NOSE AND NASAL CAVITY ; PARANASAL SINUSES Flashcards
The prominent anatomic structure located inferior and medial to the eyes
NOSE
Helps in breathing and olfaction
NOSE
The complex chamber located posterior to the vestibule and atrium of the nose
NASAL CAVITY
- Pseudostratified columnar epithelium with cilia
- Highly vascular and easily congested
- When this tissue is irritated, its blood vessels ref exively dilate and the glands secrete, normally leading to sneezing
RESPIRATORY EPITHELIUM
The nose is ______ in form. Fractures of the
______ bones are common—these are the most
frequently broken bones in the face.
pyramidal, nasal
The opening in the skull is the piriform aperture and is bounded by 2 bones:
______
______
Nasal
Maxilla
3 pairs of bones form the root of the nose:
______ (nasal process)
______ ( frontal process)
______
Frontal
Maxilla
Nasal
Because the root of the nose is made of bone, it is ______.
fixed
3 different major cartilages form the dorsum and apex of the nose:
______
______ (upper nasal)
______ (lower nasal)
Septal
Lateral nasal
Major alar
Minor cartilages that complete the nose are the:
______ (3 to 4 cartilages)
______
Lesser alar
Vomeronasal
Because the dorsum and apex are cartilaginous, the nose is quite ______.
mobile
The cavity of the nose opposite the alar cartilage is called the ______ and is lined by many coarse hairs called ______.
vestibule, vibrissae
The skin over the nose is ______ epithelium.
keratinized stratified squamous
The cavity posterior to the vestibule is the ______.
atrium
At the apex are found the 2 ______, or ______, which are separated by the septum connecting the apex to the philtrum of the upper lip.
nostrils, anterior nares
______ tissue helps connect the cartilages together and
posteriorly to the maxilla.
Fibrous
The primary lymphatic drainage of the nose is in to the ______ nodes
submandibular lymph
The blood supply to the nose arises from 3
major arteries:
______
______
______
These vessels are derived from the ______
and ______ carotid arteries.
These arteries an astomose along the nose.
Ophthalmic, Maxillary, Facial, external, internal
Many nosebleeds are due to trauma to the ______ branch of the ______ artery from the ______ artery.
septal, superior labial, facial
WHAT ARTERY?
Source: Internal carotid a.
Course:
- Enters the orbit through the optic foramen immediately inferior and lateral to the optic n.
- Crosses the optic n. to reach the medial part of the orbit - - While in the orbit, besides other branches including the orbital vessels, it gives rise to 2 major branches that supply the nose:
• Dorsal nasal
• External nasal from the anterior ethmoidal a.
Ophthalmic
WHAT ARTERY?
Source: Ophthalmic a.
Course:
- 1 of 2 terminal branches of the ophthalmic a.
- Exits the orbit along the superomedial border along with
the infratrochlear n.
- Supplies the area along the bridge of the nose
Dorsal nasal
WHAT ARTERY?
Source: Anterior ethmoid a.
Course:
- A terminal branch of the anterior ethmoid a.
- Supplies the area along the extemal nose at the juncton
between the nasal bone and the lateral nasal cartilage
External nasal
WHAT ARTERY?
Source: External carotid a.
Course:
- Gives rise to a series of branches, only 1 provides blood supply to the nose: nasal branch of the infraorbital a.
Maxillary
WHAT ARTERY?
Source: Maxillary a.
Course:
- Infraorbital is the continuation of the maxillary a.
- Arises wih the inferior palpebral branch and the superior
labial branch
- Supplies the lateral aspect of the nose
Nasal branch of the infraorbital
WHAT ARTERY?
Source: External carotid a.
Course:
- Passes superiorly immediately deep to the posterior belly of the digastric m. and the stylohyoid m.
- Passes along the submandibular gland, giving rise to the submental a., which helps supply the gland
- Passes superiorly over the body of the mandible at the masseter, giving rise to the:
• Premasseteric a.
- Continues anterosuperiorly across the check to the angle of the mouth, giving rise to the:
• Superior labial a.
• Inferior labial a.
- Passes superiorly along the side of the nose, giving rise to the:
• lateral nasal a.
- Following the last branch, it continues on the side of the nose as the angular a. that terminates along the medial side of the eye
- Tortuous
Facial
WHAT ARTERY?
Source: Superior labial a.
Course:
- Supplies the septum
(Nasal) septal
WHAT ARTERY?
Source: Superior labial a.
Course:
- Supplies the ala of the nose
Alar
WHAT ARTERY?
Source: Facial a.
Course:
- Supplies the ala and dorsal surface of nose
Lateral nasal
WHAT VEIN?
Course:
- Begins as the angular v.
- Passes inferiorly along the side of the nose, receiving the lateral nasal v.
- Continues in a posteroinferior path across the angle of the mouth to the cheek, receiving the superior and inferior labial vv.
- While passing toward the mandible, the deep facial v. connects the facial vein to the pterygoid plexus
- In the submandibular triangle, the facial v. joins the anterior branch of the retromandibular to form the common facial v.
- Has no valves that can allow blood to backflow
Facial
WHAT VEIN?
Course:
- From the confluence of the supraorbital and supratrochlear vv. along the medial part of the eye
- Travels along the lateral side of the nose to become the facial v.
Angular
WHAT VEIN?
Course:
- Receives blood from the roof of the orbit and the scalp
- Anastomoses with the angular v.
- Travels posteriorly to communicate with the pterygoid plexus
Superior ophthalmic
WHAT VEIN?
Course:
- Receives blood from the floor of the orbit
- Anastomoses with the angular v.
- Travels posteriorly with the infraorbital v. that passes through the inferior orbital fissure to communicate with the pterygoid plexus
Inferior ophthalmic
The sensory supply to the nose arises from branches of the ______ and ______ divisions of the ______ nerve.
ophthalmic, maxillary, trigeminal
- Arises from the trigeminal in the middle cranial fossa
- Passes anterior on the lateral wall of the cavernous sinus immediately inferior to the oculomotor and trochlear nn., but superior to the maxillary division of the trigeminal n.
OPHTHALMIC DIVISION OF THE TRIGEMINAL
Immediately prior to entering the orbit, through the superior orbital fissure, the ophthalmic division divides into 3 major branches:
• ______
• ______
• ______
The nasociliary branch terminates as the:
• ______
• ______
Lacrimal, Frontal, Nasociliary
Anterior ethmoid n., Infratrochlear n.
WHAT NERVE?
Source: Anterior ethmoid n.
Course:
- Exits between the lateral nasal cartilage and the inferior border of the nasal bone
- Supplies the skin of the ala and apex of the nose around the nares
External nasal
WHAT NERVE?
Source: Anterior ethmoid n.
Course:
- Supplies the skin on the internal surface of the vestibule as
• Medial internal nasal n.
• Lateral internal nasal n.
Internal nasal
WHAT NERVE?
Source: Nasociliary n.
Course:
- Passes anteriorly on the superior border of the medial rectus m.
- Passes inferior to the trochlea toward the medial angle of the eye
- Supplies the skin of the bridge of the nose
- Also supplies the eyelids, the conjunctiva, and all lacrimal structures
Infratrochlear
- Travels along the lateral wall of the cavernous sinus
- Passes from the middle cranial fossa into the pterygopalatine fossa via the foramen rotundum 4 branches:
• Infraorbital-this is the continuation of the maxillary division
• Posterior superior alveolar
• Zygomatic
• Ganglionic
MAXILLARY DIVISION OF THE TRIGEMINAL
WHAT NERVE?
Source: Continuation of maxillary division of the trigeminal n.
Course:
- Passes through the inferior orbital fissure to enter the orbit
- Passes anteriorly through the in fraorbital groove and
infraorbital canal and exits onto the face via the infraorbital foramen
- Once it exits onto the face, it divides into 3 terminal branches:
• ______ (supplies the ala of the nose)
• ______ (supplies the skin of the lower eyelid)
• ______ (supplies the skin of the upper lip)
Infraorbital, Nasal, Inferior palpebral, Superior labial
WHAT NERVE?
Source: Infraorbital n.
Course:
- Supplies the ala of the nose
Nasal branch of the infraorbital
The nasal cavity is Lined by ______ epithelium with cilia
pseudostratified columnar
The ______ portion of the nasal cavity is larger than superior portion
Inferior
______ epithelium is located at the superior part of the nasal cavity around the cribriform plate
Olfactory
the Anterior opening bounded by the nasal bones and maxilla
PIRIFORM APERTURE
this Frequently deviates to 1 side, giving rise to unequal chambers
NASAL SEPTUM
these are Openings that connect the nasal cavity to the nasopharynx
CHOANAE (posterior nasal apertures)
Composed of large venous plexuses that have the appearance of erectile tissue
LATERAL WALLS
3 large elevations (______) that protrude from the lateral wall
conchae
All of the paranasal sinuses and the nasolacrimal duct drain into the ______ of the nasal cavity
lateral walls
The ______ foramen, located in the posterior portion o the lateral walls, connects the nasal cavity to the pterygopalatine fossa
sphenopalatine
NASAL CAVITY: Boundaries
Border: Superior
Structure: ______, ______ (ethmoid), ______ body
Nasal, cribriform plate, sphenoid
NASAL CAVITY: Boundaries
Border: Inferior
Structure: ______ process (maxilla), ______ plate (palatine)
Palatine, horizontal
NASAL CAVITY: Boundaries
Border: Anterior
Structure: ______ Nose
External
NASAL CAVITY: Boundaries
Border: Posterior
Structure: ______ (posterior nasal aperture)
Choanae
NASAL CAVITY: Boundaries
Border: Medial
Structure: ______ (perpendicular plate), ______, ______ cartilage
Ethmoid, vomer, septal
NASAL CAVITY: Boundaries
Border: Lateral
Structure: ______, ______ palatine, ______ (medial pterygoid plate), ______ concha, ______
Maxilla, ethmoid, sphenoid, inferior nasal, lacrimal
NASAL CAVITY: Relations
Border: Superior
Structure: ______ sinus, ______ sinus, ______ fossa with ______ lobe of brain
Frontal, sphenoid, anterior cranial, frontal
NASAL CAVITY: Relations
Border: Inferior
Structure: ______, ______ cavity
Palate, oral
NASAL CAVITY: Relations
Border: Medial
Structure: Other half of ______ cavity
nasal
NASAL CAVITY: Relations
Border: Lateral
Structure: ______ sinus, ______ sinuses, ______, ______ fossa
Maxillary, ethmoid, orbit, pterygopalatine
WHAT CONCHA?
Regions Drained:
- Sphenoethmoidal recess
- Superior meatus
Location:
- Superior to the superior meatus
- Inferior to the superior meatus
Structures Drained:
- Sphenoidal sinus
- Posterior ethmoid sinus
Superior
WHAT CONCHA?
Regions Drained: Middle meatus
Location: Inferior to the middle meatus
Structures Drained:
Anterior ethmoidal sius
Middle ethmroidal sinus
Maxillary sinus
Frontal sinus
Middle
WHAT CONCHA?
Regions Drained: Inferior meatus
Location: Inferior to the inferior meatus
Structures Drained: Nasolacrimal duct
Inferior
Major Arteries of the nasal cavity:
______
______
______
derived from the ______ and ______ carotid arteries
and generally follow the paths of the nerves
Ophthalmic, Maxillary, Facial, external, internal
The veins generally correspond to the ______
arteries
______ - anastomosis along the nasal septum
it is formed by:
Anterior ethmoid a.
Sphenopalatine a.
Greater palatine a.
Septal branch from the superior labial a.
Kiesselbach’s plexus
WHAT ARTERY?
Source: Internal carotid a.
Course:
- Enters the orbit through the optic foramen immediately inferior and lateral to the optic n.
- Crosses the optic n. to reach the medial part of the orbit
- Gives rise to the anterior & posterior ethmoid (major branches supplying the nasal cavity)
Ophthalmic
WHAT ARTERY?
Source: ophthalmic a.
Course:
- Travels with the nasociliary n. through the anterior ethmoidal foramen
- Enters the anterior cranial fossa, where it gives rise to a meningeal branch
- Continues its path to give rise to nasal branches that descend into the nasal cavity:
Lateral branch
Septal branch
- Supplies branches to the lateral wall and septum of the nose before giving rise to the external nasal a., which supplies the external nose
Anterior ethmoid
WHAT ARTERY?
Source: ophthalmic a.
Course:
- Travels through the posterior ethmoidal foramen
- Enters the anterior cranial fossa, where it gives rise to a meningeal branch
- Continues its path to give rise to nasal branches that descend into the nasal cavity through the cribriform plate:
Lateral branch
Septal branch
- Supplies part of the lateral wall near the superior nasal
concha and the posterosuperior portion of the nasal septum
Posterior ethmoid
WHAT ARTERY?
Source: External carotid a.
Course:
- Gives rise to a series of branches; 2 provide blood supply to the nasal cavity:
Sphenopalatine
Greater palatine
Maxillary
WHAT ARTERY?
Source: 3rd part of maxillary a.
Course:
- After passing through the sphenopalatine foramen, enters the nasal cavity and gives rise to the posterior nasal branches:
The posterior lateral nasal branch supplies the nasal concha, mucous membranes, and lateral wall
The posterior septal branch continues along the nasal septum to enter the hard palate via the incisive canal
Sphenopalatine
WHAT ARTERY?
Source: Descending palatine from the maxillary a.
Course:
- Travels in the palatine canal where it splits into the lesser palatine a. (supplies the soft palate and palatine tonsil), and greater palatine a., which exits the greater palatine foramen and passes anteriorly toward the incisive foramen
(supplies the hard palate gingiva, mucosa, and palatal glands) and anastomoses with the terminal branch of the sphenopalatine a. that exits the incisive foramen
- Provides branches that supply the area of the inferior meatus
Posterior ethmoid
WHAT ARTERY?
Source: External carotid a.
Course:
- Tortuous
- Passes superiorly immediately deep to the posterior belly of the digastric and the stylohyoid mm.
- Passes along the submandibular gland, giving rise to the submental a. that helps supply the gland
- Passes superiorly over the body of the mandible at the masseter m.
- Continues anterosuperiorly across the cheek to the angle of the mouth, giving rise to the superior and inferior labial aa.
- Passes superiorly along the side of the nose, giving rise to the lateral nasal a.
- Continues on the side of the nose as the angular a. that terminates along the medial aspect of the eye
Facial
WHAT ARTERY?
Source: Facial a.
Course:
- Gives rise to the septal branch that travels to the nasal septum
- The major blood supply to the anterior part of the nasal septum
Superior labial
A well-developed ______ plexus lies deep to the mucous membrane
The plexus drains into the following series of veins:
Emissary
Sphenopalatine
Anterior ethmoid
Posterior ethmoid
Septal branch of superior labial
cavernous
WHAT VEIN?
Course:
- Vein from the cavernous plexus in the nasal cavity passes through the foramen cecum to drain into the superior sagittal sinus
Emissary
WHAT VEIN?
Course:
- Blood from the anterior portion drains into the septal branch of the superior labial, which drains into the air facial v.
Septal branch of the superior labial
WHAT VEIN?
Course:
- Blood from the venous plexus along the posterior portion of the nasal cavity drains to the sphenopalatine v.
- Travels through the sphenopalatine foramen to enter the pterygoid plexus
Sphenopalatine
WHAT VEIN?
Course:
- Blood from the venous plexus in the anterior portion of the nasal cavity drains into the anterior ethmoid, which terminates in the ophthalmic v. and/ or facial v.
Anterior Ethmoid
WHAT VEIN?
Course:
- Blood from the venous plexus in the anterior portion of the nasal cavity drains into the posterior ethmoid, which terminates in the ophthalmic v. and/ or facial v.
Posterior Ethmoid
2 major types of sensory innervation to the nasal cavity:
______ (special visceral afferent) via the olfactory nerve
______ (general somatic afferent) via ophthalmic and maxillary divisions of the trigeminal nerve
Olfaction, General sensation
______ epithelium - found in the roof of the nasal cavity including the adjacent superior portions of the lateral wall of the nasal cavity and the nasal septum
Olfactory
Roughly ______ to ______ small olfactory n. fibers, which collectively form the olfactory nerves per side, travel superiorly through the cribriform plate into the anterior cranial fossa to join the olfactory bulb
20, 25
______ Division of Trigeminal
______
- Arises from the main nerve in the middle cranial fossa and passes anterior on the lateral wall of the cavernous sinus immediately inferior to the oculomotor and trochlear nn., but superior to the maxillary division of the trigeminal n.
Ophthalmic, Sensory
Immediately before entering the orbit, through the superior orbital fissure, it divides into 3 major branches:
______
______
______
Lacrimal
Frontal
Nasociliary
The nasociliary branch terminates as ______ n. & ______ n.
Anterior ethmoid, Infratrochlear
WHAT NERVE?
Source: Nasociliary n.
Course:
- Enters the anterior ethmoid foramen and travels through the canal to enter the anterior cranial fossa
- While descending toward the nasal cavity, it provides innervation to the anterior parts of the middle and inferior conchae, as well as the region anterior to the nasal concha
- Specifically, it supplies the skin on the internal surface of the nasal cavity as the:
Medial internal nasal n.
Lateral internal nasal n.
Anterior ethmoid
______ Division of Trigeminal
______
- Travels along the lateral wall of the cavernous sinus
- Passes from the middle cranial fossa into the pterygopalatine fossa via the foramen rotundum
- Within the pterygopalatine fossa, it gives rise to 4 branches:
______ (con. of maxillary)
______
______
______
Maxillary, Sensory
Infraorbital
Posterior superior alveolar
Zygomatic
Ganglionic
WHAT NERVE?
Source: Con. of maxillary division of the trigeminal n.
Course:
- Passes through the inferior orbital fissure to enter the orbit
- Passes anteriorly through the infraorbital groove and infraorbital canal and exits onto the face via the infraorbital foramen
- While in the infraorbital canal, it gives rise to the Anterior superior alveolar n.
- The anterior superior alveolar n. has a small branch that supplies the nasal cavity in the region of the inferior meatus and inferior corresponding portion of the nasal septum
Infraorbital
WHAT NERVE?
Source: Pterygopalatine ganglion
Course:
- Passes through the sphenopalatine foramen to enter the nasal cavity
- Passes along the superior portion of the nasal cavity to the nasal septum, where it travels anteroinferiorly to the
incisive canal supplying the septum
Nasopalatine
WHAT NERVE?
Source: Greater palatine
Course:
- The greater palatine n. branches from the pterygopalatine ganglion in the pterygopalatine fossa
- It descends through the greater palatine canal to enter the hard palate via the greater palatine foramen
- While descending in the palatine canal, it gives rise to the Posterior inferior lateral nasal branch
- Supplies the posterior part of the lateral wall of the nasal cavity in the region of the middle meatus
Posterior inferior lateral nasal
WHAT NERVE?
Source: Pterygopalatine ganglion
Course:
- Passes through the sphenopalatine foramen to enter the nasal cavity
- Branches into 2 nerves:
Posterior superior medial nasal
Posterior superior lateral nasal
Posterior superior nasal
WHAT NERVE?
Source: Posterior superior nasal n. from the pterygopalatine ganglion
Course:
- Supplies the posterosuperior portion of the lateral wall of the nasal cavity in the region of the superior and middle concha
Posterior superior lateral nasal
WHAT NERVE?
Source: Posterior superior nasal n. from the pterygopalatine ganglion
Course:
- Supplies the posterior portion of the nasal septum
Posterior superior medial nasal
______ Innervation:
- Autonomic fibers are distributed through the sensory branches o the maxillary division of the trigeminal nerve via the pterygopalatine ganglion (parasympathetics) and the superior cervical ganglion (sympathetics)
- Autonomics travel to the glands and blood vessels of the nasal cavity
Autonomic
WHAT TYPE OF NEURON?
Anatomic Pathway for Parasympathetics of the Nasal Cavity
Cell Body: Superior salivatory nucleus
Characteristics:
- A collection of nerve cell bodies located in the pons Travel through the nervus intermedius of facial nerve into the internal acoustic meatus
- In the facial canal, the facial nerve gives rise to 2 parasympathetic branches:
Greater petrosal n.
Chorda tympani n.
Course of Neuron:
- Greater Petrosal Nerve
Exits the hiatus for the greater petrosal n. towards the foramen lacerum and joins the deep petrosal n.(sympathetics) to form the nerve of the pterygoid canal (vidian n.)
Vidian n. passes through the pterygoid canal and enters the pterygopalatine fossa, where it joins with the pterygopalatine ganglion
Preganglionic neuron
WHAT TYPE OF NEURON?
Anatomic Pathway for Parasympathetics of the Nasal Cavity
Cell Body: Pterygopalatine ganglion
Characteristics:
- Pterygopalatine ganglion is a collection of nerve cell bodies located in the pterygopalatine fossa
- Postganglionic parasympathetic fibers that arise in the pterygopalatine ganglion are distributed to the ophthalmic and maxillary divisions of trigeminal n. to:
lacrimal gland
nasal glands
palatine glands
pharyngeal glands
paranasal sinus glands
Course of Neuron:
- Maxillary Division Distribution
Postganglionic fibers travel along the maxillary division of the trigeminal n. to be distributed along its branches that are located in the nasal cavity, oral cavity, and pharynx (e.g., nasopalatine, greater palatine)
These fibers innervate:
Nasal glands
Palatine glands
Pharyngeal glands
Paranasal sinus glands
Postganglionic neuron
WHAT TYPE OF NEURON?
Anatomic Pathway for Sympathetics of the Nasal Cavity
Cell Body: Intermediolateral horn nucleus
Characteristics:
- Collection of nerve cell bodies located in the lateral horn nucleus of the spinal cord between spinal segments T1 and T3 (and possibly T4)
Course of Neuron:
- Arise from the intermediolateral horn nuclei from T1 to T3 (4)
- Travel through the ventral root of the spinal cord to the spinal nerve
- Enter the sympathetic chain via a white ramus communicans
- Once in the sympathetic chain, the preganglionic fibers for the eye ascend and synapse with postganglionic fibers in the superior cervical ganglion
Preganglionic neuron
WHAT TYPE OF NEURON?
Anatomic Pathway for Sympathetics of the Nasal Cavity
Cell Body: Superior cervical ganglion
Characteristics:
- Collection of nerve cell bodies located in the superior cervical ganglion, which is located at the base of the skull
- Postganglionic sympathetic fibers follow the internal carotid or external carotid a. to pass near their respective
effector organs (e.g., nasal cavity)
Course of Neuron:
- Nasal Cavity, Paranasal Sinuses, and Palate
Postganglionic sympathetic fibers follow both the internal and external carotid aa.
Postganglionic bers will form the internal carotid nerve, which travels along the internal carotid a. forming the internal carotid plexus
Postganglionic sympathetic bers from the internal carotid plexus branch in the region of the foramen lacerum to form the deep petrosal n.
The deep petrosal n. joins the greater petrosal n. parasympathetics) to form the nerve of the pterygoid canal (vidian n.)
Postganglionic sympathetic bers from the external carotid branch and follow the maxillary a.
These bers travel along the branches of the maxillary a. to be distributed along the nasal cavity,paranasal sinuses, and palate
Postganglionic neuron
______ - or nosebleed, is a hemorrhage from the nasal cavity or nose
EPISTAXIS
EPISTAXIS is Classifed by bleeding location:
• ______
• ______
Anterior, Posterior
CAUSES of ______:
May be localized or system ic:
• Trauma (blows to the face, fractures, nose picking)
• Sinus infections
• Rhinitis
• Arid environment
• Hypertension
• Hematologic disorders
• Neoplasms
EPISTAXIS
______ EPISTAXIS
• The most common form (in about 90% of cases)
• Usually found along the nasal septum and results from bleeding along Kiesselbach ’s plexus
• Many nosebleeds are due to trauma to the septal branch of the superior labial artery from the facial artery
• Typically managed with local pressure
• May be controlled by means of cautery with a silver nitrate stick or with use of anterior nasal packing if bleeding is persistent
• With ______ epistaxis, another treatment, although somewhat drastic, is septal dermoplasty
• The thin septal mucosa is replaced by a thicker graft of
skin
• Often used to treat nosebleeds caused by hereditary hemorrhagic telangiectasia or septal perforations
ANTERIOR
______ EPISTAXIS
• Usually found along the posterior part of the nasal cavity
• More difficult to treat; use of posterior nasal packing or a balloon catheter usually is successful
• Severe ______ epistaxis may require ligation of the maxillary artery
POSTERIOR
______ - a severe shift of the nasal septum from the midline
DEVIATED SEPTUM
CAUSES of DEVIATED SEPTUM
• May be acquired or congenital:
______
______
Trauma
Birth defects
CLINICAL MANIFESTATIONS of ______:
• Occlusion of 1 side, either partial or complete, producing diffculty in breathing or blocked airflow on that side
May also cause:
Sinusitis
Epistaxis
Nasal congestion
DEVIATED SEPTUM
DEVIATED SEPTUM May be treated by ______
septoplasty
______ - an inflammation of the mucosa of the nasal cavity that results in:
Nasal congestion
Sneezing
Rhinorrhea
Nasal itching
- May involve the eyes, ears, sinuses, and throat and cause headaches
- Most commonly caused by allergic rhinitis
RHINITIS
______
- Can be associated with nasal polyps, deviated septum, and asthma
- Because mast cells are located on the nasal mucosa, an allergen can bind to the mast cell, resulting in the release of histamines, prostaglandins, cytokines, and leukotrienes
- Typically treated with decongestants, antihistamines, and steroids
ALLERGIC RHINITIS
The ______ are invaginations from the nasal cavity that drain into spaces associated with the lateral nasal wall.
paranasal sinuses
There are 4 paranasal sinuses: ______, ______, ______, and ______
FRONTAL, MAXILLARY, ETHMOID, SPHENOID
Each paranasal sinus is named after the ______ in which it is located.
bone
Each paranasal sinus is lined by a ______ epithelium (pseudostratified columnar epithelium with cilia)
respiratory
Morphology of the sinuses is highy ______.
variable
______ SINUS
Flattened triangular shape
Manifests as a small outpouching at birth
FRONTAL
Artery of FRONTAL SINUS
Ophthalmic branches
Nerve of FRONTAL SINUS
Ophthalmic division of the trigeminal nerve
______ SINUS
Pyramidal shape
Small sinus is present at birth
MAXILLARY
Artery of MAXILLARY SINUS
Maxillary branches
Nerve of MAXILLARY SINUS
Maxillary division of the trigeminal nerve.
______ SINUS
3 to 18 irregularly shaped cells
Small sinus is present at birth
ETHMOID
Artery of ETHMOID SINUS
Ophthalmic and maxillary branches
Nerve of ETHMOID SINUS
Ophthalmic and maxillary divisions of the trigeminal nerve
______ SINUS
Cuboid shape
No pneumatization at birth
SPHENOID
Artery of SPHENOID SINUS
Ophthalmic and maxillary branches
Nerve of SPHENOID SINUS
Ophthalmic and maxillary divisions of the trigeminal nerve
All paranasal sinuses drain into the ______ cavity.
nasal
Different sinuses serve as a ______ for different regions.
drainage conduits
WHAT REGION DRAINED?
LOCATION: Superior to the superior concha
STRUCTURE(S) DRAINED: Sphenoid sinus
Sphenoethmoidal recess
WHAT REGION DRAINED?
LOCATION: Inferior to the superior concha
STRUCTURE(S) DRAINED: Posterior ethmoid sinus
Superior meatus
WHAT REGION DRAINED?
LOCATION: Inferior to the middle concha
STRUCTURE(S) DRAINED: Anterior ethmoid sinus, Middle ethmoid sinus, Maxillary sinus, Frontal sinus
Middle meatus
WHAT REGION DRAINED?
LOCATION: Inferior to the inferior concha
STRUCTURE(S) DRAINED: Nasolacrimal duct
Inferior meatus
The 2 frontal paranasal sinuses typically are ______.
asymmetric
The ______ is Usually not present at birth, or there is a small outpouching.
frontal sinus
The most common of the paranasal sinuses to undergo aplasia.
FRONTAL SINUS
Is the last paranasal sinus to begin to pneumatize—beginning around 2nd year.
FRONTAL SINUS
The FRONTAL SINUS is Usually developed by the age of ______ or ______ years.
7, 8
A prime expansion in size (frontal sinus) occurs when the 1st ______ molars erupt and another when the ______ molars begin to appear at about age 6.
deciduous, permanent
The adult frontal sinus has 2 extensions:
______ - extends superiorly into the frontal bone in the region of the forehead
______ - extends posteriorly into the frontal bone over the medial part of the orbit
FRONTAL, ORBITAL
FRONTAL SINUS
Drainage varies; may drain in front of, above, or into the ______.
ethmoidal infundibulum
FRONTAL SINUS
Primary lymphatic drainage is to the ______ nodes.
submandibular lymph
The frontal sinus receives its nerve supply from branches of the ______ division of the trigeminal nerve.
ophthalmic
FRONTAL SINUS
Relations of Sinus
SUPERIOR: ______ fossa and contents
INFERIOR: ______, ______ sinuses, ______ cavity
ANTERIOR: ______, ______ arches
POSTERIOR: ______ fossa and contents
MEDIAL: other ______ sinus
anterior cranial
orbit, anterior ethmoidal, nasal
forehead, superciliary
anterior cranial
frontal
FRONTAL SINUS
Location of Ostium: ______
MIDDLE MEATUS
2 Arterial Supply (Frontal Sinus)
ANTERIOR ETHMOID
SUPRAORBITAL
WHAT ARTERY?
Source: Ophthalmic artery (from the internal carotid artery)
Course:
- Enters the anterior ethmoid foramen with the nerve to pass through the canal.
- At this location, it supplies the anterior and middle ethmoid air cells and the frontal sinus.
ANTERIOR ETHMOID
WHAT ARTERY?
Source: Ophthalmic artery (from the internal carotid artery)
Course:
- Branches from the ophthalmic artery when crossing the optic nerve.
- Ascends medial to both the levator palpebrae superioris and the superior rectus muscles.
- At this location, it runs with the supraorbital nerve and is found between the levator palpebrae superioris muscle and the periosteum of the orbit.
- Travels to the supraorbital foramen (notch).
- At the level of the supraorbital margin, it supplies the frontal sinus.
SUPRAORBITAL
1 Nerve Supply (Frontal Sinus)
SUPRAORBITAL
WHAT NERVE?
Source: Ophthalmic division of the trigeminal n.
Course:
- Passes between the levator palpebrae superioris m. and periosteum of the orbit
- Continues anteriorly to the supraorbital foramen (notch)
- At the level of the supraorbital margin, it sends nerve supply to the frontal sinus
SUPRAORBITAL
- Anatomically the ______ are located between the superior portion of the nasal cavity and the orbit
- The surrounding bone is very thin. The sinus and orbit share the thin medial orbital wall, the ______
ETHMOID SINUS, lamina papyracea
______ sinuses form within the ethmoid as many individual air cells
Ethmoid
From ______ to ______ total ethmoid air cells may be present on each side, divided into an ______, ______, and ______ groups.
3, 18, anterior, middle, posterior
The most anterior ethmoid sinus is called the ______.
agger nasi
The ______, which protrudes from the lateral wall of the nasal cavity, represents the largest group of ethmoidal air cells.
ethmoidal bulla
The middle ethmoid air cells produce the swelling on the lateral wall of the middle meatus called the ______.
ethmoid bulla
______ Cells
- Air cells situated beneath the ethmoid bulla along the roof of the maxillary sinus and the most inferior portion of the lamina papyracea
- May impair mucociliary clearance when they enlarge and impinge of the ethmoid infundibulum
Haller
Lymphatic drainage
- Primary lymphatic drainage is to the ______ nodes for the anterior and middle ethmoid sinuses
- ______ nodes for the posterior ethmoid sinus
submandibular lymph, Retropharyngeal lymph
Location of Ostium (ETHMOID SINUS)
- Anterior: ______ (frontonasal duct or ethmoidal infundibulum)
- Middle: ______ (on or above ethmoid bulla)
- Posterior: ______
middle meatus, middle meatus, superior meatus
Relations of Ethmoid Sinus
- Superior: ______ fossa and contents, ______ bone with sinus
- Medial: ______ cavity
- Lateral: ______
anterior cranial, frontal
nasal
orbit
3 Arterial Supply ETHMOID SINUS
ANTERIOR ETHMOID, POSTERIOR ETHMOID, POSTERIOR LATERAL NASAL BRANCHES
WHAT ARTERY?
Source: Ophthalmic a. (from the internal carotid)
Course:
- Enters the anterior ethmoid foramen with the nerve to pass though the canal
- There it supplies the anterior and middle ethmoid air cells and sometimes the frontal sinus.
ANTERIOR ETHMOID
WHAT ARTERY?
Source: Ophthalmic a. (from the internal carotid)
Course:
- Passes through the posterior ethmoid foramen to enter the canal
- There it supplies the posterior ethmoid air cells and sphenoid sinus
POSTERIOR ETHMOID
WHAT ARTERY?
Source: Sphenopalatine a. (from the maxillary a. from the external carotid a.)
Course:
- Anastomose with the ethmoidal arteries to help supply the ethmoid air cells and sphenoid sinus
POSTERIOR LATERAL NASAL BRANCHES
3 nerve supply of ethmoid sinus
ANTERIOR ETHMOID
POSTERIOR ETHMOID
POSTERIOR LATERAL NASAL BRANCHES
WHAT NERVE?
Source: Ophthalmic a. (from the
internal carotid)
Course:
- Enters the anterior ethmoid foramen and travels through
the canal to enter the anterior cranial fossa
- While descending toward the nasal cavity, it provides innervation to the anterior and middle ethmoid air cells
ANTERIOR ETHMOID
WHAT NERVE?
Source: Nasociliary n. on the medial wall of the orbit (from the ophthalmic division of the trigeminal n.)
Course:
- Enters the posterior ethmoid foramen to supply the posterior ethmoid air cells
- Also innervates the sphenoid sinus at this location
POSTERIOR ETHMOID
WHAT NERVE?
Source: Pterygopalatine ganglion in the pterygopalatine fossa (from the maxillary division of the trigeminal n.)
Course:
- Passes through the sphenopalatine foramen to enter the nasal cavity
- Branches supply the posterior ethmoid air cells at this location
POSTERIOR LATERAL NASAL BRANCHES
The ______ sinus (also referred to as the an trum of Highmore) is a large pyramidal cavity that is present at birth
maxillary
Pneumatization of the ______ sinus occurs rapidly during the early years, with the floor of the sinus being superior to the unerupted permanent teeth
maxillary
As the permanent teeth erupt into the oral cavity, the ______ sinus pneumatizes in to the alveolar bone
maxillary
The epithelium of the maxillary sinus is often called the ______ membrane in clinical texts
Schneiderian
Because the floor of the adult maxillary sinus typically is in close proximity to the roots of the maxillary molars and
premolars, it is not uncommon for a maxillary sinus infection to manifest as ______ pain (via referred pain)
tooth
The ______ sinus tends to be more prone to sinus infections because the ostium is located at the superior part of the sinus
maxillary
The maxillary sinus is ______-walled and may be divided by ______
thin, septa
Primary lymphatic drainage of the maxillary sinus is to the ______ nodes
submandibular lymph
RELATIONS OF SINUS (maxillary sinus)
Superior: ______, ______ nerve and vessels
Inferior: roots of ______ and ______
Medial: ______ cavity
Lateral and anterior: ______
Posterior: ______ fossa, ______ fossa and contents
orbit, infraorbital
molars, premolars
nasal
cheek
infratemporal, pterygopalatine
LOCATION OF THE OSTIUM (maxillary sinus)
Middle meatus
3 ARTERIAL SUPPLY OF THE MAXILLARY SINUS
Anterior superior alveolar
Middle superior alveolar
Posterior superior alveolar
WHAT ARTERY?
Source: Maxillary artery from the external carotid artery
Course:
- Arises from the infraorbital a. of the maxillary a. after it passes through the inferior orbital fissure and into the infraorbital canal
- Descends via the alveolar canals to supply the sinus
Anterior superior alveolar
WHAT ARTERY?
Source: Maxillary artery from the external carotid artery
Course:
- When present, it arises from the infraorbital a. of the maxillary a. after passing through the inferior orbital fissure and into the infraorbital canal
- Descends via the alveolar canals to supply the sinus
Middle superior alveolar
WHAT ARTERY?
Source: Maxillary artery from the external carotid artery
Course:
- Arises from the 3rd part of the maxillary a. before the maxillary a. enters the pterygopalatine fossa
- Enters the infratemporal surface of the maxilla to supply the sinus
Posterior superior alveolar
3 NERVE SUPPLY OF THE MAXILLARY SINUS
Anterior superior alveolar
Middle superior alveolar
Posterior superior alveolar
WHAT NERVE?
Source: Infraorbital n., which is the continuation of the maxillary division of the trigeminal n.
Course:
- Branches from the infraorbital n. as it travels in the infraorbital canal
- As it descends to form the superior dental plexus, it innervates part of the maxillary sinus
Anterior superior alveolar
WHAT NERVE?
Source: Infraorbital n., which is the continuation of the maxillary division of the trigeminal n.
Course:
- When present, it branches from the infraorbital n. as it travels in the infraorbital canal
- As it descends to form the superior dental plexus, it innervates part of the maxillary sinus
Middle superior alveolar
WHAT NERVE?
Source: Maxillary division of the trigeminal n.
Course:
- Arises in the pterygopalatine fossa
- Travels laterally through the pterygomaxillary fissure to enter the infratemporal fossa
- Enters the infratemporal surface of the maxilla
- As it descends to form the superior dental plexus, it innervates part of the maxillary sinus
Posterior superior alveolar
The sphenoid sinus consists of ______ large, irregularly shaped cavities
2
The sphenoid sinus is Separated by an irregular ______
septum
Pneumatization of sphenoid sinus begins around ______ to ______ months after birth
7, 8
Sphenoid sinus anatomy is important in trans sphenoidal approaches to the ______ gland
pituitary
Primary lymphatic drainage of the sphenoid sinus is to the ______ nodes
retropharyngeal lymph
Relations of SPHENOID SINUS
Superior: ______ fossa, ______ gland, ______ chiasm
Inferior: ______, ______ canal
Medial: Other ______ bone
Lateral: ______ sinus, ______ artery, ______ nerves III, IV, V1, V2, and VI
Anterior: ______ cavity
Hypophyseal, pituitary, optic
Nasopharynx, pterygoid
sphenoid
Cavernous, internal carotid, cranial
Nasal
2 SPHENOIDAL SINUS Arterial supply
Posterior Ethmoid
Posterior lateral nasal branches
WHAT ARTERY?
Source: Ophthalmic a. (from the internal carotid a.)
Course:
- Passes through the posterior ethmoid foramen toenter the canal.
Posterior Ethmoid
WHAT ARTERY?
Source: Sphenopalatine a. from the maxillary a. (from the external carotid a.)
Course:
- These branches anastomose with the ethmoidal arteries to help supply the sphenoid sinus and the ethmoid air cells
Posterior lateral nasal branches
______ - an inflammation of the membrane of the sinus cavities caused by infections (by bacteria or viruses) or non-infectious means (such as allergy)
Sinusitis
TWO TYPES OF SINUSITIS
ACUTE
CHRONIC
TYPES OF SINUSITIS
______ - typically caused by colds resulting in inflammation of sinus membranes. normally resolves in 1 to 2 weeks. ______ sinusitis can form once a secondary bacterial infection settle in passageways after a cold. Streptococcus pneumoniae and Haemophilus influenzae may begin to increase.
ACUTE, Acute bacterial
TYPES OF SINUSITIS
______ - infection that is present for more than a month and requires longer-duration medical therapy. Either ______ (antibiotics) or ______ sinusitis (steroids and nasal washes).
CHRONIC, chronic bacterial, chronic non-infectious
WHAT PROCEDURE?
- The frontal sinus is completely removed to treat problematic cases of frontal sinus infection, osteomyelitis, and trauma.
- Once the sinus is opened, all of the sinus membrane is removed with a burr; otherwise, any remaining membrane may form a mucocele.
- The remaining area often is filled with adipose tissue from the patient because it is thought to impede regrowth of the mucoperiosteum.
Frontal Sinus Obliteration
- The intraoral ______ procedure allows direct entry into the maxillary sinus also provides access to the ethmoid sinus.
- The maxillary sinus is entered through the canine fossa above the maxillary premolar teeth.
- The maxillary antrum is opened, the sinus membrane is stripped, and an additional antrostomy is made between the maxillary sinus and the inferior meatus.
Caldwell-Luc
- The antrostomy allows drainage of the maxillary sinus into the nasal cavity
- With the advent of functional endoscopic sinus surgery for antrostomies, the ______ procedure often is used for exposure and removal of tumors.
- Used to be commonly performed to treat chronic maxillary sinusitis
- Was also used for procedures such as removal of benign tumors and foreign bodies, access to the pterygopalatine fossa, and closure of dental fistulas into the maxillary sinus.
Caldwell-Luc
- Placement of ______ implants is a common dental procedure to add fixed maxillary teeth to the oral cavity
- Patient should be in relatively good health
- Patient must have sufficient bone in a location suitable for placement of an implant
- It is becoming more common to use ______ grafting before the surgical implant is placed
- ______ grafts to provide adequate bed for implants may be harvested from the body or as allografts, or may be supplied as xenografts or synthetic bone substitutes
maxillary, bone, Bone
- A ______ procedure is also called maxillary sinus augmentation
- It is a surgical procedure important for maxillary dental implants
- When teeth are lost, the alveolar bone is resorbed, which can affect neighboring teeth
- Additionally, when posterior teeth are lost (maxillary premolars and molars), the sinus will pneumatize, with reduction in the amount of bone available in those areas
- Because a dental implant relies heavily on osseointegration of the implant into the bone, if there is not enough bone to allow osseointegration, a dental implant will fail
- The goal of the procedure is to increase the amount of bone, to allow for proper osseointegration
sinus lift
- In ______ surgery, an endoscope is inserted into the nose to view the nasal cavity and sinuses, thereby eliminatin g an external incision
- Often performed as an outpatient procedure
- Provides increased visualization of the area, making it easier to remove diseased tissue and leave a greater amount of normal tissue intact
- Standard surgical treatment for sinusitis for people whose chronic sinus problems do not respond to medical therapy
- Also used for removal of polyps, mucoceles, tumors, and foreign bodies and for control of epistaxis
functional endoscopic sinus
