ANATOMY AND PHYSIOLOGY OF THE NOSE AND PARANASAL SINUSES The Internal Nose

 Nasal Vestibule – the anterior portion of the internal nose, from the nostril to the
ANATOMY nasal valve.
The External Nose  Keratinizing stratified squamous epithelium lining
 The anterior portion and caudal portion of the nose is cartilaginous, while  “nose hair” is called VIBRISSAE
posteriorly and superiorly, it is bony.  ROOF: the roof of the nose is adjacent to the anterior cranial fossa.
 The sensation of smell is limited in man to a very small area of mucosa in the
superior recesses of the nose.
 FLOOR: the floor of the nose is formed by the hard palate

The nasal septum

 The nasal septum divides the nose into two halves
 The nasal septum is very rarely present in the mid-line and more often than not
is deviated to one side.
 ‘C’ or an “S’ shaped deviation
 Occasionally “spurs” or sharp angulations or may be present.
 Lined by respiratory epithelium

 Arterial supply of the External Nose

THE LATERAL NASAL WALL

 Blood supply to the lateral wall of nose

Source: External Carotid Artery

 Trigeminal Nerve Distribution of Sensation

- Very well supplied

- Main: Sphenopalatine A – branch of External Carotid A

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  Nerve Supply of lateral wall of nose
 TURBINATES OR CONCHAE – three or sometimes four bony shelves covered by
erectile mucosa
- Increase the interior surface area
- Facilitate heat and water exchange
- The turbinates are also chief structures involved in pathologic obstruction.
 MEATUS – anteroposterior passages located on the lateral wall of the human
nasal cavity, where drainage of the sinuses are located
o Inferior Meatus – contains orifice of nasolacrimal duct.
o Middle meatus – contains the openings of the maxillary, frontal, and
anterior ethmoidal sinuses.
o Superior meatus – drains posterior ethmoid cells.
o Spheno-ethmoidal recess – orifice of sphenoid sinus.
 The nasal mucosa is made up of RESPIRATORY EPITHELIUM (pseudo stratified
ciliated columnar epithelium with mucus-producing goblet cells)
THE PARANASAL SINUSES
- The paranasal sinuses are a group of air-conditioning spaces in the skull,
surrounding and draining into, the nasal cavity.
ENT
 MAXILLARY SINUSES
- largest of the paranasal sinuses
- They occupy the bodies of the maxillae and communicate with the middle
nasal meatus
- Anterior & Posterior wall: Maxillary Bone
- Roof: Inferior orbital wall
- Floor: Hard palate
- Drainage: Maxillary ostium (ostia), middle nasal meatus (via semilunar
hiatus)
 THE ETHMOID SINUSES
- The ethmoids play a pivotal role in the pathophysiology of sinus
inflammatory disease.
- Divided into ANTERIOR & POSTERIOR groups of air cells
- HORIZONTAL PLATE: cribriform plate
- VERTICAL PLATE: perpendicular plate
- TWO LATERAL ETHMOIDAL SINUSES
- LAMINA PAPYRACEA – a paper thin bone that bone that forms part of the
lateral wall of each sinus, separating it from the orbit.
- The optical canal with the optic nerve comes in close relation with the lateral
wall of the posterior group pf the ethmoidal sinus cells
 THE FRONTAL SINUS
- The frontal sinus is the last sinus to develop, its complete development takes
place by 14-16 years.
- FLOOR: forms the orbital roof
- ANTERIOR WALL: formed by the thick bone of the skull
- POSTERIOR WALL: related to the anterior cranial fossa (considerably thinner
than the anterior wall)
 THE SPHENOID SINUS
- Drainage: spheno-ethmoidal recess
- Deepest and most difficult to access of the paranasal sinuses
- Important structures like the optic nerve and the internal carotid artery are
frequently found bulging into the sphenoid sinus.
- The pituitary gland lies above the roof of the sphenoid sinus and can thus be
approached trans-sphenoidally.
FUNCTIONS OF THE NOSE
 “AIR CONDITIONER” of the body, responsible for:
- Warming and saturating inspired air
- Removing bacteria and particulate debris
- Conserving heat and moisture from expired air
 Nasal breathing is important for optimal pulmonary function
o Nasal ostium -
 It is also prominent cosmetic feature of the face
HISTOLOGY OF THE NOSE
 The sinuses are line by RESPIRATORY EPITHELIUM also Pseudostratified ciliated
columnar containing mucus-producing goblet cells.
MUCOCILLARY CLEARANCE
 Mucus is swept posteriorly to the nasopharynx and swallowed.
 As much a as 1 liter/day
 The mucous layer of the maxillary sinus is renewed about every 30 minutes.
 Sinus disorders occur when this normal function is disturbed.
 Changes in the amount or consistency of the mucous: Thickened mucus
 TWO LAYERS OF NORMAL MUCUS: viscous outer gel layer & an inner thinner sol
layer
 The cilia sweep most effectively against the sol layer.
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 If the sinuses produce too much mucus, this can “swamp” the cilia and interfere
with their sweeping action.
 Gravity can draw the mucous into the lower regions of the sinus where it can
become stagnant and infected.
 Pathology:
1) Ineffective ciliary function:
- A variety of irritants and conditions can interfere with the natural
sweeping action of the cilia.
- Certain systemic illnesses like cystic fibrosis (CF) and immotile cilia
syndrome are associated with ciliary dysfunction.
2) Blockage of mucus flow: Any blockage to the outflow of mucous will lead to
its buildup in the sinus and increased risk of infection.
3) Allergies or viral infections can produce mucosal edema and subsequent
obstruction.
4) Polyps, Severe nasal septum deviation, or anatomic narrowing of a crucial
area called the ostiomeatal complex (OMC) will also increase the frequency
and duration of sinus infections.

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