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Anatomy of Nose & Paranasal Sinuses

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1 Anatomy of Nose & Paranasal Sinuses
Dr. Vishal Sharma

2 Development of nose

3 Face develops from 5 projections: frontonasal process (ectoderm over forebrain) + 2 maxillary processes + 2 mandibular processes (1st arch) An ectodermal olfactory placode divides fronto-nasal process into medial nasal & lateral nasal process, which give rise to external nasal skeleton Olfactory placode deepens into olfactory pit & later olfactory sac which forms nasal cavities Nasal septum develops from mesodermal tecto-septal expansion from Rathke’s pouch













16 External Framework

17 External Framework Nasal Bone Frontal Process of Maxilla
Upper Lateral Nasal Cartilage Lower Lateral Nasal (Alar) Cartilage Septal Cartilage Lesser Alar (Sesamoid) Cartilages

18 Internal Nose Openings: Anterior nares & posterior nares (Choanae).
Vestibule of nose: lined by skin Nasal cavity proper:  Lateral Wall  Medial Wall (Septum)  Roof  Floor


20 Nasal Septum

21 Nasal Septum

22 Nasal Septum 1. Septal cartilage 7. Medial alar crus
2. Ethmoid plate Upper lateral cartilage 3. Vomer Nasal bone crest 4. Palatine crest Frontal spine 5. Maxillary crest Sphenoid rostrum 6. Vomeronasal Membranous septum cartilage





27 Lateral Nasal Wall  3 - 4 bony conchae covered with mucosa
to form turbinates. Space below & lateral to turbinate is called meatus.  Middle meatus contains a round bulla ethmoidalis separated from uncinate process by hiatus semilunaris that leads to a funnel shaped ethmoidal infundibulum.

28 Meatal Drainage 1. Inferior meatus: Nasolacrimal duct ( guarded at its end by a mucosal valve called HASNER’s valve ) 2. Middle meatus: a. Frontal b. Anterior ethmoid c. Maxillary (natural + accessory ostia) 3. Superior meatus: Posterior ethmoid 4. Spheno-ethmoidal recess: Sphenoid



31 Ostio-meatal Complex

32 Ostio-meatal Complex Complex micro-architectural pathway in ethmoid
labyrinth that drains anterior group of paranasal sinuses. Consists of: frontal recess + ethmoid infundibulum + hiatus semilunaris + uncinate process + bulla ethmoidalis + middle meatus. O.M.C. pathology leads to infection of all anterior paranasal sinuses (Naumann).

33 Variants in O.M.C. Concha bullosa (pneumatized M.T.)
Paradoxically curved middle turbinate Medially turned uncinate process Large bulla ethmoidalis Haller’s cell in orbital floor Agger nasi cell anterior to M.T. Onodi Cell with dehiscent Optic Nerve Mucosal pathology

34 Concha bullosa

35 Concha bullosa

36 Paradoxically curved M.T.

37 Paradoxically curved M.T.

38 Medialized Uncinate Process

39 Large bulla ethmoidalis

40 Haller cell

41 Agger nasi cell

42 Onodi cell with dehiscent optic nv

43 Mucosal disease

44 Blood Supply Sphenopalatine artery (main artery)
Greater palatine artery Superior labial artery Anterior Ethmoidal artery Posterior Ethmoidal artery 1, 2, 3 & 4 form Kiesselbach’s plexus over Little’s area on anterior septum




48 Venous drainage Ethmoidal veins:  ophthalmic veins  cavernous sinus
Sphenopalatine vein:  pterygoid plexus  maxillary vein  Woodruff’s venous plexus: present on lateral wall near posterior end of middle turbinate Retro-columellar vein: behind columella

49 Sensory Nerve Supply Long & short Nasopalatine nerves
Greater palatine nerve Infra-orbital nerve branches Anterior ethmoidal nerve Olfactory nerve



52 Autonomic Nerve Supply
Deep petrosal nerve (sympathetic) + greater superficial petrosal nerve (para-sympathetic)  vidian nerve  pterygo-palatine ganglion  nasal glands Sympathetic stimulation  vasoconstriction + ed nasal secretions Para-sympathetic stimulation  vasodilatation + ed nasal secretions

53 Lining Epithelium Skin: over nasal vestibule
Olfactory epithelium: upper 1/3rd of nasal cavity above superior turbinate Respiratory epithelium (pseudo-stratified ciliated columnar): rest of nasal cavity + paranasal sinus

54 Lining Epithelium

55 Lymphatic Drainage 1. External nose & anterior nasal cavity  submandibular lymph nodes 2. Remaining nasal cavity  upper deep cervical lymph nodes 3. Nasal roof (dangerous area of nose)  subarachnoid space along olfactory nv 4. P.N.S.  retropharyngeal & J.D. node

56 Paranasal Sinuses Anterior group:  frontal  anterior ethmoidal
 maxillary Posterior group:  posterior ethmoidal  sphenoid




60 First X-ray appearance
Development of P.N.S. Appear first First X-ray appearance Reach adult size by Maxillary At birth 4 mth 15 yr Ethmoidal 1yr 12 yr Sphenoid 2 yr 4 yr 18 yr Frontal 6 yr


62 Sphenoid Sinus Relations





67 Muco-ciliary blanket Goblet cells in nasal mucosa secrete a mucous blanket; moved backwards like a conveyer belt into nasopharynx. Consists of:  Superficial mucous or gel layer  Deep serous or sol layer

68 Muco-ciliary blanket

69 Muco-ciliary blanket

70 Thank You

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