Nose

&
Paranasal Sinuses

Dr Yasrul Izad Abu Bakar

Medical Faculty, UniSZA
 Learning outcome
• State the anatomical components of the conducting
and respiratory parts of the respiratory system.

• Describe the anatomy of nose (nasal septum and

lateral wall).

• State the paranasal sinuses and describe their

anatomy.

• Describe clinical application of nose and paranasal

sinuses.
 Anatomical components of
respiratory system
1. Nose

2. Pharynx

3. Larynx

4. Trachea

5. Bronchi

6. Lungs
 Anatomical components of
respiratory system
Conductive Parts
• Parts of respiratory system
where exchange of gases does
not take place
• Include nose, pharynx, larynx,
trachea, and bronchi

Respiratory Parts
• Parts of respiratory system
where exchange of gases takes
place
• Lungs
 Nose
The functions of nose are:

1. Olfaction
2. Respiration

3. Filtration of dust (by hair &

mucus)

4. Adjust the temperature &

humidity of inspired air (by
action of rich blood supply)

5. Reception of secretions
from the paranasal sinuses
and nasolacrimal duct
 Surface anatomy

Ala
 Nose
Include external nose & nasal cavity

Regions:
• Nasal vestibule – small dilated
space just internal to the naris,
lined by skin & contains hair
follicles
External Respiratory
nose
• Respiratory region – largest part,
lined by respiratory epithelium &
rich of neurovascular supply

• Olfactory region – small area at

the apex, lined by olfaction
epithelium
 Nose
Olfactory
Epithelium
• At the upper 1/3
of nasal cavities
OLFACTORY AREA
Respiratory
epithelium
• The rest of the RESPIRATORY AREA
upper respiratory
tract is lined by
ciliated
pseudostratified
columnar
epithelium
 External Nose
• Is the visible portion that
projects from the face

Bone
• Skeletal framework:
Cartilages (main)
Bones

Cartilage
 Skeleton of the external nose
Nasal bone
• Bone Frontal
process of
1. Nasal bones maxilla
2. Frontal processes of
maxillae
3. Nasal part of frontal
bone
4. Nasal septum (bony
part)
 Nasal spine of frontal bone

Nasal bone

Nasal cartilage
Nasal septum
 Skeleton of the external nose
• Cartilages (hyaline):
1. Lateral cartilages
2. Major alar
Septal cartilage
cartilages Lateral
cartilage
3. Septal cartilage
 Accesory nasal cartilage
 Minor alar cartilage

Major alar
cartilage
 Nasal bone Frontal
process of
maxilla

Septal cartilage
SKELETON OF
Lateral
THE EXTERNAL
nasal
cartilage NOSE

Major alar
Minor alar
cartilage
cartilage

Accesory nasal cartilage

 Nasal cavities
• Opens anteriorly through the
external nares (nostrils)
• Opens posteriorly into
nasopharynx through the
choanae (posterior nasal apertures) Choanae
Nares

• Anterior area (smaller): external

nose
• Posterior area (larger): within
the skull

• Lined by mucosa except nasal

vestibule (i.e. lined by skin)
 Nasal cavities
• Are the uppermost parts
of respiratory tract

• Elongated wedge-shaped
space

• Divided into right & left

halves by nasal septum

• Held open by skeletal

framework
 Nasal cavities
• Each nasal cavity has a floor, roof,
medial & lateral walls

• Openings of paranasal sinuses are

on the lateral wall & roof

Relations:
• Inferior - separated from oral
cavity by hard palate
• Superior - separated from cranial
cavity by parts of frontal, ethmoid
& sphenoid bones
• Lateral - orbits
 Bony framework of nasal cavities
Unpaired : Paired:
1. Ethmoid bone 1. Nasal
2. Sphenoid 2. Maxillary
3. Frontal 3. Palatine
4. Vomer 4. Lacrimal
5. Inferior
*Ethmoid is the chonchae
main component
of nasal cavities
 Ethmoid bone
• Contributes to the roof, lateral &
medial walls
• Cuboidal in shape

Composed:
• Labyrinths – on each side
• Cribriform plate – perforated, apex of
nasal cavity
• Perpendicular plate – part of nasal
septum
• Orbital plate
• Superior & middle conchae
• Bulla – bulge form by middle
ethmoidal cells
• Infundibulum – groove that open into
frontal sinus
 Ethmoid bone
Articulations with other Articulations of its
bones: perpendicular plate:
• Superior surface of • Anterior – nasal spine
labyrinth with frontal of frontal bone & nasal
bone bone

• Anterior – frontal • Posterior – crest of

process of maxilla & sphenoid bone
lacrimal
• Inferior – septal
• Inferior – medial margin cartilage & vomer
of maxilla
 Nasal cavities: boundaries
• ROOF • MEDIAL WALL
- divided into 3 parts: Nasal septum
1. Frontonasal
2. Ethmoidal
3. Sphenoidal

• FLOOR • LATERAL WALL

1. Palatine process of - divided into 3 parts:
maxilla 1. Vestibule (anterior)
2. Horizontal plate of 2. Nasal Conchae (posterior)
palatine bone
 Roof
• Frontonasal part is formed by:
Nasal bone & cartilage
Nasal spine of frontal bone Frontonasal Ethmoidal
Sphenoidal
• Ethmoidal part is formed by:
Cribriform plate of ethmoid
bone

• Sphenoidal part is formed by:

Sphenoid bone
 Nasal spine of frontal bone

Cribriform plate of ethmoid bone

Nasal bone
Sphenoid
 Floor
• Soft tissues of
external nose

• Palatine process of
maxilla

• Horizontal plate of
palatine
 Nasal septum
• It is the partly bony and cartilaginous (soft mobile) that
divides the chamber of the nose into 2 nasal cavities

• Bones form the nasal septum include:

1. Frontal bone
Perpendicular plate
2. Perpendicular plate of ethmoid bone of ethmoid bone
3. Vomer
4. Sphenoid bone Frontal
5. Maxilla (nasal crest) bone Sphenoid
6. Palatine (nasal crest)

• Cartilages form the nasal septum:

1. Septal cartilage Vomer
2. Major alar cartilage
 NASAL SEPTUM

Frontal Perpendicular plate

bone of ethmoid bone

Sphenoid

Septal cartilage

Vomer
Major alar cartilage

maxilla palatine bone

 Lateral wall
Consists of
Concha
Vestibule:
• A small depressed area
anteriorly
• Lined by modified skin
• Contains vibrissae (short hairs)

Nasal conchae (turbinates):

• Bone projections
• Increase surface area of
contact between tissues &
respired air
• Covered by mucous Vestibule
membrane
 Lateral wall
• Consists of 3 conchae – inferior concha
(IC), middle concha (MC) & superior
concha (SC)

Conchae
• Are curved shelves of bone that
project medially & inferiorly
• Divide nasal cavity into 4 air channels:
1. Inferior nasal meatus (between inferior
concha & nasal floor)
2. Middle nasal meatus (between IC & MC)
3. Superior nasal meatus (between MC &
SC)
4. Sphenoethmoidal recess (between SC &
nasal roof)
 Sphenoethmoidal recess

Conchae

Meatuses

Vestibule

Vibrissae
 Superior & middle conchae
Projects from ethmoidal
labyrinth
Ethmoid bone (labyrinth)

• Superior concha connected to Superior concha

the middle concha

• Superior concha serve to

protect the olfactory bulb

• Middle concha project

downwards over the openings
of the maxillary & ethmoid
sinuses - act as buffers to protect the Middle concha
sinuses from coming in direct contact
with pressurized nasal airflow
 Inferior concha
• Is an independent bone

• Is the largest turbinate

• Responsible for the majority

of airflow direction,
humidification, heating, and
filtering of air inhaled
through the nose

Inferior concha
 Inferior Meatus
• Underneath
inferior concha

• Largest

• Has opening for

nasolacrimal duct
(drains tears from lacrimal
sac) Inferior meatus
Openings of NL duct
 Middle meatus
• Underneath middle • Openings:
concha 1. Opening of frontal
sinus (at anterior end of
hiatus)
• Contains:
2. Opening of
• ethmoidal bulla maxillary sinus (at
(rounded elevation
posterior end of hiatus)
produced by middle
ethmoidal sinus) 3. Openings of anterior
& middle ethmoidal
sinus
 Probe inserted from
frontal sinus Openings of middle
ethmoidal sinus

Opening of frontal sinus

Ethmoidal bulla

Opening of
anterior ethmoidal
sinus
Opening of maxillary sinus
 Superior meatus
• Below the
superior
concha

• Receives
openings of
posterior
ethmoidal
sinus
 Sphenoethmoidal recess
• Above the
superior
concha

• Receives
opening of
sphenoidal
air sinus
 Sphenoethmoidal recess

Superior meatus Openings of sphenoidal

sinus

Openings of
posterior
ethmoidal
sinus
 Arterial supply
• Originates from external carotid artery (maxillary & facial arteries)
& internal carotid artery (opthalmic artery)

• Arterial supply of medial & lateral wall of nasal cavity:

1. Anterior ethmoidal artery (from OA)
2. Posterior ethmoidal artery (from OA)

3. Sphenopalatine artery (from MA)

4. Greater palatine artery (from MA)
5. Septal branch of Superior labial artery (from FA)

The anterior part of nasal septum is the Kiesselbach area (surgical

Little’s area) – anastomosis involving all arteries
 Septal branch of Greater palatine artery
superior labial artery

Little’s area
Posterior septal branch
of sphenopalatine
artery
Nasal septum
turned up
anterior ethmoidal
nerve
posterior
ethmoidal artery
 Little’s area
• An area of anastomosis
between all these arteries
(excluding post. ethmoidal)
is present on the antero-
inferior part of the nasal
septum = Little’s area or
Kiesselbach’s plexus

• The commonest site of

epistaxis
 Arterial supply: nasal septum
Artery Area supplied
1 The posterior septal branch of the posteroinferior quadrant
sphenopalatine artery (branch of maxillary a.)

2 The anterior septal branch of anterior anterosuperior quadrant

ethmoidal a. and septal branch of posterior
ethmoidal a. (branches of the ophthalmic a.)

3 The greater palatine artery (branch of anteroinferior portion

maxillary a.)

4 The superior labial branch of facial a. anterior (vestibular area)

 Arterial supply: lateral wall
Artery Area supplied
1 The posterior lateral branch of posteroinferior
sphenopalatine a. (branch of maxillary a.) quadrant

2 The anterior lateral branch of anterior anterosuperior

ethmoidal a. and lateral nasal branch of quadrant
posterior ethmoidal a. (branches of the
ophthalmic a.)
3 The greater palatine a. (branch of region of the inferior
maxillary a.) meatus

4 The alar branches of the lateral nasal anterior (vestibular

branch of facial artery area)
45
 Innervation of nasal cavities
1. Trigeminal nerve CN V (CN VI & CN V2) – general sensation
Ophthalmic nerve (CN V1)
• Anterosuperior area
• External nose (except alae)

Maxillary nerve (CN V2)

• Posteroinferior area
• Alae of nose

2. Olfactory nerve CN I – olfaction

3. Facial nerve CN VII (greater petrosal nerve) - sympathetic

innervation to glands (parasympathetic – T1)
*both joins CN V2
 Innervation: Nasal Septum
Nerve Area supplied

1 The medial posterior superior nasal n. Posteroinferior portion

and the nasopalatine n. (V2)
2 Medial internal branch of anterior Anterosuperior portion
ethmoidal n. (from nasociliary n. of V1)
3 The internal nasal branch of the vestibule
infraorbital n. (V2)
4 The anterior superior alveolar n. of the part of the septum, the floor near the
infraorbital n. (from V2) anterior nasal spine
5 Branches from the nerve of pterygoid upper and posterior part of the roof;
canal septum

47
 CN V2
CN VI

Olfactory nerve
 Innervation: Lateral wall
Nerve Area supplied

1 The lateral posterior superior nasal Posteroinferior portion

and the lateral posterior inferior
nasal branches of the greater
palatine n. (V2)
2 Lateral internal branch of anterior Anterosuperior portion
ethmoidal n. (from nasociliary n. of
V1)
3 The anterior superior alveolar n. of anterior part of the lateral wall as high
the infraorbital n. (from V2) as the opening of the maxillary sinus

4 The internal nasal branch of the vestibule

infraorbital n. (V2)

49
 Paranasal Sinuses
• Paranasal sinuses are air-filled spaces
within the bones of the skull and face

• Humans possess 4 paranasal sinuses

• Paired

• Each named according to the bone in

which it is found

• Lined by respiratory mucosa

(epithelium)

• Open into nasal cavities

• Innervated by branches of CN V
 PARANASAL SINUSES
• Frontal sinuses • Maxillary sinuses
1. Apex
2. Base
• Sphenoidal sinuses 3. Roof
4. Floor
• Ethmoidal sinuses
1. Anterior ethmoidal cells
2. Middle ethmoidal cells
3. Pposterior ethmoidal cells
 Frontal sinus

Ethmoidal sinus

Maxillary sinus
 Frontal sinuses
• The most superior sinus

• Triangular in shape

• In the part of frontal bone under

the forehead

• Lie at the midline above the

bridge of the nose

• Laterally related to the orbits

• Each sinuses drains through the

frontonasal duct  pentrates
ethmoidal labyrinth & continues as
ethmoidal infundibulum at the anterior
end of semilunar hiatus of the middle
meatus
Frontal sinus

Opens at anterior part of hiatus

semilunaris
 Ethmoidal sinus
Ethmoidal sinuses
• Comprise of several small cavities
(ethmoidal cells) – located in the of
ethmoidal labyrinth (between nasal cavity & orbit)

• Anterior & Middle Ethmoidal Cells

open into the middle meatus
AEC open into ethmoidal infundibulum /
frontonasal duct
MEC open at lateral wall of ethmoidal bulla

• Posterior Ethmoidal Cells

open into the lateral wall of superior
meatus
 Sphenoidal sinuses
• Located in the body of
sphenoid

• Open via aperture s on the

posterior wall of
sphenoethmoidal recess
(roof of nasal cavity)

Related:
• Cranial cavity, particularly
pituitary gland & optic
chiasm (superior)
• Cavernous sinuses (lateral)
• Nasal cavity (anterior &
inferior)
 Clinical application
• Pituitary gland can be
surgically approached
through the roof of
nasal cavity –
sphenoidal sinuses –
hypophyseal fossa
 Maxillary sinuses
• Largest paranasal sinus
• Pyramidal cavities that occupy
the bodies of the maxillae
• Apex directed laterally

Apex: extends into zygomatic bone

Base: lateral wall of nasal cavity
Roof: floor of orbit
Floor / medial wall: maxilla
Roof

Apex

Maxillary sinus
Base

Floor
 Maxillary sinuses
Opening (maxillary ostium):
• Near the top of base (roof)
into the middle meatus
(in the centre of semilunar hiatus)

Relations:
• Superolateral – orbit
• Anterolateral – roots of
upper molar & premolar
teeth
• Posterior – infratemporal
fossa
Maxillary ostium
 Clinical Applied Anatomy
• Rhinitis

• Sinusitis

• Infection of the Ethmoidal Cells

• Infection of the Maxillary sinuses (most

common because its opening is high near to
the roof, so mucus can easily accumulate)
Thank you