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ANATOMY OF NOSE
Transcript of ANATOMY OF NOSE
the nose is exemplified by the number of
complications that may arise from poor surgical
handling of this area.
Dr.P.Krishna Soumya Reddy
Narayana Hrudayalaya Hospitals
ANATOMY OF NOSE & PNS
NOSE & PARANASAL SINUSES
Skeletal Frame Work
External Skeletal Framework
-The nasal keystone region is an aptly named
confluence of bone and cartilage at the
junction of the upper and middle thirds of
-consists of contributions from the paired nasal bones
cephalically, paired upper lateral cartilages (ULCs) caudally,
quadrangular cartilage anterior-inferiorly,and perpendicular
plate of the ethmoid (PPE) posterior-inferiorly.
-Its the continuation of
frontal muscle onto the
-Is attached to nasal bones
& upper lat.cartilage.
Levator Labii Superioris
-Inserted into septum
& back part of ala.
-Arise from incisive
fossa of maxilla
-Action: draws ala of
-The nasal cartilages are composed of hyaline cartilage which may be ossified. They prevent collapse of the vestibule on inspiration.
-The groove between the upper and lower lateral cartilages is known as the limen nasi, which is the site of
Blood Supply of External Nose
Origin-lateral nasal branch
(upper part of facial or
Dorsal nasal artery
External nasal artery
Nerve Supply of External Ear
-Supratrochlear & infratrochlear branches of the ophthalmic
nerve supply the skin of root,bridge,upper portion of side of
-Infraorbital branch of the maxillary nerve supply the skin on
side of nearly the lower half of nose.
-Ext.nasal branch of Ant. Ethmoidal nerve skin over dorsum
-Vestibule of Nose
-Nasal Cavity Proper
The cavity of the nose is subdivided into right and left halves by the nasal septum.
- The two halves open anteriorly on the face through the nostrils (anterior nares), and open posteriorly into the nasopharynx through the posterior nasal aperture.
Anterior Nasal Opening
Posterior Nasal Opening
-Separate bone covered by thick
-Nasolacrimal opening is inferior
to inferior turbinte.
-Slit like opening is protected by fold
of mucous membrane, the plica
lacrimalis or valve of Hasner.
-Part of ethmoid bone
-Has 3 attachments.
it is an ethmoidal cell(largest)
- may extend superiorly to skull base
- space behind bulla is called retrobullar recess, above called suprabullar
- both together called
SINUS LATERALIS GRUNWALD
-Crescent shaped bone curved downward/backwards
-Variation of attachment:
It is a crescenteric groove (2 dimentional space) lying below the bulla ethmoidalis.
leadIt receives the following openings:
i. Anterior ethmoial air sinus.
ii. Frontal air sinus.
iii. Maxillary air sinus.
-Is appx. half length of
-Starts about midde of lower
turbinate & becomes
continous with tham
Sphenoethmoidal recess lies
between superior &
-Its thelargest of the three meatuses of the nose, is the space
between the inferior concha and the floor of the nasal cavity.
-Anteriorly it receives the nasolacrimal duct.
Through the hiatus semilunaris the meatus communicates with a curved passage termed the infundibulum, which communicates in front with the anterior ethmoidal cells and in rather more than fifty percent of skulls is continued upward as the frontonasal duct into the frontal air-sinus; when this continuity fails, the frontonasal duct opens directly into the anterior part of the meatus.
Superior Nasal Meatus
-Smallest of the three meatuses of the nose
-The sphenopalatine foramen opens into it behind,
and the posterior ethmoidal cells in front.
-The sphenoidal sinus opens into a recess, the
sphenoethmoidal recess, which is placed superior
to and posterior to the superior concha.
Septum is made up of:
Perpendicular plate of
Cartilage of the septum
Crest of the maxilla
Crest of the palatine bone.
-The fleshy external end of the nasal septum is sometimes
also called columella. The nasal septum contains bone and
-Opening of frontal, ant. ethmoid, & maxillary sinus.
(A fold of mucous membrane at the lower end of the nasolacrimal duct. If well developed, it generally prevents air from being blown back from the nose into the lacrimal sac.)
-From Little's area /Kiesselbach's
1. Sphenopalatine artery
- It is a branch from the maxillary artery (main arterial supply).
2. Septal branch of the superior labial artery from facial artery.
3. Ascending branch of the greater palatine artery from the maxillary artery .
- There is anastomoses between the above three arteries to form “Kieselbach's plexus” on the antero-inferior part of the nasal septum (Little’s area).
- This area is a common site for epistaxis (bleeding from the nose).
4. Anterior and posterior ethmoidal branches of the ophthalmic artery. supply the roof and upper parts of the lateral wall and septum.
Nerve Supply-Lateral Wall
I. Lateral wall
- Olfactory area (1 cm)-Olfactory nerves.
(this area includes the roof and upper parts of the septum &
lateral nasal walls)
- Vestibular area -Infraorbital nerve.
- Respiratory area of the lateral wall:
a. Antero-superior:Anterior ethmoidal N.
b. Antero-inferior (inf. concha):Internal nasal nerve(from
anterior ethmoidal N)
c. Postero-superior:Lateral posterior superior nasal brncs.
d. Postero-inferior:Lateral posterior inferior nasal brncs
(from greater palatine N).
Nerve Supply-Medial Wall
- Olfactory area -Olfactory N.
- Anterior part - Internal nasal N.(from the anterior ethmoidal nerve). - Postero-superior part - Medial posterior superior nasal branches.
(from sphenopalatine ganglion).
- Postero-inferior part - Nasopalatine nerve(long sphenopalatine nerve).
The nasopalatine nerve, greater and lesser palatine nerves, medial and lateral posterior superior nasal nerves, and the posterior inferior nasal nerve are branches from the sphenopalatine ganglion.
The anastomosis here is made up of branches from the internal maxillary artery namely its sphenopalatine and ascending pharyngeal branches.
-It is responsible for post.bleeds.
The maxillary sinus ostium forms the dividing line between the anterior and posterior nasal bleeds.
- They are air-filled spaces in certain bones which form the boundary of the nasal cavity.
- They open into the lateral wall of the nose.
1. Warming and humidifying the inspired air.
2. Diminishing the weight of the skull.
3. They add resonance to the voice.
1.Maxillary sinus-Inside the body of the maxilla.
2.Frontal sinus-Between the two plates of the
3.Sphenoid-Inside the body of the sphenoid bone.
4.Ethmoid-Inside the lateral part of the ethmoid
*All the sinuses are present at birth except the frontal sinus which appears
during the second year.
-Two sinuses are rarely
Opening of the frontal sinus:
-Drainage into frontal recess
anterior to the infundibulum(55%)
-Drainage above but not into the
-Drainage into infundibulum(15%)
-Drainage above the bulla(1%)
Blood supply of frontal sinus:
Small vein that unites the
& Superior ophthalmic
Supraorbital nerve(ophthalmic nerve)
Supratrochlear nerve(ophthalmic nerve)
-Also known as Antrum of Highmore
-Pyramidal cavity in the maxilla.
3-4mm in diameter
Post part of medial wall
Drains into middle meatus through ethmoidal infundibulum
Greater palatine artery
Greater palatine nerve
Post lateral nasal nerves
Superior alveolar (infraorbital nerve)
-divided into the anterior, middle and posterior groups.
-These are the air cells of the ethmoid bone.
-The Posterior group:
-The Middle group :
-The Anterior group :
into the superior meatus
into the middle meatus of the nose
on or above the bulla ethmoidalis.
into the middle meatus of the nose by way of the infundibulum.
: Posterior ethmoidal cells seen
just in front of sphenoid.
: Ant. ethmoidal cells seen
anteriorly & below the orbit.
-Anterior ethmoidal artery
-Post. Ethmoidal artery
-Sphenoidal artery(maxillary artery)
-owing to the lateral displacement of the
intervening septum they are rarely symmetrical.
- opens into the roof of the nasal cavity via apertures on the posterior wall of the sphenoethmoidal recess directly above the choana.
Posterior ethmoidal artery(roof of sinus)
Sphenopalatine artery(floor of sinus)
Trigeminal (1/11 div)
Radiographic positions to study the paranasal sinuses are standardised around three positions:
1. Two anatomical - namely coronal and sagittal
2. One radiographic - termed as radiographic base line..
The various radiographic positions used to study paranasal sinuses are:
1. Occipito-mental view (Water's view)
2. Occipital-frontal view (Caldwell view)
3. Submento-vertical position (Hirtz position/jug handle)
4. Lateral view
5. Oblique view 39 Degrees oblique (Rhese position)
Contains horizantal and alar part
superiorly- skull base