the pterygoid canal pterygopalatine ganglion b. Pterygopalatine ganglion: site of para/post cell bodies c. For lacrimal gland: i. Pterygopalatine ganglion lacrimal gland d. For nasal/palatine glands i. Pterygopalatine ganglion greater palatine nerve nasal/palatine mucosa