Nasal Cavity, Paranasal Sinuses, Maxillary Division of

Trigeminal Nerve
Can't stress enough, ORIENT YOURSELF

Bones of the Nasal Cavity

It is always a good idea to learn the bones of a region

before proceeding further. The bones of the nasal
septum and other landmarks are:

1. nasal
2. frontal
3. ethmoid
4. sphenoid
5. vomer
6. perpendicular plate of ethmoid
7. maxilla
8. horizontal process of palatine bone
9. medial pterygoid plate

10.occipital condyle
The skeleton of the lateral nasal wall include:

1. nasal
2. frontal
3. ethmoid
4. sphenoid
5. maxilla
6. horizontal process of palatine
7. superior concha (ethmoid)
8. middle concha (ethmoid)
9. inferior concha
10.sphenopalatine foramen
11.medial pterygoid plate
12.pterygoid hamulus of medial plate

Notice that the roof of the nasal cavity is:

1. nasal
2. frontal
3. ethmoid
4. sphenoid

and the floor:

• maxilla and its palatine process (5)

• palatine and it horizontal process (6)

 Nasal Septum

Usually when the head is bisected, the nasal septum

is either destroyed or left behind on one side.
The nasal septum is made up of the following:

• perpendicular plate of ethmoid

• vomer
• maxilla

• septal cartilage

The septum and the nasal cavity, in general is

highly vascularized. One reason for this might be to
warm the air before it reached the bronchi and
lungs. The major arteries of the septum are:

1. anterior ethmoidal (ophthalmic)

2. posterior ethmoidal (opththalmic)
3. sphenopalatine (maxillary)
4. greater palatine (maxillary)

5. branch of superior labial (facial)

Sensory innervation to the nose is also important in
that it provides reflexes (such as the sneeze reflex)
to keep foreign particles out of the respiratory
system. The sensory nerves to the septum are:

1. anterior ethmoidal (V1) (nasociliary)

2. nasopalatine (V2) (maxillary)

 Lateral Nasal Wall

ORIENT YOURSELF!

Be sure you know which is front and back and up

and down. Look at the lateral wall of the nasal
cavity and identify:

• sphenoethmoid recess (arrow above 1)

• superior concha (1)
• superior meatus (tip of arrow)
• middle concha (2)
• middle meatus (tip of arrow)
• inferior concha (3)
• inferior meatus (ti of arrow)

A meatus is a small space under the concha.

The superior and middle conchae are parts of the
ethmoid bone.
The inferior concha is a separate bone of the skull.
Once the most obvious structures are identified,
removal of the middle and inferior conchae reveals
other items to be identified:

• cut edges of middle and inferior conchae (1

and 2)
• hiatus semilunaris (3)
• ethmoid bulla (bulge formed by ethmoid air
cells (4)

• small bulge formed by the nasolacrimal duct

(5) (not always apparent)
In order to get an idea as to the relationship of the
nasal cavity to the air sinuses, a frontal section is
shown in the image. Again use familiar structures
to orient yourself, like the orbits with the optic
foramen (black circle). Identify:

• right and left nasal cavities on either side of

the nasal septum made up of the:
• vomer (7) and
• perpendicular plate of ethmoid (1)
• superior, middle and inferior conchae (3-5)
with the meatus deep to them
• large maxillary sinus
• ethmoid sinuses
• frontal sinus
Note that the roof of the nasal cavity is made up of
the cribriform plate (not labeled) but on each side
of (1).
Also note that the floor of the nasal cavity is made
up of the palatine processes of the maxilla (6).
The paranasal sinuses are lined with a mucous
membrane that secretes a fluid to keep the lining
moist. Under normal conditions, the sinuses drain
into various parts of the nasal cavity.

1. sphenoid sinus-->sphenoethmoid recess

2. frontal sinus-->infundibulum of middle
meatus
3. anterior ethmoid sinus-->middle meatus
4. middle ethmoid sinus-->ethmoid bulla of
middle meatus
5. maxillary sinus-->middle meatus

One other structure empties into the nasal cavity

and the is (6) the nasolacrimal duct. You can see
that this duct is close to the front of the nasal
cavity and therefore should realize why your nose
runs when you cry. This duct carries away extra
tears.
You should also realize that when the drainage
pores are closed off due to irritation, the mucous
can no longer drain out of the sinuses, they fill up
and cause pressure which can then cause
headaches (sinus headaches).
Sinus medication reduces the swelling so that
the mucous can drain.

Continuing to work you way laterally, you can

remove the bone further and open up the maxillary
sinus. You can also see the nasopalatine nerve (1)
emerging through the sphenopalatine foramen.
Once the foramen is identified, you can then see a
small bulge formed by the bony greater palatine
canal. If this is broken down, you would see the
greater palatine nerve and artery in the canal.
After more of the lateral nasal wall has been
removed, you can see the major nerve coming into
this region, the maxillary division of the trigeminal.
Now identify:

1. infraorbital nerve
2. posterior superior alveolar nerve
3. pterygopalatine ganglion (parasympathetic)
4. greater palatine nerve
5. lesser palatine nerve
6. cut nasopalatine nerve
7. nerve of the pharyngeal canal

All of the nerves are sensory branches of V2. The

pterygopalatine ganglion is suspended from V2 by
two sensory roots. Since the ganglion is
parasympathetic, there are preganglionic neurons
feeding into it from the facial nerve (greater
petrosal branch) that synapse at this point then
continue onward as postganglionic neurons. Their
destination is the lacrimal nerve and reach there by
rejoining the maxillary nerve through a sensory
root, hopping onto the zygomatic nerve (V2),
running up the lateral side of the orbit to jump onto
the lacrimal nerve (V1) and then to the lacrimal
gland to produce tears.
As you go posterior to the inferior concha, you
enter the nasopharynx. The roof is the body of the
sphenoid, the floor is the soft palate and it is open
to nasal cavity anteriorly and pharynx posteriorly.
When the mucous membrane is carefully removed,
you can see the small muscles of the soft palate
and upper pharynx. Landmarks are the tubal
elevation (torus tubarius) and the uvula (u).
The muscles are:

1. tensor palati
2. levator palati
3. palatopharyngeus
4. salpingopharyngeus

To identify the tensor, first feel for the medial

pterygoid plate and find its posterior border. The
muscle is located there. You might see a small
artery at this site, the terminal part of the
ascending palatine artery (external carotid)
The palato- and salpingopharyngeus muscles
join the stylopharyngeus to form the longitudinal
muscles of the pharynx. The help elevate the
pharynx when you swallow.

The major sensory innervation to the nasal cavity is from branches of the maxillary division of the
trigeminal (nasopalatine, infraorbital, greater palatine). Other sensory branches are from the
ophthalmic division (anterior ethmoidal nerve). Any secretory glands of the nasal cavity are
supplied by branches of the pterygopalatine ganglion. The olfactory epithelium in the roof of the
nasal cavity is innervated by the olfactory nerve (I) and receives smell sensations.
The major arterial supply to the nasal cavity are from the ophthalmic and maxillary arteries by
way of anterior and posterior ethmoidal branches and sphenopalatine branches respectively.

Table of Muscles

Nerve
Muscle Origin Insertion Action
supply
scaphoid fossa of pterygoid aponeurosis of elevates and
tensor palati V3
fossa soft palate tenses soft palate
levator palati apex of petrous temporal aponeurosis of pulls soft palate X
 bone and auditory tube soft palate up and back
palatopharyngeus aponeurosis of soft palate wall of pharynx elevates pharynx X
salpingopharyngeus cartilage of auditory tube wall of pharynx elevates pharynx X

Items to Remember in this Lesson

Bones Nerves

nasal V2
frontal greater palatine
ethmoid lesser palatine
crista galli nasopalatine
perpendicular plate infraorbital
superior concha posterior sup. alveolar
middle concha
sphenoid body
medial pterygoid plate Muscles
hamulus
inferior concha tensor palati
maxilla levator palati
palatine processes palatopharyngeus
palatine bone
horizontal process Nerves

Air sinuses V2
greater palatine
frontal lesser palatine
nasopalatine
 sphenoid infraorbital
ethmoid posterior sup. alveolar
maxillary
Nerves
Muscles
V2
tensor palati greater palatine
levator palati lesser palatine
palatopharyngeus nasopalatine
salpingopharyngeus infraorbital
posterior sup. alveolar
Muscles
Arteries
tensor palati
levator palati sphenopalatine
palatopharyngeus descending palatine