Applied Anatomy & Physiology of Nose & Paranal sinuses 🌻
External nose
Structures
Skin
Muscle
Bone
Cartilage
Mucosa
Nasal bone
Frontal process of maxilla
Piriform aperture รูที่กระดูกด้านล่างเปิดสู่ External nose
Upper lateral cartilages
Lower lateral cartilages
Medial crus
Lateral crus
Control patency of nasal vestibule
Alar collapse
Medial nose?
Nasal septum
- Vomer bone
- Horizontal plate of palatine bone
- Palatine process of maxilla
- Septal cartilage
Deviated nasal septum
Causes
- Development
- Post-traumatic
Symptoms
Nasal obstruction
Sinusitis
- Perpendicular plate of ethmoid bone
Nasal vestibules
Respiratory region
Olfactory region
Nasopharynx
Auditory tube opening
Nasal valve
Surrounded by
Isthmus region (resistant 50%)
Junction between upper & lower lateral cartilages
Septum
Anterior end of Inferior turbinate
Muscle dilator naris (innervate by CN7)
Lateral nasal wall
Turbinate or concha
Meatus
Sphenoethmoidal recess
Inferior
Middle
+- Supreme
Superior
Mee correlate to Turbinate
Inferior
Middle
(Osteomeatal complex contain these 3)
Superior
Opening of ...
Nasolacrimal duct
(Valve of Hasner or Plica lacrimalis)
Frontal sinus
Ant. Ethmoid sinus
Maxillary sinus
Post. Ethmoid sinus
Sphenoid sinus
Nasal mucosa
🐇 Epithelium
- Keratinized, stratified squamous
- Pseudostratified ciliated columnar
Ciliated columnar cell
Non-ciliated columnar cell
Goblet cell
Basal cell
- Olfactory
🐇 Basement mb
🐇 Laminate propia(nasal submucosa)
Connective tissue
WBC (mononuclear cells)
Nasal gland
Nerve
Vessels
Blood vessels
- Resistance: Arterioles
- Exchange: Capillaries
- Shunt: Arteriovenous
- Capacitances (nasal airway resistance): ⭐Venous sinus — Cavernous sinusoid
Nasal glands
- Anterior serous gland
- Seromucous gland
- Intraepithelial gland
Vestibule
Located Submucosa
Serous : mucous = 8 : 1
Found in Trachea, Bronchi
Paranasal air sinuses
(PNS)
- Frontal sinus
- Ethmoid sinus
- Maxillary sinus
- Sphenoid sinus
Film
Film PNS (Water’s view)
or Occipitomental view or Nose-chin position
Film PNS (Caldwell’s view)
Maxillary sinus
Sphenoid sinus (if อ้าปาก)
Frontal sinus
Ethmoid sinus
CT: coronal, axial & sagittal For Frontal sinus
Superior
Lateral
Posterior
Pituitary gland
Optic nerve
⭐Cavernous sinus
Internal carotid a
CN 3, 4, 6, 5(1), 5(2)
Develop-Xrays
Vascular & Lymphatic supply ❤
External nose
⭐⭐Nasal cavity & PNS
Arterial supply
Venous drainage
(no valves)⭐
ECA
br into
ICA
Br into
Facial a.
Superior labial a.
Lateral nasal a.
Angular a.
Dorsal nasal a.
External nasal a.
⇦ Ant. Facial v.
⇦ Angular v.
⇦ Ant. Facial v.
⇦ Common facial v.
IJV
⇦ Inf. Ophthalmic v.
Cavernous sinus
⇦ Infraorbital v.
⇦ Pterygoid venous plexus
Cavernous sinus
Danger triangle of Face
as no valves so infection can spread to all
Lympathic drainage
Lympathic vv. around Ant. Facial v.
⇨ Submandibular nodes
Arterial supply
Venous drainage
Lymphatic drainage
⇦ ECA
Ophthalmic a.
Ant. & Post. Ethmoidal a.
Supraorbiral & Supratrochlear a.
⇦ ICA
Internal maxillary a.
Superior labial a.
⭐ Sphenopalatine a. ⭐
Descending palatine a.
Infraorbital, Posterosuperior alveolar, Anterosuperior alveolar a.
Pharyngeal a.
Kisselbach’s plexus/ Little’s area
Anterior ethmoid (ICA)
Superior labial a (Facial)
Sphenopalatine a (IMAX)
Greater palatine a (IMAX)
Woodruff’s plexus
Sphenopalatine a.(pharyngeal & nasal branches) (IMAX)
Posterior ethmoid (ICA)
⇦ Supratrochlear/supraorbital/Ant&Post ethmoidal v.
⇦ SP/Alveolar/Palatine v,
⇦ Ophthalmic v.
Cavernous sinus
⇦ Maxillary v.
⇦ Posterior facial v.
⇦ Common facial v.
IJV
Ant. 1/3 of nasal cavity,
Frontal, Maxillary, Ant. Ethmoid
Post. 2/3 of nasal cavity,
Post. Ethmoid, Sphenoid
Lympathic vv around Ant. Facial v.
⇨ Submandibular nodes
Retropharyngeal nodes (Node of Rouviere)
Neural supply
- Olfactory n.
- Sensory n. ⇨ CN5(1), 5(2)
- Autonomic innervation
Sympathetic system
Parasympathetic system
Superior cervical gg.
Supply blood vv. #
Vasoconstriction ⇨ ⬇ nasal airway resistance
Pterygopalatine gg,
Supply blood vv & nasal gl. #
Vasodilatation & Glandular secretion
Physiology of Nose
1⃣ Breathing
Obligate nasal breathing (not until 6-9 mo ถึงจะหายใจทางปากได้)
Nasal cycle
Nasal valve ⇨ Turbulent flow
Func
- Adjust Temp & Humidify Air
- Filter air & Protect Lower airway
Mucous blanket (dust > 4 micron)
Lysozyme, Lactoferrin, oxidized form of Thiocyanate, IgA, IgG
Bacteria flora (S. Viridans)
- Sol layer
(preciliary layer)
- Gel layer
(mucous layer)
Nasal mucociliary clearance
Cilia ส่วนต้น ⇨ พัดออกนอกจมูก
Cilia ส่วนหลัง ⇨ พัดลงคอ
Prolonged mucociliary transport time
Infection
Dehydration
Trauma
Atrophic rhinitis
Cystic fibrosis
2⃣ Smell
Olfactory mucosa
Volatile substance
water&fat soluble จะรับกลิ่นได้ดี
Vomeronasal organ
จุดบุ๋มตรง septum
3⃣ ออกเสียง
Hyponasal voice may cause fr Sick or บีบจมูก
4⃣ ถ่ายเทอากาศ & รับของเหลวจาก nearby organ
Nasolacrimal duct
Eustachian tube
Physiology of Sinuses
Defense mech of Sinuses
Resonance (เสียงก้องกังวาน)
Perceive odor
Adjust by Humidify & Warm air
Makes skull เบา & keep balance
Shock absorbance ( ⬇ severity fr กระทบกระแทก)
พยุง upper air way when อยู่ในน้ำ
ฉนวนป้องกัน skull & eyeballs fr too hot or cold
Adjust pressure within nasal cavity
Mucociliary transport - cilia
Patency of sinus ostia
Paranasal secretion - Ig, NO