1. GROSS ANATOMY OF THE NASAL CAVITY & THE PHARYNX

2. External Nose The External Nose includes:
The root (area between the eyebrows)
The bridge
The dorsum nasi terminating at the apex
Just inferior to the apex is the philtrum.
The external openings of the nose: nostrils or nares are bounded laterally by the flared alae.
It is covered with the skin and contains two nasal bones, several cartilages and muscles of facial expression
The External Nose contains the most anterior part of the Nasal Cavity and Nasal Vestibule.

3. External Nose Dorsum Root Bridge Philtrum Apex Ala Ala Septum Nasal
vestibule
Ala
Septum
Philtrum

4. Nasal Cartilages
Nasal
bone
Nasal
bone
Nasal
bone

5. External Nose, Nasal Bones & Cartilages

6. Nose, Nasal Bones & Cartilages

7. Nose & Nasal Cartilages
Muscles of
Facial Expression
Vibrissal Hairs

8. Main Functions of Nasal Cavity
It provides an airway for respiration
It filters and cleans inspired air
It moistens and warms (cools) the entering air
It serves as a resonating chamber for speech
It houses the olfactory (smell) receptors

9. Functions of Nasal Cavity
It is also filtered & cleaned there.

10. Walls of Nasal Cavity
The Nasal Cavity is divided by its septum into the right and left halves and each half has 4 walls:
Superior (Roof)
Inferior (Floor)
Lateral
Medial (Nasal Septum)

11. Bones of Nasal Cavity Walls: Nasal Roof Nasal Floor Lateral Wall
Frontal
Ethmoid (cribriform plate)
Sphenoid (anterior & inferior surfaces of body)
Nasal Floor
Intermaxillary (incisive) bone
Palatine process of Maxilla
Horizontal plate of Palatine bone
Lateral Wall
Maxilla
Lacrimal
Ethmoid (labyrinth)
Inferior concha
Palatine (vertical lamina)
Sphenoid (medial lamina of pterygoid process)
Medial Wall (Nasal Septum)
Vomer
Ethmoid (perpendicular plate)

12. Bones Of Facial Skeleton

13. Individual Cranial Bones
Frontal
Parietal
Occipital
Ethmoid
Temporal
Sphenoid
Nasal
Lacrimal
Maxilla
Zygomatic
Inferior
Nasal
Concha
Mandible
Vomer

14. Bones of Nasal Cavity
Nasal Cavity

15. Ethmoid Bone – Coronal Cross Section
Cribriform Plate
Right Labyrinth
Left Labyrinth
Right
Middle
Concha
Left
Middle
Concha
Perpendicular Plate

16. Areas of Lateral Nasal Wall
Vestibule of nose
Atrium of middle meatus
It is above and posterior to vestibule and anterior to middle meatus
Agger nasi – Additional concha close to nasal bone
Inferior concha
Inferior meatus – below concha
Middle concha
Middle meatus – below concha
Superior concha
Superior meatus – below concha
Spheno-ethmoidal recess
Above superior concha

18. Nasal Vestibule
Is a slight dilation inside the nostril, limited by a ridge (limen nasi) over which skin is continuous with the mucosa
It is surrounded by cartilage
It is lined with the skin containing coarse hairs sebaceous glands and sweat glands

19. Lateral wall & Openings of Paranasal Sinuses
Superior Meatus
Sphenoethmoidal Recess S
Atrium of Middle Meatus
Middle Meatus
Nasopharynx
Inferior Meatus
Nasal Vestibule
Oral Cavity

20. Bones of Lateral Nasal Wall

21. Bones of Nasal Roof & Floor
Frontal
Nasal Roof
Nasal
Ethmoid
Sphenoid
Inferior Nasal Concha
Maxilla
Palatine
Nasal Floor

22. Bones of Nasal Floor

23. Components of Inferior Nasal Wall in Adult
View from Oral Cavity
Interpalatine suture
Secondary Palate
or Incisive bone
(primary palate)

24. Nasal Septum Components: Vomer Perpendicular plate of ethmoid bone
Nasal crest of maxilla
Nasal crest of palatine bone
Nasal crest of sphenoid bone
Vertical crest of nasal bone
Nasal spine of frontal bone
Nasal septal cartilage

25. Components of Nasal Septum
Vertical Crest of
Nasal Bone
Nasal Spine of Frontal Bone
Nasal Crest of Sphenoid Bone
Perpendicular plate
of Ethmoid bone
Septal Cartilage
Vomer
Nasal Crest of Palatine Bone
Nasal Crest of Maxilla

26. Paranasal Sinuses
These are air-filled cavities, which develop in facial and cranial bones.
The paranasal sinuses are paired and are named for the bone in which they are located:
Frontal bone – 2 Frontal sinuses
Sphenoid bone – 2 Sphenoidal sinuses
Ethmoid bone – 2 Labyrinths with Ethmoidal sinuses (groups of air cells)
2 Maxillary bones – 2 Maxillary sinuses
Spaces of sinuses communicate with the nasal cavity via their openings.
The sinuses are lined with mucous membrane, which has mucous glands, and it is continuous with that of the nasal cavity
Sinuses drain into the nasal cavity due to coordinated ciliary activity.
This movement of mucus which is known as muco-ciliary clearance is not random but rather programmed so that mucus moves along in a pattern.
This secretion keeps the nose and sinuses moist.
The sinus does not “drain” by gravity-it is an active process

27. Location of Paranasal Sinuses
Frontal- Paired, in the frontal bone. One sinus per side located in the forehead. They are separated from each other by a bony septum which deviates from the median plane. Usually asymmetrical, and roughly in shape extending upward above the medial end of the eyebrow and backward into the medial part of the roof of the orbit.
Ethmoidal- Contained within the labyrinths of the ethmoid bone. Approximately 6-12 small sinuses per side, located in the lateral wall of nasal cavity between the orbit and nasal cavity.
Sphenoidal- Paired, in the body of sphenoid bone. One sinus per its side, located behind the ethmoid sinuses, beside the midline of the body. Pituitary fossa of Sella Turcica projects into this space. Each sinus opens into the spheno-ethmoidal recess above the superior concha.
Maxillary (Antrum) - Paired, in maxilla. One sinus located in each side of the face. It is pyramidal in shape with the base forming the lateral wall of the nose and the apex in the zygomatic process of the maxilla. Inferiorly related to tooth-bearing area of maxilla. The roof is formed by the floor of the orbit while the floor is formed by the alveolar process of maxilla. The roots of the first, second premolars, the molar and sometimes the root of the canine project up into the sinus.

28. Location of Paranasal Sinuses

29. Location of Paranasal Sinuses

30. Location of Paranasal Sinuses

31. Frontal Sinus (Sagittal Section)

32. Right Frontal Sinus – Diploe is removed
Orbit
Nose

33. Extension of Frontal Sinuses in Upper Orbital Walls
Anterior Cranial Fossa
Frontal Sinus
Frontal Sinus

34. Paranasal Air Sinuses Ethmoid Air Sinuses Sagittal Cross Section
Sphenoid Air Sinus
Maxillary Air Sinus
Sagittal Cross Section

35. Sphenoidal Sinus – Sagittal Cross Section

36. Sphenoidal Sinus – Coronal Cross Section (Posterior View)

37. Ethmoidal Sinuses (Air Cells)
Coronal Cross Section

38. Roof of Ethmoidal Sinuses in Labyrinths
Horizontal Cross Section

39. Left Maxilla – Medial View
Maxillary Sinus

40. Small Right Maxillary Sinus – Coronal Section
Right Orbit
Palate

41. Left Maxillary Sinus – Coronal Section
From Behind
Infraorbital Canal
Inferior Orbital Wall
Roof
Base
Maxillary Sinus
Floor
Apex
Hard Palate
Molar Tooth

42. External Nose & Left Maxillary Sinus

43. Knife Entering Left Maxillary Sinus

45. Paranasal Sinuses: Site of Drainage to Nasal Cavity
Maxillary
It drains into the middle nasal meatus through the hiatus semilunaris
Frontal
It drains into the middle meatus via frontonasal duct, infundibulum and hiatus semilunaris
Sphenoidal
It drains into the sphenoethmoidal recess
Ethmoidal
Anterior Group of air cells
They drain into the Infundibulum and into the middle nasal meatus
Middle Group of air cells
They drain into the Middle nasal meatus on or above bulla ethmoidalis
Posterior Group of air cells
They drain into the Superior nasal meatus

46. CLINICAL SIGNIFICANCE
Sinuses frequently become infected due to obstruction of normal drainage, and negative pressure in a sinus can cause headaches.
Blockage of the sinus ostium results in reduction of ventilation and drainage.
If the ostium is smaller than 2.5 mm, sinus is predisposed to development of disease.
Obstruction interrupts the self-cleaning mechanism of the affected sinus therefore secretion stagnates and changes composition.
Neoplasms which arise in the sinuses can be occult for quite a long time, so that they are usually very advanced at the time of diagnosis.

47. Water’s View of Paranasal sinuses

48. Drainage of Nasolacrimal Duct into Inferior Nasal Meatus

49. Nerves of Nasal Septum Olfactory nerves
Medial nasal branches of anterior ethmoidal nerve (anterior & upper part of septum)
Nasal Branches from pterygopalatine ganglion
Nasopalatine nerve
Medial posterior superior nasal branches
Nasal branches of Infraorbital nerve (movable part of nasal septum)
Nasal branch of Anterior superior alveolar nerve
Near anterior nasal spine
Nasal branches from nerve of pterygoid canal

50. NERVES OF NASAL SEPTUM

51. Nerves of Nasal Walls

52. Nerves of Lateral Nasal Wall
Olfactory nerves
External nasal branch of anterior ethmoidal nerve
Lateral nasal branches of anterior ethmoidal nerve
Branches from pterygopalatine ganglion
Lateral posterior superior nasal branches
Lateral posterior inferior nasal branches of greater palatine nerve
Infratrochlear nerve (side of the nose)
Infraorbital nerve (maxillary sinus, nasal vestibule)
Nasal branch of Anterior superior alveolar nerve (floor and lateral wall up to semilunar hiatus)
Facial nerve (nasal muscles)

53. Nerves of Lateral Nasal Wall

54. Autonomic Nerves of Nasal Cavity

55. Arteries of Nasal Septum
Septal branches of Sphenopalatine artery
Septal branches of anterior ethmoidal artery
Septal branches of posterior ethmoidal artery
Septal branch of superior labial artery
Terminal nasal part of greater palatine artery

56. Nasal Arteries

57. Arteries of Lateral Nasal Wall
Lateral branches of Sphenopalatine artery
Terminal nasal branch of Greater palatine artery
Lateral branches of anterior Ethmoidal artery
Lateral branches of posterior Ethmoidal artery
Nasal branches of Infraorbital artery
Superior (anterior & posterior) Alveolar arteries
Lateral branch of superior Labial artery
Lateral nasal branch of Facial artery

58. Arteries of Lateral Nasal Wall

59. Arteries of External Nose

60. Venous Drainage of Nasal Cavity
Drainage is via veins accompanying arteries.
Veins form rich submucosal cavernous plexus, which is dense in lower part of septum and in middle and inferior conchae – swell bodies
Arteriovenous anastomoses occur there.
A few veins pass through cribriform plate to drain into intracranial veins of anterior cranial fossa.
When foramen caecum is patent it transmits a vein from nasal cavity to superior sagital venous sinus.

61. Nasal Veins

62. Swell Bodies
Every minutes, swell bodies on one side of nasal cavity become engorged with blood, resulting in swelling of conchal mucosa and decrease in the flow of air, which is directed to other side of nasal cavity. These periodic intervals of occlusion allow respiratory epithelium to recover from over chilling, overheating or over drying (desiccation).

63. Venous Drainage from External Nose

64. GROSS ANATOMY OF THE PHARYNX

65. The Pharynx Is located behind nasal cavities, mouth & larynx
Is a musculocutaneous tube, 12 – 14 cm long
Extends from cranial base to level of C6 & lower border of cricoid cartilage of the larynx
Has its width greatest superiorly (3.5 cm) and it is reduced up to 1.5 cm at junction with esophagus
Is attached from above downwards on each side to:
Base of skull has strong liner attachment of pharyngobasilar fascia to basilar occipital & petrous temporal bones:
From pharyngeal tubercle - laterally, to external carotid foramen and then anteromedially, to base of medial pterygoid plate
Posterior Border of Medial Pterygoid Plate
Pterygomandibular Raphe
Posterior end of Mylohyoid line of Mandible
Side of Tongue
Hyoid bone
Thyroid & Cricoid cartilages

66. The Pharynx Is subdivided into three parts:
Nasopharynx: behind choanae
From base of the skull in front of C1 & C2
It communicates with Tympanic Cavity via Auditory tube
Oropharynx: behind the mouth
In front of C3
Laryngopharynx: behind the larynx
In front of C4, C5, C6
Pharyngeal wall has the following layers:
Mucous membrane
Pharyngobasilar fascia
Muscular coat
Buccopharyngeal fascia

67. The Pharynx
Nasopharynx
Oropharynx
Pharynx C3
Laryngopharynx

68. Skull – Attachment of Pharyngobasilar Fascia
Line of Attachment
Pharyngeal
Tubercle

69. Skull – Attachment of Pharyngobasilar Fascia

70. Anterior Pharyngeal Wall from Behind

71. Pharyngeal Musculature
It includes three Constrictor and three Elevator muscles.
Constrictor muscles:
Superior Pharyngeal Constrictor
Middle Pharyngeal Constrictor
Inferior Pharyngeal Constrictor
Elevator muscles:
Stylopharyngeus  Glossopharyngeal nerve
Palatopharyngeus
Salpingopharyngeus
Motor innervation is from cranial part of Accessory nerve through Vagus: its branches forming Pharyngeal plexus (Exception: Stylopharyngeus)
Sensory innervation: Pharyngeal plexus, which is formed by pharyngeal branches of Vagus, Glossopharyngeal and rami of Sympathetic trunk. Nasopharynx is supplied by branches of the Maxillary nerve.

72. Attachments of Pharyngeal Constrictors
Middle
Superior
Inferior

73. Pharyngeal Muscles from Behind

74. Pharyngeal & Palatal Muscles from Behind

75. Pharyngeal Muscles from the Side

76. View of Pharynx from Behind

77. Naso & Oropharynx C2 Nasopharynx Oropharynx Pharyngeal Tonsil S.S.
Middle Concha
Inferior Concha
Torus tubarius
Opening of Auditory Tube
Nasopharynx
Palatopharyngeal fold
Tubal Tonsil
Palatoglossal fold C2
Tongue
Palatine
Tonsil
Oropharynx
Lingual
Tonsil
Epiglottis

78. Right Auditory Tube (Cartilaginous Part)

79. Pharyngeal Blood Supply
Branches of Ascending Pharyngeal Artery
Branches of Facial Artery
Ascending palatine
Tonsillar rami
Branches of Maxillary Artery
Greater Palatine
Pharyngeal
Artery of Pterygoid Canal
Branches of Lingual Artery
Dorsal Lingual Rami
Venous Drainage:
Pharyngeal plexus of veins to Pterygoid Plexus, Internal Jugular Vein & Facial vein

80. Structures of Naso & Oropharynx

81. Pterygoid Plexus of Vein
Pterygoid Plexus of Veins

82. THANK YOU