Anatomy of Nose &

Paranasal Sinuses

Dr. Vishal Sharma

Development of
nose
• Face develops from 5 projections: frontonasal
process (ectoderm over forebrain) + 2 maxillary
processes + 2 mandibular processes (1st arch)
• An ectodermal olfactory placode divides fronto-
nasal process into medial nasal & lateral nasal
process, which give rise to external nasal skeleton
• Olfactory placode deepens into olfactory pit & later
olfactory sac which forms nasal cavities
• Nasal septum develops from mesodermal tecto-
septal expansion from Rathke’s pouch
External Framework
 External Framework
• Nasal Bone

• Frontal Process of Maxilla

• Upper Lateral Nasal Cartilage

• Lower Lateral Nasal (Alar) Cartilage

• Septal Cartilage

• Lesser Alar (Sesamoid) Cartilages

 Internal Nose
• Openings: Anterior nares & posterior

nares (Choanae).

• Vestibule of nose: lined by skin

• Nasal cavity proper:

 Lateral Wall  Medial Wall (Septum)

 Roof  Floor
Nasal Septum
Nasal Septum
 Nasal Septum
1. Septal cartilage 7. Medial alar crus

2. Ethmoid plate 8. Upper lateral cartilage

3. Vomer 9. Nasal bone crest

4. Palatine crest 10. Frontal spine

5. Maxillary crest 11. Sphenoid rostrum

6. Vomeronasal 12. Membranous septum

cartilage
 Lateral Nasal Wall
 3 - 4 bony conchae covered with mucosa

to form turbinates. Space below & lateral

to turbinate is called meatus.

 Middle meatus contains a round bulla

ethmoidalis separated from uncinate

process by hiatus semilunaris that leads

to a funnel shaped ethmoidal infundibulum.

 Meatal Drainage
1. Inferior meatus: Nasolacrimal duct

2. Middle meatus:

a. Frontal

b. Anterior ethmoid

c. Maxillary (natural + accessory ostia)

3. Superior meatus: Posterior ethmoid

4. Spheno-ethmoidal recess: Sphenoid

Ostio-meatal Complex
 Ostio-meatal Complex
Complex micro-architectural pathway in ethmoid

labyrinth that drains anterior group of paranasal

sinuses. Consists of: frontal recess + ethmoid

infundibulum + hiatus semilunaris + uncinate

process + bulla ethmoidalis + middle meatus.

O.M.C. pathology leads to infection of all anterior

paranasal sinuses (Naumann).

 Variants in O.M.C.
1. Concha bullosa (pneumatized M.T.)

2. Paradoxically curved middle turbinate

3. Medially turned uncinate process

4. Large bulla ethmoidalis

5. Haller’s cell in orbital floor

6. Agger nasi cell anterior to M.T.

7. Mucosal pathology
Concha bullosa
Concha bullosa
Paradoxically curved M.T.
Paradoxically curved M.T.
Medialized Uncinate Process
Large bulla ethmoidalis
Haller cell
Agger nasi cell
Onodi cell with dehiscent optic nv
Mucosal disease
 Blood Supply
1. Sphenopalatine artery (main artery)

2. Greater palatine artery

3. Superior labial artery

4. Anterior Ethmoidal artery

5. Posterior Ethmoidal artery

1, 2, 3 & 4 form Kiesselbach’s plexus over

Little’s area on anterior septum
 Venous drainage
Ethmoidal veins:  ophthalmic veins

 cavernous sinus

Sphenopalatine vein:  pterygoid plexus

 maxillary vein 

Woodruff’s venous plexus: present on lateral wall

near posterior end of middle turbinate

Retro-columellar vein: behind columella

 Sensory Nerve Supply

• Long & short Nasopalatine nerves

• Greater palatine nerve

• Infra-orbital nerve branches

• Anterior ethmoidal nerve

• Olfactory nerve
 Autonomic Nerve Supply
• Deep petrosal nerve (sympathetic) + greater
superficial petrosal nerve (para-sympathetic) 
vidian nerve  pterygo-palatine ganglion 
nasal glands
• Sympathetic stimulation  vasoconstriction +
ed nasal secretions
• Para-sympathetic stimulation  vasodilatation
+ ed nasal secretions
 Lining Epithelium
• Skin: over nasal vestibule

• Olfactory epithelium: upper 1/3rd of nasal cavity

above superior turbinate

• Respiratory epithelium (pseudo-stratified

ciliated columnar): rest of nasal cavity +

paranasal sinus
Lining Epithelium
 Lymphatic Drainage
1. External nose & anterior nasal cavity 
submandibular lymph nodes

2. Remaining nasal cavity 

upper deep cervical lymph nodes

3. Nasal roof (dangerous area of nose) 

subarachnoid space along olfactory nv

4. P.N.S.  retropharyngeal & J.D. node

 Paranasal Sinuses
• Anterior group:

 frontal

 anterior ethmoidal

 maxillary
• Posterior group:

 posterior ethmoidal

 sphenoid
 Development of P.N.S.
Appear First X-ray Reach adult
first appearance size by
Maxillary At birth 4 mth 15 yr

Ethmoidal At birth 1yr 12 yr

Sphenoid 2 yr 4 yr 18 yr

Frontal 4 yr 6 yr 15 yr
Sphenoid Sinus Relations
 Muco-ciliary blanket

• Goblet cells in nasal mucosa secrete a

mucous blanket; moved backwards like a

conveyer belt into nasopharynx.

• Consists of:

 Superficial mucous or gel layer

 Deep serous or sol layer

Muco-ciliary blanket
Muco-ciliary blanket
Thank You