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Pasha Chapter 1 - Rhinology and Paranasal Sinuses > Anatomy of the Nose and Paranasal Sinuses > Flashcards

Anatomy of the Nose and Paranasal Sinuses Flashcards

1
Q

Turbinates (Conchae)

A

Inferior, middle, superior, supreme
Covered by erectile mucosa
Increases interior surface area
Warms, moisturizes and filters airflow

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2
Q

Superior Meatus

A

Area under superior turbinate

Drainage pathway of sphenoid and posterior ethmoid sinuses

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3
Q

Middle Meatus

A

Area underneath middle turbinate

Drainage pathway of the frontal, anterior ethmoid and maxillary sinuses

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4
Q

Inferior Meatus

A

Area underneath the inferior turbinate

Contains orifice of nasolacrimal duct

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5
Q

Uncinate Process

A

Sickle-shaped bone covered by mucoperiosteum
Part of the ethmoid bone
Anteriorly attaches to lacrimal bone
Inferiorly attaches to inferior turbinate
Superiorly attaches to lamina papyracea (80%), skull base or middle turbinate

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6
Q

Ethmoid Infundibulum

A

Pyramidal space
Houses the drainage pathways of maxillary, anterior ethmoid and frontal sinuses
Seems synonymous with OMC from this description

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7
Q

Recess Terminalis

A

When the uncinate inserts superiorly into the lamina papyracea, a blind pouch in the infundibulum is formed. This is the name of that pouch

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8
Q

Semilunar Hiatus

A

Gap emptying the ethmoid infundibulum

Between uncinate process and ethmoid bulla

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9
Q

Sphenopalatine Foramen

A

Posterior to the inferior attachment of the middle turbinate

Contains SPA, sensory nerve fibers, secretomotor fibers (parasympathetics from vidian nerve to pterygopalatine ganglion)

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10
Q

Concha Bullosa

A 
Pneumatized turbinate (middle turb most common)
May obstruct nasal cavity or OMC
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11
Q

Paradoxical Middle Turbinate

A

Middle turbinate that “turns” medially instead of laterally

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12
Q

Ostiomeatal Complex (OMC)

A

Region of the anterior ethmoids that contains the ostia of maxillary, frontal and ethmoid sinuses, lateral to the middle turbinate

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13
Q

Nasal Fontanelles

A

Areas of lateral nasal wall where no bone exists
Located above the insertion of the inferior turbinate
May be the site of the accessory maxillary ostia

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14
Q

Draw the anatomy of the lateral nasal wall including vascular supply

A

See Page 3 of Pasha to confirm

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15
Q

Nasolacrimal Duct and Sac

A

Duct lateral to anterior uncinate process
Sac lateral to agger nasi
Sac opens into inferior meatus via Hasner’s valve

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16
Q

Where is Hasner’s Valve

A

Inferior meatus

3 - 6mm anterior to level of maxillary sinus ostium

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17
Q

When does the Frontal Sinus develop?

A

Last sinus to develop

Does not pneumatize until 5 - 6 years old

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18
Q

Volume of an adult Frontal Sinus

A

4 - 7 mL by age 12 - 20 years old

5 - 10% will be aplastic/hypoplastic

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19
Q

Drainage of Frontal Sinus

A

Frontal Recess
Drains into anterior middle meatus
Most commonly medial to uncinate (when uncinate attaches superiorly to skull base or middle turb)

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20
Q

Vasculature in Frontal Sinus

A

Supraorbital Artery
Anterior Ethmoid Artery
Ophthalmic Vein (to Cavernous Sinus)
Supraorbital Vein (to anterior facial veins)

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21
Q

Innervation of Frontal Sinus

A

Supraorbital Nerve (V1)

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22
Q

Frontal Recess

A 
Drainage between the frontal sinus and semilunar hiatus/middle meatus
Boundaries:
Posterior wall of agger nasi
Lamina papyracea
Middle Turbinate
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23
Q

Frontal Sinus Infundibulum

A

Space that drains into frontal recess

Superior to agger nasi

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24
Q

Foramina of Breschet

A

Small venules that drain sinus mucosa into dural veins

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25
Q

Frontal Cells

A

Anterior ethmoid cells that pneumatize frontal recess
May cause obstruction or pesistent disease
Posterior to agger nasi
4 Types

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26
Q

Type I Frontal Cell

A

Single cell above agger nasi

Below floor of frontal sinus (infundibulum)

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27
Q

Type II Frontal Cell

A

Multiple Cells above agger nasi

May extend into the frontal sinus proper

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28
Q

Type III Frontal Cell

A

Single large cell that extends supraorbitally through the floor of the frontal sinus
Attaches to the anterior table

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29
Q

Type IV Frontal Cell

A

Single isolated cell that is within the frontal sinus

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30
Q

When does the Maxillary Sinus Develop?

A

First do develop
Biphasic growth:
Age 3
Age 7 - 18

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31
Q

Volume of Adult Maxillary Sinuses

A

15mL

Largest paranasal sinus

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32
Q

Drainage of Maxillary Sinus

A 
Ethmoid infundibulum (Middle meatus)
10 - 30% have accessory ostium
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33
Q

Vasculature of Maxillary Sinus

A

Branches of the maxillary artery

Corresponding veins to facial vein/pterygoid plexus

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34
Q

Innervation of Maxillary Sinus

A

Branches of Maxillary Nerve (V2)

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35
Q

Structures Adjacent to Maxillary Sinus

A

Lateral nasal wall
Alveolar process of maxilla (contains second bicuspid and first and second molars)
Orbital floor
Posterior maxillary wall (contains pterygopalatine fossa housing maxillary artery, pterygopalatine ganglion, branches of V2)

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36
Q

When do the Ethmoid Sinuses develop?

A

3 - 4 cells present at birth
Most developed paranasal sinus at birth)
Formed from 5 ethmoturbinals
Reach adult size by age 12 - 15 years old

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37
Q

Derivatives of First Ethmoturbinal

A

Agger Nasi

Uncinate

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38
Q

Derivative of Second Ethmoturbinal

A

Middle Turbinate

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39
Q

Derivative of Third Ethmoturbinal

A

Superior Turbinate

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40
Q

Derivative of Fourth - Fifth Ethmoturbinals

A

Supreme Turbinate

41
Q

Volume of adult ethmoid sinuses

A

2 - 3 mL

Distributed among 10 - 15 aerated cells

42
Q

Drainage of Ethmoid Sinuses

A

Anterior Cells: Into ethmoid infundibulum

Posterior Cells: Into superior meatus

43
Q

Vasculature of the ethmoid sinuses

A 
Anterior ethmoid artery
Posterior ethmoid artery (from ophthalmic)
Branches of SPA
Maxillary veins
Ethmoid veins (to cavernous sinus)
44
Q

Distance relationship of anterior lacrimal crest, anterior/posterior ethmoid arteries and optic foramen

A

24/12/6 rule
Anterior Lacrimal Crest to AEA: 24mm
AEA to PEA: 12mm
PEA to Optic Foramen: 6mm

45
Q

Innervation of ethmoid sinuses

A

Anterior ethmoidal nerve
Posterior ethmoidal nerve
From nasociliary nerve (V1)

46
Q

Structures adjacent to the ethmoid sinuses

A

Skull base
Anterior ethmoidal artery (roof or anterior ethmoid cells)
Nasal Cavity
Orbit

47
Q

Agger Nasi Cells

A

Most anterior or anterior ethmoid cells
Found anterior and superior to middle turbinate attachment to lateral nasal wall
Posterior wall of the agger nasi forms anterior wall of the frontal recess

48
Q

Ethmoid Bulla

A

Largest of the anterior ethmoid cells
Lies above the infundibulum
Anterior ethmoid artery courses superior and posterior to this cell

49
Q

Basal Lamella

A

Bony attachment of the middle turbinate to the lateral nasal wall
Separates anterior and posterior ethmoids
Anterior part inserts vertically into crista ethmoidalis
Middle part inserts obliquely into lamina papyracea
Posterior third attaches to the lamina horizontally

50
Q

Onodi Cells

A

Ethmoid cells that pneumatize lateral or posterior to anterior wall of the sphenoid
Commonly mistaken as sphenoid cells
Optic nerve or carotid artery may indent into lateral wall

51
Q

Haller Cells

A

Ethmoid cells that extend into the maxillary sinus above the ostium
Pneumatize medial and inferior orbital walls

52
Q

Lamina Papyracea

A

Lateral thin bony wall of ethmoid sinus
Separates orbit from ethmoid cells
Part of the medial orbital wall

53
Q

Fovea Ethmoidalis

A

Roof of ethmoid sinus

54
Q

Supraorbital Cell

A

Pneumatization of posterior orbital plate of the frontal bone
Often forms septations in the frontal recess

55
Q

Olfactory Fossa

A

Depression in anterior cranial cavity
Floor formed by cribriform plate
Olfactory cleft lies below

56
Q

Keros Classification

A

Relationship between olfactory fossa and ethmoid roof (how deep is lateral lamella)
Type 1: 1 - 3mm
Type 2: 4 - 7mm
Type 3: 8 - 16mm

57
Q

Lamellae of Ethmoid Bone

A

1 - Uncinate Process
2 - Bulla Ethmoidalis
3 - Basal Lamella of Middle Turbinate
4 - Lamella of Superior Turbinate

58
Q

Embryology of Sphenoid Sinus

A

Evagination of nasal mucosa into sphenoid bone

Reaches adult size at 12 - 18 years old

59
Q

Volume of an adult sphenoid sinus

A

0.5 - 8 mL

60
Q

Drainage of Sphenoid Sinus

A

Sphenoethmoidal Recess (SER)

61
Q

Vasculature of the Sphenoid Sinus

A

Posterior Ethmoidal Artery
Sphenopalatine Artery
Maxillary Vein (to Pterygoid Plexus)

62
Q

Innervation of Sphenoid Sinus

A

Posterior Ethmoidal Nerves (V1)

63
Q

Structures adjacent to the sphenoid sinus

A 
Pons
Sella Turcica (and therefore Pituitary)
Carotid Artery (Lateral wall, 25% dehiscent)
Optic Nerve (Lateral wall, 5% dehiscent)
Cavernous Sinus (laterally)
V1, V2
Clivus
Septal branch of the SPA (inferior aspect of the sphenoid os)
64
Q

Piriform Aperture

A

Bony anterior opening to nasal cavity
Bounded inferolaterally by maxilla
Bounded superiorly by nasal bones

65
Q

Upper Lateral Cartilage

A

Paired cartilage supporting nasal sidewall

Inferior to nasal bone

66
Q

Lower Lateral Cartilage

A

Paired cartilage forming the alae
Inferior to the lower lateral cartilage
Composed of lateral and medial crura

67
Q

Lesser Alar Cartilage

A

Also called sesamoid cartilages?

Small cartilaginous plates lateral to the lower lateral cartilages

68
Q

Muscles attached to the external nose

A 
Procerus
Nasalis
Dilator naris anterior
Depressor septi
Levator labii superioris alaeque nasi
All innervated by VII
69
Q

Components of Nasal Septum

A

Quadrangular Cartilage
Perpendicular plate of the Ethmoid bone
Vomer
Nasal Crest (Maxillary and Palatine Bones)
Anterior Nasal Spine (Bony projection anterior to piriform aperture)

70
Q

Blood Supply to Nasal Septum

A 
Anterior Ethmoid Artery
Posterior Ethmoid Artery
Sphenopalatine Artery
Greater Palatine Artery
Superior Labial Artery
71
Q

Nasal Vestibule

A

Just inside the naris
Anterior to the limen nasi (ridge that marks beginning of nasal cavity)
Lined by keratinized stratified squamous epithelium
Contains coarse hair-bearing skin inferiorly

72
Q

Roof of Nasal Cavity

A

Bounded by nasal/frontal bone anteriorly

Bounded by cribriform plate and sphenoid face posteriorly

73
Q

Floor of Nasal Cavity

A

Formed by palatine process of maxilla and horizontal plate of palatine bone
Communicates with piriform aperture anteriorly
Communicates with choana posteriorly

74
Q

Sensory innervation to external nose

A

Nasal Dorsum: Supratrochlear, infratrochlear nerves (V1)
Nasal Tip: External branch of anterior ethmoid nerve (V1)
Malar, lateral nose, subnasal regions: Infraorbital nerve (V2)

75
Q

Sensory innervation to Nasal Cavity

A

Anterosuperior Nasal Cavity: Internal nasal branch of anterior ethmoid nerve (V1)
Posterosuperior Nasal Cavity: Posterior ethmoid nerve (V1)
Posterior and Inferior Septum: Nasopalatine Nerve (V2)
Posterior lateral wall, floor and roof: Greater Palatine Nerve (V1)
Anterior septum, floor, lateral wall: Superior Alveolar Nerve (V2)

76
Q

Branches of External Carotid Supplying the Nose

A

iMax > Descending Palatine Artery > Greater Palatine and lesser Palatine Arteries
iMax > Sphenopalatine Artery > Medial (Nasoseptal) and Lateral nasal arteries
Facial > Superior labial artery (columella, nasal septum, alar branches)
Facial > Lateral nasal artery
Facial > Angular artery (nasal sidewall, tip, dorsum)

77
Q

Branches of Internal Carotid Supplying the Nose

A

Ophthalmic > Anterior ethmoid artery (lateral nasal wall and septum)
Ophthalmic > Posterior ethmoid artery (superior turbinate and septum)
Ophthalmic > Dorsal nasal artery (external nose)

78
Q

Venous Drainage of Nose

A

Greater Palatine Vein > Posterior Facial Vein (EJ) and Cavernous Sinus
Septal Vein > Anterior Facial Vein (IJ)
Sphenopalatine Vein > Cavernous Sinus and Maxillary Vein (IJ)
Anterior and Posterior Ethmoidal Veins > Opthalmic Veins (Cavernous Sinus)
Angular Vein > Anterior Facial Vein (IJ) or Ophthalmic Veins (Cavernous Sinus)

79
Q

Danger Triangle

A

Bounded by oral commissures and nasal bridge

Retrograde drainage from superficial veins may lead to intracranial extension of infection

80
Q

Lymphatic Drainage of the Nose

A

External: Primarily to Level IB, root of nose drains to superficial parotid nodes
Internal: Anterior nasal cavity drains superficially, then to IB, remainder drains to retropharyngeal and upper cervical nodes

81
Q

Nasal Cycle Overview

A

Airflow regulated by volume of venous sinusoids in nasal erectile tissue (inferior turb and anterior septum)
Hypothalamus also stimulates sympathetic tone via superior cervical sympathetic ganglia for vasoconstriction

82
Q

Nasal Flow Formula

A

Pressure/Resistance

Flow may be laminar or turbulent

83
Q

Sneeze Pathway

A

Allergens, ammonia, viral infections, exercise or other irritants stimulate trigeminal afferents
Complex efferent input triggers:
Slow inspiratory phase, glottic and velopharyngeal closure (increase subglottic pressure), sudden glottic opening (sneeze)

84
Q

Asymmetric Congestive Response (Nasal Cycle)

A

Normal physiologic congestion/decongestion cycle

Alternates between nasal sides every 2 - 7 hours

85
Q

Symmetric Congestive Response

A

Temporary bilateral congestion
Induced by exercise, changes in body position, hyperventilation, cold air, sulfur, histamine, other irritants
Lasts 15 - 30 minutes

86
Q

Role of microvasculature in nasal congestion

A

Regulates volume, humidity and heat exchange

87
Q

Resistance Vessels of the Nasal Mucosa

A

Arterioles and precapillary sphincters

Regulate blood flow to the nasal mucosa

88
Q

Subepithelial Capillaries of the Nasal Mucosa

A

Fenestrated vessels

Allow for transport of solutes and fluids

89
Q

Venous sinusoids of the nasal mucosa

A

Capacitance vessels

Determine blood volume and nasal congestion

90
Q

Arteriovenous Anastomoses of the Nasal Mucosa

A

Regulate nasal blood flow

Allow blood to flow directly from resistance vessels to venous sinusoids

91
Q

Sympathetic Regulation of Nasal Microvasculature

A

Provides vasoconstrictor tone to arteries and capacitance veins
Primarily via norepinephrine
Also via Neuropeptide Y (weak vasoconstrictor, enhances function of norepinephrine)
Lastly via Avian Pancreatic Polypeptide (APP)

92
Q

Parasympathetic Regulation of Nasal Microvasculature

A

Controls secretions, dilates resistance vessels
Primarily via Acetylcholine
Also using Vasoactive Intestinal Peptide (VIP)
Also using Peptide Histamine Isoleucine (PHI)

93
Q

Function of Nasal Mucociliary System

A

Humidification
Filtering
Eliminating debris and excess secretions from sinuses and nasal airway

94
Q

Pattern of Nasal Mucociliary Flow

A

1cm/minute

Migration begins at floor of maxillary sinus > Natural Ostium > Nasal Cavity > Nasopharynx

95
Q

Components of Nasal Mucociliary System

A

Ciliated, Pseudostratified Columnar Epithelium
Double-Layered Mucous Blanket
Mucus-Producing Glands

96
Q

Location of Ciliated, Pseudostratified Columnar Epithelium within the nasal cavity

A

Anterior border begins at limen nasi

97
Q

Double-Layered Mucous Blanket in the Nose

A

Deep: Less viscous, serous periciliary fluid (sol phase)
Superficial: More viscous, mucous fluid (gel phase)

98
Q

Mucus-Producing Glands in the Nose

A 
Goblet cells (Columnar, basal nucleus, secretory granules at lumen end)
Deep and superficial seromucinous glands (serous or mucous acini with cuboidal-lined duct complexes)
Intraeptihelial glands (20 - 50 mucous cells around a single duct)
99
Q

Major Composition of Nasal Mucus

A 
95% water
3% glycoproteins (mucin)
2% salts
IgA
Lysozymes (bacteriolytic)
Lactoferrin (bacteriostatic)

Pasha Chapter 1 - Rhinology and Paranasal Sinuses (1 decks)

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