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soumya reddy

on 14 December 2013

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Transcript of ANATOMY OF NOSE

-Its importance to the stability and structure of
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


External Nose
External Nose
Surface Anatomy
Skeletal Frame Work
Blood Supply
Nerve Supply
Surface Anatomy
Basal View
External Skeletal Framework
Applied Anatomy
-The nasal keystone region is an aptly named
confluence of bone and cartilage at the
junction of the upper and middle thirds of
the nose.
-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.
Nasal Bone
Upper Lateral
-Its the continuation of
frontal muscle onto the
-Is attached to nasal bones
& upper lat.cartilage.
-Action:shortens or
elevates nose.
-Dilates nostrils/pulls
upper lip.

Levator Labii Superioris
(Dilator naris)
Depressor Septi
-Inserted into septum
& back part of ala.
-Arise from incisive
fossa of maxilla
-Action: draws ala of
nose downwards
constricts nares.

-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
intercartilaginous incisions.
Blood Supply of External Nose
Origin-lateral nasal branch
from angular
(upper part of facial or
ext. maxillary).

Dorsal nasal artery
Infraorbital 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
to tip.

Internal Nose
-Vestibule of Nose
-Nasal Cavity Proper
Lateral Wall
Medial Wall
Nasal Cavity
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
Lateral Wall
Inferior Turbinate
-Largest turbinate.
-Separate bone covered by thick
mucous membrane
-Nasolacrimal opening is inferior
to inferior turbinte.
-Slit like opening is protected by fold
of mucous membrane, the plica
lacrimalis or valve of Hasner.

Middle Turbinate
-Part of ethmoid bone
-Has 3 attachments.
1.cribriform palte
2.Lamina papyracea
3.maxillary sinus

-ethmoidal bulla

-uncinate process

-semilunar hiatus

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
Ethmoidal Bulla
Uncinate Process
-Crescent shaped bone curved downward/backwards
-Variation of attachment:
lamina papyracea
cribrifom plate
middle turbinate

Hiatus Semilunaris
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.

Superior Turbinate
-Is appx. half length of
middle turbinate.
-Starts about midde of lower
turbinate & becomes
continous with tham
Sphenoethmoidal recess lies
between superior &
supreme turbinate.

Inferior Meatus
-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.

Middle Meatus

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.
Nasal Septum
Septum is made up of:
Perpendicular plate of
Vomer bone
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
hyaline cartilage.
Arterial Supply
-Opening of frontal, ant. ethmoid, & maxillary sinus.
-Hasner’s valve.
(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
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.

Venous Drianage
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
frontal bone.
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:
Supraorbital artery
Supratrochlear artery

Venous drainage:
Small vein that unites the
& Superior ophthalmic

Nerve supply:
Supraorbital nerve(ophthalmic nerve)
Supratrochlear nerve(ophthalmic nerve)
Lymphatic drainage
Submandibular nodes
Maxillary Sinus
-Also known as Antrum of Highmore
-Largest pns.
-Pyramidal cavity in the maxilla.

Maxillary Ostia
3-4mm in diameter
Post part of medial wall
Drains into middle meatus through ethmoidal infundibulum

Blood supply
Facial artery
Infraorbital artery
Greater palatine artery
Sphenopalatine artery

Nerve Supply
Greater palatine nerve
Post lateral nasal nerves
Superior alveolar (infraorbital nerve)

Ethmoid Sinus
-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.

Haller cell
Blood Supply
-Anterior ethmoidal artery
(ophthalmic artery)
-Post. Ethmoidal artery
-Sphenoidal artery(maxillary artery)

Venous drainage
-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.
Blood Supply
Posterior ethmoidal artery(roof of sinus)
Sphenopalatine artery(floor of sinus)

Nerve Supply
Trigeminal (1/11 div)

Retropharyngeal nodes

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)

Water's View
Caldwell view
Lateral View
Thank you!
Contains horizantal and alar part

superiorly- skull base
laterally-lamina papyrace
medially-middle turbinate
inferiorly-bulla ethmoidalis
Full transcript