THE NOSE AND SINUSES

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THE EXTERNAL NOSE

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 SURFACE APPEARANCE
 Itis a visible component of the face, projecting
over and allowing entrance into the nasal cavity
 Has a pyramidal shape
 Has a nasal root located superiorly and is
continuous with the forehead
 Has an apex that ends inferiorly in a rounded tip

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 Spanning between the root and apex is the
dorsum of the nose
 Located immediately inferiorly to the apex
are the nares- piriform openings into the
vestibule of the nasal cavity
 The nares are bounded by;
Medially- nasal septum
Laterally- ala nasi

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 SKELETAL STRUCTURE
 Bony components
 Locatedsuperiorly
 Comprised of contributions from the nasal, maxilla and frontal
bones
 Cartilaginous component
 Located inferiorly
 Comprised of 2 lateral cartilages, 2 alar cartilages and 1 septal
cartilage
Whilst the skin over the bony part of the nose is thin, that
overlying the cartilaginous part is thicker with many
sebaceous glands
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 VASCULAR SUPPLY
Arterial supply
 Branches of maxillary and ophthalmic arteries supply
the skin of the nose
 The septum and alar cartilages receive additional
supply from the angular and lateral nasal arteries- both
branches of facial artery
Venous drainage
 Drained by facial vein into the internal jugular vein

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 LYMPHATICS AND INNERVATION
Lymphatics
 Via superficial lymphatic vessels accompanying the facial
vein
 Ultimately drain into the deep cervical nodes

Innervation
 Sensory innervation is from the trigeminal nerve
 External nasal nerve, a branch of ophthalmic nerve, supplies the
skin of the dorsum, nasal alae and vestible
 Infraorbital nerve, branch of maxillary nerve, supplies the lateral
aspect
 Motor innervation to the nasal muscles is via the facial 9
nerve
 APPLIED ANATOMY
Saddle Nose Deformity
 Occurs primarily as a result of nasal trauma,
whereby septal support to the nose is lost
 Subsequently, the middle part of the nose
appears sunken
 Either as a result of direct damage to the septal
bone or cartilage, or a consequence of nasal
septal haematoma

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 APPLIED ANATOMY
Danger triangle of the face
 Venous drainage of the nose and surrounding area
is unique
 This is due to the communication between the
facial vein and cavernous sinus via the ophthalmic
vein
 As the cavernous sinus lies within the cranial
cavity, this enables infections from the nasal area
to spread to the brain
 This can lead to sinus thrombosis, meningitis or 12
brain abscess
 THE PARANASAL
SINUSES
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INTRODUCTION
 They are air-filled extensions of the respiratory
part of the nasal cavity
 Their function is not clear, it is thought that they
may contribute to humidifying of the inspired
air
 They also reduced the weight of the skull

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 They are formed in childhood by the nasal
cavity eroding into surrounding bone
 There are 4 paired sinuses, named
according to the bone in which they are
located;
Maxillary
Frontal
Sphenoid
Ethmoid

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FRONTAL SINUSES
 Most superior in location
 Found under the forehead
 They are variable in size, but always triangular-
shaped
 They drain into the nasal cavity via the
frontonasal duct, which opens out at the
hiatus semilunaris on the lateral wall

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 SPHENOID SINUSES
 They also lie relatively superiorly, at level of the
spheno-ethmodial recess
 Found more posteriorly, and are related superiorly
and laterally to the cranial cavity
 They drain out onto the roof of the nasal cavity
 The pituitary gland can be surgically accessed via
passing through the nasal roof, into the sphenoid
sinus and through the sphenoid bone

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 ETHMOIDAL SINUSES
 There are 3 ethmoidal sinuses;
Anterior ethmoidal sinus
Middle ethmoidal sinus
Posterior ethmoidal sinus
 They empty into the nasal cavity at different
places;
Anterior- hiatus semilunaris
Middle- ethmoid bulla
Posterior- superior meatus

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 MAXILLARY SINUSES
 Largest of the sinuses
 Located laterally and slightly inferiorly to the
nasal cavities
 Drains into the nasal cavity at the hiatus
semilunaris, underneath the frontal sinus opening
 This is a potential pathway for spread of
infection, as fluid drainage from the frontal sinus
can enter the maxillary sinus

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 APPLIED ANATOMY
Sinusitis
 As the paranasal sinuses are continuous with the nasal
cavity, an upper respiratory tract infection can spread to
the sinuses
 Infection of the sinuses causes inflammation of the
mucosa, and is known as sinusitis
 If more than one sinus is affected, it is called
pansinusitis
 Maxillary nerve supplies both the maxillary sinus and
maxillary teeth, and so inflammation of that sinus can
present with toothache
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 NASAL CAVITY

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INTRODUCTION
 The nose is an olfactory and respiratory organ
 Consists of nasal skeleton, which houses the
nasal cavity
 The nasal cavity has 4 functions;
Warms and humidifies the inspired air
Removes and traps pathogens and particulate matter
from the inspired air
Responsible for sense of smell
Drains and clears the paranasal sinuses and lacrimal
ducts 23
 DIVISIONS
 The nasal cavity is the most superior part of the
respiratory tract
 It extends from the vestibule of the nose to the
nasopharynx
 Has 3 divisions;
Vestibule- area surrounding the anterior external
opening to the nasal cavity
Respiratory region- lined by ciliated
pseudostratified epithelium
Olfactory region- located at the apex of the nasal
cavity, lined by olfactory cells with olfactory 24

receptors
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 NASAL CONCHAE
 They are curved shelves of bone that project out
of the lateral walls of the nasal cavity
 They are also called turbinates
 They function to increase the surface area of the
nasal cavity-this increase the amount of inspired
air that can come into contact with the walls
 They make air spend longer in the nasal cavity,
so that it can be humidified

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 They are 3 in number;
 Superior concha
 Middle concha
 Inferior concha
 They project into the nasal cavity, creating 4 pathways
for airflow;
 Inferior meatus- between inferior concha and floor of nasal
cavity
 Middle meatus- between the inferior and middle concha
 Superior meatus- between middle and superior concha
 Spheno-ethmoidal recess- superiorly and posteriorly to the
superior concha

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OPENINGS INTO THE NASAL CAVITY
Semilunar hiatus
 A crescent-shaped groove on the lateral walls of
the nasal cavity
 Marks the location of the opening in the middle
meatus, where the frontal, maxillary and anterior
ethmoidal sinuses drain.
Ethmoidal bulla
 A bulge in the lateral wall formed by the middle
ethmoidal sinus which empties out onto it
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 The posterior ethmoidal sinuses open out at the
level of the superior meatus
 The sphenoid sinus drains onto the posterior
roof
 The nasolacrimal duct, which drain tears from
the eye, opens into the inferior meatus
 The auditory/Eustachian tube opens into the
nasopharynx at the level of the inferior meatus

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 GATEWAYS TO THE NASAL CAVITY
Cribriform plate
 Part of ethmoid bone that forms a portion of the roof of the nasal
cavity
 Contains very small perforations that allow fibres of the olfactory
nerve to enter or exit
Sphenopalatine foramen
 Located at the level of the superior meatus

 Allows communication between the nasal cavity and the

pterygopalatine fossa
 Transmit sphenopalatine artery, nasopalatine and superior nasal
nerves
Incisive canal
 A pathway between the nasal cavity and the incisive fossa of the 32oral
cavity
 Transmit the nasopalatine nerve and greater palatine artery
 ARTERIAL SUPPLY
 The nose has a very rich vascular supply which allows it to
effectively change humidity and temperature of inspired air
 The nose receives blood from both the internal and external carotid
arteries
 They include;
 Anterior ethmoidal artery
 Posterior ethmoidal artery
 Sphenopalatine artery
 Greater palatine artery
 Superior labial artery
 Lateral nasal arteries

 These arteries form anastomoses with each other and is particularly

prevalent in the anterior portion of the nose
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VENOUS DRAINAGE
 The veins of the nose tend to follow the arteries
 They drain into the pterygoid plexus, facial vein or
cavernous sinus
 In some individuals, a few nasal veins join with the
sagittal sinus
 This represents a potential pathway by which
infection can spread from the nose into the cranial
cavity

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INNERVATION
Functionally divided into special and general innervation
Special sensory innervation
 Carried out by the olfactory nerves

 Branches of the olfactory nerve run through the

cribriform plate to provide special sensory innervation
to the nose
General sensory innervation
 Nasopalatine (maxillary)and nasociliary
(ophthalmic)nerves- septum and lateral walls
 Trigeminal nerve- external skin of nose

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APPLIED ANATOMY
Spread of infection
 As the auditory tube connects the middle ear
and upper respiratory tract, it is a path by which
infection can spread from the upper respiratory
tract to the ear
 Infection of the auditory tube causes swelling
of the mucous linings and the tube becomes
blocked
 This can result in diminished hearing
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 APPLIED ANATOMY
Epistaxis
 Medical term for nosebleed
 It is a common occurrence due to the rich blood
supply of the nose
 Most likely to occur in the anterior third of the
nasal cavity, an area known as the
Kiesselbach/little area
 The cause can be local (trauma) or systemic
(hypertension)
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APPLIED ANATOMY CONT’D
Cribriform plate fracture
 Can occur as a result of nose trauma

 A fractured plate can penetrate the meningeal linings

of the brain, causing leakage of CSF
 This increases the risks of meningitis, encephalitis
and cerebral abscesses
 The olfactory bulb which lies on the cribriform plate
can be damaged irreversibly by the fracture
 In this case, the patient may present with anosmia

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