The Nasal Cavity, Paranasal Sinuses and Pharynx and its Clinical Anatomy Flashcards
what nerve does sensation and pain temp touch to nasal cavity and sends off branches to lateral nasal wall and septum and to hard palate and the gums
maxillary nerve
what nerve is the lingual( chord tympani fibres-taste) nerve a branch of
mandibular nerve
4 main paranasal sinuses
Frontal sinus
Ethmoid sinus
Maxillary sinus
Sphenoid sinus
function of the nasal cavity
airway provision
warming and humidification of inspired air
filtering of large particulate matter
mucuous production, trapping and ciliary clearance
olfaction
drainage of paranasal sinuses
why is an infection more likely in infants than adults
tube connecting the nasal cavity and the ear is more horizontal so easier to move
sinus congestion and stuffiness can affect the pressure in your ears
what tube connects the middle ear to the nasopharynx
Eustachian tube
what are paranasal sinuses
air filled extensions of the nasal cavity
what type of cell lines each sinus
ciliated pseudo stratified epithelium with goblet cells
what does the nasal septum do
inside the nose and separated the two nostrils and nasal cavities
fibrocartilage and bone
nasal cavity is divided into right and left and each one has a roof, floor and ….
medial and lateral walls
The nasal cavity is the most superior part of the respiratory tract. It extends from the vestibule of the nose to the nasopharynx, and has three divisions- what are they
Vestibule – the area surrounding the anterior external opening to the nasal cavity.
Respiratory region – lined by a ciliated psudeostratified epithelium, interspersed with mucus-secreting goblet cells.
Olfactory region – located at the apex of the nasal cavity. It is lined by olfactory cells with olfactory receptors.
the nasal septum on the medial wall is made of what bones
Frontal, Ethmoid, sphenoid, maxilla, vomer and nasal bone
Lateral wall thrown into folds by 3 bony projections called concha(turbinates) which become cyclically engorged every 2-3 hours. this increases what
Increase the surface area of the nasal cavity, slow the flow of air to allow more time for heating/humidifying
The nasal bones are commonly fractured following trauma. Epistaxis (bleeding from the nose) is a common sequelae and sometimes patients require a MUA (manipulation under anaesthesia). The nasal septum is composed of bone and cartilage and deviations (bends) in the septum are common. A septal haematoma after nasal injury is a risk to the nasal airway and carries a potential for what
cartilage necrosis.
Septal cartilage relies on overlying perichondrium for its blood supply
A haematoma can lift the perichondrium away from the cartilage, starving it of its blood supply
If this is not drained quickly this can result in septal cartilage necrosis causing a what type of deformity to the external not e
saddle shaped
looks like huge skin bulges in nostril
Projecting out of the lateral walls of the nasal cavity are curved shelves of bone. They are called conchae (or turbinates).
what are the 3 concha
inferior
middle and superior
the conch project into the nasal cavity - creating 4 pathways for air to flow - these pathways are called what
meatuses
also there is the spheno-ethmodial recess
what is the function of the concha
increase SA of the nasal cavity
- increase amount of inspired air to come into contact with cavity walls - also make air slower so can be humidified
mucosa around the concha has vast blood supply so keeps it warm
which major arteries supply blood to nasal cavity
internal and external carotids
where is the mostly likely place in the nasal cavity for an epistaxis to occur
littles area/kisselbachs area
anterior third of the nasal cavity
due to local causes ( trauma) or systemic ( hypotension)
what internal carotid branches supply the nasal cavity
anterior and posterior ethmoidal arteries branch of ophthalmic
what external carotid branches supply the nose
spehnopalatine
greater palatine
superior labial
lateral nasal
what can you use medically to stop a nose bleed
silver nitrate sticks
nasal tampons - building up pressure
where do the veins of the nose drain to
pterygoid plexus,
facial vein
cavernous sinus-danger triangle
in some individuals a few nasal veins join with the sagittal sinus ( dural venous sinus)- this could represent a potential pathway by which infection can spread from where to where
the nose into the cranial cavity
what is cavernous sinus thrombosis - life threatening
is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart.
symptoms of cavernous sinus thrombosis
a sharp and severe frontal headache, particularly around the eye.
swelling and bulging of the eye(s) and the surrounding tissues.
eye pain that’s often severe.
double vision
complications of cavernous sinus thrombosis
compress cranial nerves
the innervation of the nose can be functionally divided Ito special and general innervation.What is special innervation
ability to smell carried out by the olfactory nerves
what is general sensory innervation delivered to and by what nerves
the septum and lateral walls
nasopalatine nerve( branch of maxillary ) nasocillary nerve ( branch of ophthalmic nerve)
what nerve does the nasopalatine nerve come from
maxillary nerve
what nerve does the nasocillary nerve come from
ophthalmic nerve
innervation to the external skin of the nose is supplied by what nerve
trigeminal nerve
a fracture of the cribiform plate can occur as a result of nose trauma - what can a fractured cribiform plate can penetrate what and cause leakage of what
meningeal linings of the brain causing CSF to leak out
increasing the risk of meningitis , encephalitis and cerebral abscesses
glucose?
what other major structure can be damaged by a cribifrom plate injury
the olfactory bulb can be damaged irreversibly so patent will present with anosmia
the paranasal sinuses are named accordingly to the bone in which they are located in what are paranasal sinuses
air-filled spaces
function of paranasal sinuses
lightening weight of head, support immune defence of nasal cavity, humidifying inspired air, increasing resonance of the voice.
where do all the paranasal sinuses drain to
All drain inot the nasal cavity – openings on the roof and lateral walls.
triangular shape. Drainage via frontonasal duct (opens at the semilunaris, within the middle meatus of the nasal cavity. Sensation via supraorbital nerve (ophthalmic nerve), anterior ethmoidal artery (internal carotid)
what sinus
frontal sinus
open into nasal cavity in spheno-ethmoidal recess (supero-posterior to superiror cocha). Innervated by posterior ethmoidal nerve (ophthalmic nerve) and branches of maxillary nerve. Pharyngeal branches of maxillary arteries.
what sinus
sphenoid sinus
what sinus - 3 on each side, anterior, middle and posterior. Anterior opens onto hiatus semilunaris (middle meatus), middle and posterior open onto lateral wall of superior meatus. Innervated by anterior and posterior ethmoidal branches of nasociliary nerve and maxillary nerve. Anterior and posterior ethmoidal arteries.
ethmoid sinus
largest. Drain into the nasal cavity at the hiatus semilunaris underneath frontal sinus opening (drain against gravity)
what sinus
maxillary sinus
as we know the paranasal sinuses drain into the nasal cavity - which sinuses open into the middle meatus
frontal
maxillary
anterior ethmoidal sinus ( middle ethmoidal into ethmoidal bulb and poster open at superior meatus)
The only structure not to empty out onto the lateral walls of the nasal cavity is the …….. It drains onto the posterior roof.
sphenoid sinus
in addition to the paranasal sinuses what other things drain into the nasal cavity
nasolacrimal duct (a groove formed by the lacrimal bone and frontal process of the maxilla) auditory( Eustachian tube)
the nasolacrimal duct acts to drain tears from the eyes what meatus does it open into
inferior
the Eustachian tube opens into the nasopharynx at the level of the inferior meatus what is its function
it allows the middle ear to equalise with atmospheric air pressure
As the auditory tube connects the middle ear and upper respiratory tract, it is a path by which infection can spread from the upper respiratory tract to the ear. Infection of the auditory tube causes swelling of the mucous linings, and the tube becomes blocked. This results in diminished hearing.
Sinusitis
As the paranasal sinuses are continuous with the nasal cavity, an upper respiratory tract infection can spread to the sinuses.
Infection of the sinuses causes inflammation (particularly pain and swelling) of the mucosa, and is known as sinusitis. pansinusitis( more than one)
the maxillary nerve supplies both the maxillary sinus and maxillary teeth and so inflammation of the sinus can present with what
toothache
what nerve innervates the sphenoid sinus
and where does it get its blood supply from
posterior ethmoid nerve
maxillary arteries
If someone has a pituitary adenoma - what is the surgery of choice
endoscopic trans-sphenoidal surgery- way to accessory pituitary gland through this sinus ( hypophyseal fossa)
Avoid the need for craniotomy for a mid-line structure.
why is the maxillary sinus most commonly affected by sinusitis
uphill drainage against gravity so commonly infected
the lacrimal gland produces lacrimal fluid which does what
protects and lubricates the eye
what is the pharynx
Muscular tube that connects the nasal and oral cavities with the larynx and oesophagus
where does the pharynx begin and end
Begins at the base of the skull and ends at the cricoid cartilage (C6)
3 divisions of the pharynx
Nasopharynx
Oropharynx
Laryngopharynx
middle ear effusion
Middle ear effusion is a build-up of fluid in the space behind your child’s eardrum
blockage of the tube during ear infection
what area is the nasopharynx
base of the skull to the soft palate
Communicates with middle ear cleft via eustachian tube (unwinds when yawning/chewing to allow air in middle ear to maintain atm pressure).
oropharynx goes from where
soft palate ( uvula) to the level of the epiglottis
blood supply of the oropharynx
Rich blood supply from lingual, facial and ascending pharyngeal branches of the external carotid artery.
laryngopharynx runs from where
tip of the epiglottis to th eoesphagis at the level of c6
which muscle marks the transition into the oesophagus
cricopharyngeus
prevent the reflux of foods from the esophagus into the throat, the cricopharyngeus remains contracted and tight at most times.
where the larynx bulges into the pharynx is called the piriform fossa - is this the most common place for sharp ingested foreign bodies such as fish bones to lodge
true
All muscles of the pharynx are innervated by vagus nerve except stylopharyngeus which is innervated by what nerve
by glossopharyngeal nerve.
true or false
Rich blood supply from lingual, facial and ascending pharyngeal branches of the external carotid artery.
Venous drainage via the pharyngeal venous plexus, which drains into the internal jugular vein
true
what type of cells line the nasopharynx
ciliated pseudostratified columnar epithelium
what nerve innervates the nasopharynx
pharyngeal branch of maxillary nerve (V2)
what tube connects the nasopharynx to the middle ear
Eustachian tube
the adenoids are lymphoid tissue that increase in size secondary to infection and enlargement can obstruct the Eustachian tube leading to what in children
glue ear
in adults need to be investigated
adenoid hypertrophy can block the nasopharynx resulting in what
mouth breathing
glue ear
adhesive otitis, is a condition that occurs when the middle part of your ear fills with fluid. This part of the ear is located behind the eardrum. The fluid can become thick and sticky, like glue. Overtime, glue ear is likely to lead to a middle ear infection.- bulging ears
symptoms include temporal hearing loss and earache or ear pain
what does the oropharynx contain
posterior 1/3 of the tongue
lingual tonsils
palatine tonsils
what nerve innervates the oropharynx
glossopharyngeal nerve - sensory
tonsillitis and symptoms
infection and inflammation of the tonsils
swollen tonsils
sore throat
difficulty swallowing
tender lymph nodes on the side of the neck
what is quinsy
complication of tonsillitis - collection of pus that develops between th back on one of the tonsils and wall of the throat known as an abcess
normally a complication of bacterial tonsillitis
symtpms
dysphargia - dribble as can’t swallow
trismus - hot potato voice
can obstruct airway and needs drainage
what is the ring of lymphoid tissue in the pharynx called
waldeyers ring of lymphoid tissue
Piriform fossa is a deep recess anterolateral to the larynx (on each side). Sharp ingested foreign bodies may lodge here
true or false
true
what innervates the laryngopahrynx
sensory innervation by vagus nerve via internal branch of superior laryngeal nerve.
pharyngeal pouch is what
Potential gap between the upper oblique fibres (thyropharyngeus) and lower transverse fibres (cricopharyngeus) of inferior constrictor
muscle
The submucosa and mucosa of the pharynx may herniate into this space forming a pouch.
symptoms of pharyngeal pouch
This causes halitosis( bad breath) , dysphagia and cachexia( extreme weight loss and muscle wasting)
if the pharyngeal pouch spills into the larynx what can it cause
aspiration
3 phases of swallowing (Deglutition )
1 – voluntary chewing and pushing food bolus into oropharynx
2 – involuntary – soft palate seals off nasopharynx, larynx elevated and pulled forward, widens pharynx
3 – involuntary – sequential contraction of pharyngeal constrictors causes peristalsis into oesophagus for semi-solid or solid material. Liquids may shoot down oesophagus passively.
a food bolus is a semi solid mass of food - constrictor muscles have to contract to push food down the oespahgus - by what process does this go by
peristalsis
- also bowel movements
the lacrimal nerve is a branch of what nerve
ophthalmic nerve
the small perforations in the cirbiform plate allows fibres of what nerve to enter and exit
olfactory nerve
at the level of the superior meatus the sphenopalatine foramen is located. This hole allows communication between the nasal cavity and the the pterygopalatine fossa. what travels through here
sphenopalatine artery
nasopalatine and superior nasal nerves
a child bites ic cream ands gets brain freeze - what region is going to be the source of this pain
maxillary sinus - nerves to maxillary teeth run in mucosa of the sinus walls and are sensitive to cold
acute sinusitis symptoms or signs
nasal blockage or nasal discharge
facial pain/pressure - he ache or loss of smell
altered speech indicating nasal obstruction
tenderness and swelling or redness over the cheekbone and perioribial areas
cough
symptoms over more than 10 days - bacterial - severe local pain and fever over 38degreees
