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External nose
The base of the nose has two openings
Bony Cartilaginous
Nasal cavity
It is 5 to 7 cm in length and 5 cm in height. The different parts are
Roof Floor Medial side and Lateral side
Nasal septum
It is the osteocartilagious partitiion between the two halves of the nasal cavity. The small anterior skin lines area is the membranous septum (columella)
Pediatric Sinuses
Bony Structure
Ethmoid Maxilla Palatine Lacrimal Pterygoid plate of Sphenoid Nasal Inferior Turbinate 9
Arterial Supply
External Carotid Maxillary A. Sphenopalatine Internal Carotid Ophthalmic A. Ant. Ethmoid Post. Ethmoid Supraorbital Supratrochlear
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Innervation
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Neurovascular Supply 12
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Ethmoid Sinus
Development
Present at birth Anterior/Posterior Variability
Structure
Volume/shape Roof Lateral wall
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Ethmoid Roof
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Ethmoid Cells
Three planes Childhood sinus Hiatus Semiluninaris/Superior Hiatus Semilunaris Suprabullar/retrobullar recesses (Sinus Lateralis)
Ethmoid Bulla
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Basal/Ground Lamella
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Ethmoid Infundibulum
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Suprabullar/Retrobullar Recess
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Ethmoid Arteries
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Osteomeatal Complex
Middle meatus Maxillary Sinus Ostium Anterior Ethmoid Drainage
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Maxillary Sinus
Development
Present at birth Biphasic growth Level of the floor
Structure
Volume & shape Walls, floor, roof
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Maxillary Sinus
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Maxillary Sinus
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Maxillary Sinus
Related Structures
Fontanelles Natural ostium
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Fontanelles
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Nasolacrimal Duct
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Frontal Sinus
Development
Structure
Related Structures
Frontal recess
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Frontal Sinus
Ostium Frontal recess
Boundaries Dumbbell shape
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Sphenoidal Sinus
Development
Arise within the nasal capsule (no pouch) Age 3 begins to pneumatize
Structure
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Sphenoid Sinus
Sphenoid Sinus
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Sphenoid Sinus
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Sphenoid Sinus
Ostium
Size (.5-4mm) Location (sinus floor, anterior nasal floor, anterior sinus wall, superior turbinate, cribiform plate) Bony dehiscence Sphenoethmoidal recess Sphenoid rostrum Onodi cell
Related Structures
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Microscopic Anatomy
Mucosa
Basal cells
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Microscopic AnatomyContd
Goblet Cells
Glycoproteinsviscosity and elasticity Innervation (para=thick, symp=thin)
Basement membrane
Submucosal glands
Distribution
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Microscopic Anatomy
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Mucous Blanket
Two layers
Superficial layer Sol layer
Function
Superficial layer traps bacteria and particulate matter. Enzymes, antibodies, immune cells
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Mucociliary Transport
Directional Flow of Mucous
Contact inhibition
Hallers cells Surgery
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Mucociliary Transport
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New Frontiers
Sleep apnea and the sinuses
Humidification contributes up to 6.9mm Hg serum pO2 Mouth breathers noted to have decreased end-tital CO2increased serum CO2apneas (high baseline) NO produced primarily in sinuses Toxic to bacteria, fungi, viruses Increases cilliary motility
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Case Report
39 yom with h/o sinus disease c/o headache, rhinorrhea. PMHx of sinus surgery years ago ROS reveals h/o two episodes of meningitis in past few years PE: right superior nasal mass. S/p FESS. Clear rhinorrhea. 49
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References
Anon, Jack B., et al, Anatomy of the Paranasal Sinuses, Theime, New York, c1996. Bhatt, Nikhil J., Endoscopic Sinus Surgery: New Horizons, Singular Publishing Group, Inc., San Diego, c1997. Bailey, Byron J., et al, Head & Neck Surgery -- Otolaryngology, Lippincott Williams & Wilkins, Philadelphia, c2001. Lundberg, J., Weitzberg, E. Nasal Nitric Oxide in Man. Thorax 1999; 54(10):947-952. McCaffrey, Thomas V., Rhinologic Diagnosis and Treatment, Thieme, New York, c1997. Marks, Steven C. Nasal and Sinus Surgery, W.B. Saunders Co., Philadelphia, c2000. Navarro, Joao A.C., The Nasal Cavity and Paranasal Sinuses, Springer, Berlin, c2001. Watelet, J.B., Cauwenberge P. Van, Applied Anatomy and Physiology of the Nose and Paranasal Sinuses. Allergy 1999; 54, Supp 57:14-25.
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