Nasal Anatomy

Dr Khia Duncan MBBS DM

Otolaryngology
Faculty of Medical Sciences
Dental School
• • The human nose is the most protruding part of the face
• • Bears the nostrils and is the first organ of the respiratory
• system
• • Principal organ in the olfactory system
• • Shape of the nose is determined by the nasal bones and
• the nasal cartilages and the nasal septum which separates
• the nostrils and divides the nasal cavity into two
• • On average the nose of a male is larger than that of
• a female
• • Main function of the nose is respiration
• Nasal mucosa lining the nasal cavity and the paranasal
• sinuses carries out the necessary conditioning of inhaled air
• by warming and moistening it
• • Nasal conchae, shell-like bones in the walls of the cavities,
• play a major part in this process.
• • Filtering of the air by nasal hair in the nostrils prevents
• large particles from entering the lungs.
• • Sneezing is a reflex to expel unwanted particles from the
• nose that irritate the mucosal lining
• Several bones and nasal cartilages make up the bony-cartilaginous
framework
• of the nose, and the internal structure
• • The nose is also made up of types of soft tissue such as skin,
epithelia,mucous
• membrane,muscles, nerves, and blood.
• • In the skin there are sebaceous glands, and in the mucous membrane
there
• are nasal glands
• • Arrangement of the cartilages allows flexibility through muscle
control to
• Pyramidal Root/ Glabella
• Bridge
• Apex
• External nares or nostrils
• Dorsum nasi
• Alae nasi
• Philtrum
Nasal root- top of the nose/ junction with
forehead
• above the bridge and below the glabella
• Forms an indentation at the nasion
• Frontonasal suture is where the frontal bone
meets
the nasal bones.
• Nasal Dorsum- between the root and the tip
of the nose
• The ala of the nose- lower lateral surface of
the external
nose
• Shaped by the alar cartilage and covered in
dense
connective tissue.
• The alae flare out to form a rounded
 eminence around

• Skin of the nose varies in thickness along its

• length
• • Glabella to the bridge the skin is thick, fairly
• flexible, and mobile.
• • Tapers to the bridge where it is thinnest and
• least flexible as it adheres to the bony
• framework.
• • The rest of the skin of the lower nose is as
• thick as the top section and has
• more sebaceous glands.
• • The glands produce sebum in a higher
• concentration than on other parts of the body.
 Internal Structure
• • Combination of bony and
cartilaginous structures
• • Bones
• • Nasal bones
• • Frontal process of maxilla
• • Nasal part of frontal bone
• • CARTILAGES
• • septal
• • lateral nasal
• • major and minor alar
Bony Anatomy
• Nasal process of frontal bone
• Lies between the brow ridges, and ends in a serrated
nasal notch
• Notch articulates
• At the front with the paired nasal bones
• At the sides with the small lacrimal bones
• With the frontal process of each maxilla
• Nasal bones
• Upper part of the nose- joined together by the midline
internasal
suture
• Join with the septal cartilage at a junction known as the
rhinion.
• Rhinion is the midpoint of the internasal suture at the
 join with the

• • Nasal septal bones

• • Made up of the perpendicular plate of the
• ethmoid bone,
• • Bony lower part is made up of the vomer
• bone that lies below
• • Floor of the nose is made up of the incisive
• bone and the horizontal plates of the palatine bones
• • Also makes up the hard palate of the roof of the
• mouth
• • Two horizontal plates join at midline and form
• the posterior nasal spine
• • Gives attachment to the musculus uvulae in
• the uvula
• Internal roof composed of the horizontal,
• perforated cribriform plate of the ethmoid
• bone through which pass sensory fibres of
• the olfactory nerve (CN1)
• • Below and behind the cribriform plate, sloping down
• at an angle, is the face of the sphenoid bone.
• • Two maxilla bones join at the base of the nose at the
• lower nasal midline between the nostrils, and at the
• top of the philtrum to form the anterior nasal spine.
• • This thin projection of bone holds the cartilaginous
• center of the nose
 Nasal Cartilages
• Septal, lateral, major alar, and minor alar cartilages

• • The major and minor cartilages are also known as the greater and

• lesser alar cartilages.

• • Septal nasal cartilage

• • Extends from the nasal bones in the midline, to the bony part of

• the septum in the midline, posteriorly.

• • Septum is quadrangular–the upper half is attached to the two lateral

• nasal cartilages which are fused to the dorsal septum in the midline.

• • The septum is laterally attached to the bony margin of the anterior

• nasal aperture

• • Inferior ends of the lateral cartilages are free unattached

• • The three or four minor alar cartilages are adjacent to the lateral

• cartilages, held in the connective tissue membrane, that connects the

• lateral cartilages to the frontal process of the maxilla.

Major Alar Cartilages
Medial and Lateral Crura
• Thin, U-shaped plates of cartilage on each
side
of the nose that form the lateral and medial
walls of the vestibule
• Medial crura- attached to the septal
cartilage,
forming fleshy parts at the front of the
nostrils
on each side of the septum, called the medial
crural footpads
 Major Alar
cartilages
• The medial crura meet at the midline below
• the end of the septum to form
• the columella and infratip lobule.
• • At the peaks of their folds they form
• the alar domes the tip-defining points of the
• nose.
• • Then fold outwards, above and to the side
• of the nostrils forming the lateral crura.
• • The major alar cartilages are freely
• moveable and can respond to muscles to
• either open or constrict the nostrils.
• The nasal cavity is the large internal space of the nose.
• • The cavity is divided into two fossae by the nasal septum, which
• separates the nostrils.
• • Each fossa is the continuation of a nostril.
• • The division into two fossae enables the functioning of the nasal
• cycle that slows down the air conditioning process.
• • Other nasal cavities are the four paired paranasal sinuses that drain into
• the nasal cavity.
• • The nasal cavity is lined with respiratory epithelium.
• • This is a ciliated tissue with mucus-secreting goblet cells
• • Maintains the nasal moisture and protects the respiratory tract
• from infection and atmospheric particulates.
• • Respiratory epithelium is also the lining of the paranasal sinuses
 Lateral Walls
• On the lateral wall of each cavity are three shell-like
• bones called conchae
• • Arranged as superior, middle and inferior nasal conchae.
• • The conchae are also known as turbinates.
• • Below each concha is a corresponding superior, middle,
• and inferior nasal meatus, or passage.
• • Sometimes when the superior concha is narrow, a
• fourth supreme nasal concha is present situated above
• and sharing the space with the superior concha.
• • The conchae extend along the length of the nasal cavity
 Nasal Roof
• The internal roof of the nasal cavity is
• composed of the horizontal,
• perforated cribriform plate of the ethmoid
• bone through which pass sensory fibres of
• the olfactory nerve.
• • There is an area of olfactory mucosa in the
• roof of the cavity.
• • This region is about 5 square cm in each
• fossa covering the superior concha, the
• cribriform plate, and the nasal septum.
Choanae
At the back of the nasal cavity there are
two openings, one from each fossa,
called choanae.
• The choanae are also called the posterior
nostrils and give entrance to
the nasopharynx and rest of the respiratory
tract
Nasal Valves
Nasal valve area in the cavity responsible for
providing
resistance to the flow of air.
• This enables an increased time for warming
and
moistening the air.
• The internal nasal valve is the narrowest
part of the
airway in the middle third of the cavity.
• The larger external nasal valve is located in
the alar wall.
• Bounded superolaterally by the caudal edge
of the
upper lateral cartilage, laterally by the nasal
alar and
bony piriform aperture of the maxilla, and
Nasal Vestibule
• Front most part of the nasal cavity, and is enclosed by cartilages.
• • The vestibule of the nose is lined with skin, hair follicles, and a large
number of
• sebaceous glands
• • A mucous ridge known as the limen nasi separates the vestibule from
the rest
• of the nasal cavity and marks the change from the skin of the vestibule
to the
• respiratory epithelium of the rest of the nasal cavity
• • This area is also known as a mucocutaneous junction that has a
Drainage
• The respiratory epithelium that lines the sinuses is closely adhered to
the membrane of the
• underlying bone
• • A narrow opening called a sinus ostium from each of the paranasal
sinuses allows drainage into the
• nasal cavity.
• • The maxillary sinus is the largest of the sinuses and drains into the
middle meatus.
• • Adults have a high concentration of cilia in the ostia.
• • The increased cilia and the narrowness of the sinus openings allow
for an increased time for
 Muscles
• The movements of the nose are controlled by
• groups of facial and neck muscles that are set
• deep to the skin.
• • There are four interconnected groups
• connected by the superficial fascia that covers,
• invests and forms the terminations of the
• muscles.
• • Elevator muscle group includes the
• • Procerus muscle that helps to flare the
• nostrils
• • Levator labii superioris alaeque nasi muscle
• which lifts the upper lip and the alae.
Muscles
Depressor muscle group
• Alar nasalis muscle and the depressor septi
nasi muscle.
• Compressor muscle group
• Transverse nasalis muscle.
• Dilator muscle group
• Dilator naris muscle that expands the
nostrils
• It is in two parts: (i) the dilator naris
anterior
muscle, and (ii) the dilator naris posterior
muscle.
Blood Supply
Well supplied with blood from branches of
both the internal
carotid artery, and the external carotid
artery.
• Internal carotid
• The main branches from the interior carotid
are
the anterior ethmoidal artery, and the
posterior
ethmoidal artery that supplies the septum,
and these
derive from the ophthalmic artery.
• One of the terminal branches of the
ophthalmic artery is
the dorsal nasal artery which divides into two
branches.
Blood Supply
External carotid branches
• Sphenopalatine artery
• Greater palatine artery
• Superior labial artery
• Angular artery
• The lateral walls of the nasal cavity
and the septum are supplied by the
sphenopalatine artery, and by the
anterior and posterior ethmoid
arteries.
• There is additional supply from the
superior labial artery and the
greater palatine artery.
Blood Supply
The nasal ridge is supplied by branches of
the internal
maxillary artery (infraorbital) and the
ophthalmic
arteries from the common carotid artery
system.
• The arteries supplying the nasal cavity
converge in the
front lower part of the septum in a plexus
known
as Kiesselbach's plexus.
• Anterior ethmoidal artery (branch of the
ophthalmic
artery)
• Sphenopalatine artery (terminal branch of
the maxillary artery)
• Greater palatine artery (from the maxillary

Blood Supply
• Veins of the nose
• • Angular vein- drains the side of the nose, receiving lateral nasal
veins from the alae.
• • In the posterior region of the cavity, specifically in the posterior part
of the inferior
• meatus is a venous plexus known asWoodruff's plexus.
• • This plexus is made up of large thin-walled veins with little soft tissue
such as muscle
• or fiber.
• • The mucosa of the plexus is thin with very few structures.
Nerve Supply
• Nerve supply to the nose is from the first two branches of the
trigeminal
• nerve (CN V), the ophthalmic nerve (CN V1) and the maxillary nerve
(CN V2).
• • Ophthalmic division
• • The nasociliary nerve – conveys sensation to the skin area of the
nose, and the mucous
• membrane of the nasal vestibule.
• • The anterior ethmoidal nerve- continuation of the nasociliary nerve
and conveys sensation
• in the anterior half of the nasal cavity
Nerve Supply
• Maxillary division
• • Maxillary nerve – conveys sensation to the upper jaw, the face and
the nostrils.
• • Internal nasal branches of infraorbital nerve – conveys sensation to
the septum.
• • Zygomatic nerve – through the zygomatic bone and the zygomatic
arch, conveys sensation
• to the cheekbone areas.
• • Sphenopalatine nerve – divides into the lateral branch and the septal
branch, and conveys
• sensation from the rear and the central regions of the nasal cavity.
Nerve Supply
• Maxillary division
• • Maxillary nerve – conveys sensation to the upper jaw, the face and
the nostrils.
• • Internal nasal branches of infraorbital nerve – conveys sensation to
the septum.
• • Zygomatic nerve – through the zygomatic bone and the zygomatic
arch, conveys sensation
• to the cheekbone areas.
• • Sphenopalatine nerve – divides into the lateral branch and the septal
branch, and conveys
• sensation from the rear and the central regions of the nasal cavity.
Paranasal Sinuses
• Paranasal sinuses are a group of four paired air-filled spaces that
surround
• the nasal cavity.
• • The maxillary sinuses are located under the eyes
• • The frontal sinuses are above the eyes
• • The ethmoidal sinuses are between the eyes and the sphenoidal
sinuses are
• behind the eyes.
• • The sinuses are named for the facial bones in which they are located.
 Maxillary
Sinus
• The pyramid-shaped maxillary sinus is the largest of the paranasal sinuses, and drains

• into the middle meatus of the nose through the osteomeatal complex

• • It is the largest air sinus in the body.

• • Found in the body of the maxilla

• • Maxillary sinus has three recesses:

• • an alveolar recess pointed inferiorly, bounded by the alveolar process of the

• maxilla

• • a zygomatic recess pointed laterally, bounded by the zygomatic bone

• • an infraorbital recess pointed superiorly, bounded by the inferior orbital surface of

• the maxilla.

• • The medial wall is composed primarily of cartilage.

• • The ostia for drainage are located high on the medial wall and open into the semilunar

• hiatus of the lateral nasal cavity

• • Because of the position of the ostia, gravity cannot drain the maxillary sinus contents

• when the head is erect

Maxillary Sinus
The sinus is lined with mucoperiosteum, with
cilia that beat
toward the ostia.
• This membranous lining is also referred to
as
the Schneiderian membrane
• histologically a bilaminar membrane with
pseudostratified
ciliated columnar epithelial cells on the
internal side
and periosteum on the osseous side.
• The size of the sinuses varies in different
skulls, and even on
the two sides of the same skull.
Maxillary Sinus
• The infraorbital canal usually projects into the cavity as a well-marked
ridge
• extending from the roof to the anterior wall
• • Additional ridges are sometimes seen in the posterior wall of the
cavity and
• are caused by the alveolar canals.
• • The mucous membranes receive postganglionic parasympathetic
nerve
• innervation for mucous secretion originating from the greater petrosal
• nerve (a branch of the facial nerve).
Maxillary Sinus
• Walls
• • The nasal wall of the maxillary sinus, or base, presents, in the
disarticulated bone
• • Large, irregular aperture communicating with the nasal cavity.
• • the uncinate process of the ethmoid above,
• • the ethmoidal process of the inferior nasal concha below
• • the vertical part of the palatine behind
• • and a small part of the lacrimal above and in front
Maxillary Sinus
• • The sinus communicates through an opening into the semilunar
hiatus on the lateral nasal wall
• • On the posterior wall are the alveolar canals, transmitting the
posterior superior alveolar
• vessels and nerves to the molar teeth
• • The floor is formed by the alveolar process, and, if the sinus is of an
average size, is on a level
• with the floor of the nose; if the sinus is large it reaches below this
level
• • Projecting into the floor of the antrum are several conical processes,
corresponding to the
• roots of the first and second maxillary molar teeth

Frontal Sinus
The frontal sinuses are situated behind the
brow
ridges.
• Mucosa-lined airspaces within the bones of
the face
and skull.
• Located between anterior and posterior
tables of
frontal bone
• Each opens into the anterior part of the
corresponding middle nasal meatus of the
nose
through the frontonasal duct which traverses
the
anterior part of the labyrinth of the ethmoid.
• These structures then open into the
 semilunar

Frontal Sinus

• Frontal sinuses are rarely symmetrical and

• the septum between them frequently deviates
• to one or other side of the middle line.
• • The mucous membrane in this sinus is
• innervated by the supraorbital nerve, which
• carries
• the postganglionic parasympathetic nerve
• fibers for mucous secretion from the
• ophthalmic nerve
• • Vascular supply by the supraorbital
• artery and anterior ethmoidal artery
Frontal Sinus
• Frontal sinuses are absent at birth, but are generally fairly well
developed between
• the seventh and eighth years, only reaching their full size after puberty.
• • Through its copious mucus production, the sinus is an essential part
of the immune
• defense/air filtration carried out by the nose.
• • Nasal and sinus mucosae are ciliated and move mucus to the
choanae and finally to
• the stomach.
• • The thick upper layers of nasal mucus trap bacteria and small
particles in tissue
Ethmoid Sinus
paired paranasal sinuses.
• The cells are variable in both size and
number in
the lateral mass of each of the ethmoid bones
and
cannot be palpated during an extraoral
examination.
• Divided into anterior and posterior groups.
• Numerous thin-walled cavities situated in
the ethmoidal
labyrinth and completed by
the frontal,maxilla, lacrimal, sphenoidal, and
palatine
bones
• Lie between the upper parts of the nasal
cavities and
the orbits

Ethmoid Sinus
• The groups of the ethmoidal air cells drain into the nasal meatuses.
• • The posterior group the posterior ethmoidal sinus drains into the
superior
• meatus above the middle nasal concha; sometimes one or more opens
into
• the sphenoidal sinus.
• • The anterior group the anterior ethmoidal sinus drains into the
middle meatus of
• the nose by way of the infundibulum.
• • The two groups are divided by the basal lamella.
Ethmoid Sinus
• The ethmoidal sinuses are not present at birth, however by 2 years of
age they are recognizable
• through the use of CT scanning.
• • The ethmoidal air cells receive sensory fibers from the anterior and
posterior ethmoidal nerves, and
• the orbital branches of the pterygopalatine ganglion, which carry
• the postganglionic parasympathetic nerve fibers for mucous secretion
from the facial nerve.
• • Haller cells are infraorbital ethmoidal air cells lateral to the lamina
papyracea. These may arise from
• the anterior or posterior ethmoidal sinuses.
Sphenoid Sinus
The sphenoid sinus is one of the four
paired paranasal sinuses
• Contained within the body of the sphenoid
bone
• Vary in size and shape- rarely symmetrical
• Cannot be palpated during an extra-oral
examination.
 Sphenoid Sinus
• When exceptionally large the sphenoid sinuses may extend
• into the roots of the pterygoid processes or great wings, and

• may invade the basilar part of the occipital bone.

• • Opens into the roof of the nasal cavity via apertures on the

• posterior wall of the sphenoethmoidal recess directly above

• the choana

• • The apertures are located high on the anterior walls of the

• sinuses
• • They are present as very small cavities at birth, and slowly

• develop with the growth of the skull.

• • The mucous membrane receives sensory innervation by

• the posterior ethmoidal

• nerves and postganglionic parasympathetic fibers of the facial

• nerve -controls secretion of mucus.

Questions