nose ANATOMY OF THE NOSE PARANASAL SINUSES ANATOMY

nose

ANATOMY OF THE NOSE & PARANASAL SINUSES

ANATOMY OF SINO-NASAL TRACT • External nose • Nasal cavity • Paranasal sinuses

Anatomy of the External Nose

Anatomy of the External Nose

Anatomy of the External Nose

THE NASAL CAVITY • Nasal Vestibule • Nasal Cavity Proper

THE NASAL VESTIBULE

THE NASAL CAVITY • Roof • Floor • Lateral wall • Medial wall (septum)

The Roof

The Floor

The Medial Wall (Nasal Septum)

Lateral Nasal Wall

Lateral Nasal Wall

The Lining Mucosa • Respiratory mucosa • Olfactory mucosa

The Olfactory Mucosa

The Respiratory Mucosa

The Respiratory Mucosa

Arterial Blood Supply • External Carotid – Maxillary – Facial • Internal Carotid – Ophthalmic

Blood Supply Of The Nasal Cavity Lateral Wall Nasal Septum

Venous Drainage • Facial vein Internal jugular • Angular vein Ophthalmic Cavernous sinus

Lymphatic Drainage • Submandibular • Retropharyngeal • Superior deep cervical

Nerve Supply Of The Nasal Cavity • Olfactory • General sensory: Trigeminal nerve • Autonomic: sphenopalatine ganglion

Olfactory Nerve Supply

Sensory Nerve Supply • Ophthalmic and maxillary branches of the trigeminal

Autonomic Nerve Supply • Sphenopalatine ganglion – Sympathetic: SCG – Parasympathetic: SSN

ANATOMY OF THE PARANASAL SINUSES

The Maxillary Sinus

The Maxillary Sinus

The Maxillary Sinus • Sinus ostium located in the middle meatus

The Ethmoid Sinuses

The Ethmoid Sinuses

The Ethmoid sinuses • Anterior ethmoids: drain into the middle meatus • Posterior ethmoids: drain into superior meatus

The Frontal Sinus • Rarely present at birth; usually not visible until age 2 • Great variability in size; congenitally absent in 5%

The Frontal Sinus

The Frontal Sinus

The Sphenoid Sinus

The Sphenoid Sinus

The Sphenoid Sinus

The Sphenoid Sinus

Lining of the Sinuses • Pseudostratified, columnar epithelium (respiratory epithelium) which is continuous with the nasal epithelium

Blood Supply • Branches from the internal and external carotids

Nerve Supply • Branches from the trigeminal

Functions Of The Nose • Respiratory channel • Warming and humidifying inspired air

Warming And Humidifying Inspired Air

Functions Of The Nose • Respiratory channel • Warming and humidifying inspired air • Cleaning and filtering inspired air

Cleaning And Filtering Inspired Air

Cleaning And Filtering Inspired Air

Cleaning And Filtering Inspired Air

Functions Of The Nose • Respiratory channel • Warming and humidifying inspired air • Cleaning and filtering inspired air • Olfaction

Olfaction

Investigation of Nasal Diseases • Endoscopy • Rhinometry • Measurement of olfaction • Skin allergy test • Mucociliary clearance tests • Imaging

Endoscopy

Rhinometry • Objective measurement of the nasal resistance or the flow of air in the nasal cavities

Measurement Of Olfaction • Identification tests • Threshold detection tests

Skin allergy test

Mucociliary clearance tests • Phase contrast microscopy (frequency of the cilia beats) • Saccharine test • Measuring the movement velocity of a radioactive tracer placed anteriorly in the nose • Electron microscopy

Ultrastructure of The Cilia

X-Rays Nasal Bones

Imaging of The Paranasal Sinuses • Plain X-Rays • CT scan • MRI

Occipitomental View (Water’s View)

Occipito-frontal View (Caldwell View)

Occipito-mental Occipito-frontal

Lateral View

Submento-vertical view

Occipito mental Occipito frontal Lateral Submento vertical

CT Paranasal Sinuses Axial Coronal

Normal Axial

Normal coronal

MRI

Development Of The Nose

Development of the nose

Development of the sinuses A) at birth B) at 10 -years C) at 15

Development of the sinuses

CONGENITAL ANOMALIES

Anterior Nares Deformity

Dermoid cysts

Meningo and encephaloceles

CHOANAL ATRESIA

THE CHOANA

Choanal Atresia • ? Due to persistence of the primitive bucconasal membrane • Unilateral or bilateral • Bony, membranous or mixed

Unilateral Choanal Atresia

Unilateral Choanal Atresia • Usually diagnosed late in life • Presents by unilateral nasal obstruction and unilateral mucoid nasal discharge • Treatment is by elective surgical repair

Bilateral Choanal Atresia • Isolated anomaly in 60 -70% • May be linked to CHARGE association

CHARGE ASSOCIATION • Coloboma • Heart disease • Atresia • Retarded growth • Genital hypoplasia • Ear deformity

Bilateral Choanal Atresia • Usually presents at birth by attacks of cyclic cyanosis and respiratory obstruction • Nasal discharge

Diagnosis • Clinical examination: “mirror test” • Inability to pass a catheter into nasopharynx • Endoscopy • Radiographs the

Management • Emergency – Immediate airway support with oral airway, Mc. Govern nipple, or intubation • Definitive surgery

Surgical Approaches to the Choana • Transnasal • Transpalatal • Transseptal • Lateral rhinotomy • External rhinoplasty

Transpalatal Approach

THE NASAL VESTIBULE

Acute Infections • Acute vestibulitis • Furunculosis

Acute Vestibulitis • Inflammation of the skin of the vestibule, usually due to Staphylococcus aureus

Causes • Habitual rubbing of the nose • Allergy • Rhinorrhea

Clinical Features • Pain • Irritation • Redness and swelling • Crusting

Treatment • Local antibiotics and corticosteroids

Furunculosis • Acute infection of the hair follicles with Staphylococcus aureus

Complications • Local abscess • Spreading cellulitis • Cavernous sinus thrombophlebitis

Treatment • Avoid squeezing • Local application of heat • Antibiotics

Other Conditions of Vestibule and External Nose • Erysipelas • Impetigo • Herpes simplex and zoster • Warts • Lupus vulgaris • Syphilis • Basal and squamous cell carcinoma

Diseases of the nasal septum • Deviated nasal septum • Septal hematoma and abscess • Perforated septum

DEVIATED NASAL SEPTUM

Etiology • Trauma • Maldevelopment

Symptoms • Nasal obstruction

Symptoms • Nasal obstruction • External deformity • Crusting, epistaxis

Examination

Radiology • Unnecessary in most cases

Treatment • No treatment • Septoplasty

Septoplasty

Complications of Septoplasty • Septal hematoma & abscess • Septal perforation • Nasal deformity • Synechia (adhesion)

HEMATOMA OF THE SEPTUM

Etiology • Direct trauma • Operative trauma • Blood dyscrasias

Clinical Features

Complications • Cartilage necrosis • Septal abscess • Permanent thickening of the septum

Treatment • Incision and drainage • Systemic antibiotics

PERFORATION OF SEPTUM

Etiology • Septal surgery • Other trauma • Cocaine • Chrome perforation • Syphilis, TB, Lupus, etc. • Tumors

Clinical features • Asymptomatic • Crusting • Epistaxis • Whistling

Treatment • No treatment • Nasal wash • Surgical closure

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