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

  1. Vomer bone
  1. Horizontal plate of palatine bone
  1. Palatine process of maxilla
  1. Septal cartilage

Deviated nasal septum

Causes

  1. Development
  1. Post-traumatic

Symptoms

Nasal obstruction

Sinusitis

  1. 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

  1. Keratinized, stratified squamous
  1. Pseudostratified ciliated columnar

Ciliated columnar cell

Non-ciliated columnar cell

Goblet cell

Basal cell

  1. Olfactory

🐇 Basement mb

🐇 Laminate propia(nasal submucosa)

Connective tissue

WBC (mononuclear cells)

Nasal gland

Nerve

Vessels

Blood vessels

  1. Resistance: Arterioles
  1. Exchange: Capillaries
  1. Shunt: Arteriovenous
  1. Capacitances (nasal airway resistance): ⭐Venous sinus — Cavernous sinusoid

Nasal glands

  1. Anterior serous gland
  1. Seromucous gland
  1. Intraepithelial gland

Vestibule

Located Submucosa

Serous : mucous = 8 : 1

Found in Trachea, Bronchi

Paranasal air sinuses
(PNS)

  1. Frontal sinus
  1. Ethmoid sinus
  1. Maxillary sinus
  1. 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

  1. Olfactory n.
  1. Sensory n. ⇨ CN5(1), 5(2)
  1. 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

  1. Adjust Temp & Humidify Air
  1. Filter air & Protect Lower airway

Mucous blanket (dust > 4 micron)

Lysozyme, Lactoferrin, oxidized form of Thiocyanate, IgA, IgG

Bacteria flora (S. Viridans)

  1. Sol layer
    (preciliary layer)
  1. 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