Nasal and Paranasal Air Sinuses

NASAL CAVITY & PARANASAL AIR SINUSES
BY
MISS UMEANO, A.V

INTRODUCTION
• The nose is an olfactory and respiratory organ.
• It consists of nasal skeleton, which houses the nasal cavity.
• The nasal cavity has four functions, They are;
 Warm and humidify the inspired air.

 Removes and traps pathogens and particulate matter from the inspired air.
 Responsible for sense of smell.
 Drains and clears the paranasal sinuses and lacrimal ducts.
DIVISIONS
• The nasal cavity is the most superior part of
the respiratory tract extending from the
vestibule of the nose to the nasopharynx,
and has three divisions:
 Vestibule – the area surrounding the anterior

external opening to the nasal cavity.
 Respiratory region – lined by a ciliated

psudeostratified epithelium, interspersed
with mucus-secreting goblet cells.
Sagittal section of the nasal cavity.

 Olfactory region – located at the apex of the Conchae are present on the lateral
nasal cavity. It is lined by olfactory cells walls
with olfactory receptors.
NASAL CONCHAE
• Projecting out of the lateral walls of the
nasal cavity are curved shelves of bone.
They are called conchae (or turbinates).
• There are three conchae – inferior, middle

and superior.
• They project into the nasal cavity, creating
four pathways for the air to flow called
meatuses:
 Inferior meatus – between the inferior

concha and floor of the nasal cavity.
 Middle meatus – between the inferior and
middle concha.
NASAL CONCHAE
 Superior meatus – between the middle and
superior concha.
 Spheno-ethmoidal recess – superiorly and
posteriorly to the superior concha.
• The function of the conchae is to increase

the surface area of the nasal cavity hence
increasing the amount of inspired air that
can come into contact with the cavity walls.
• They also disrupt the fast, laminar flow of
the air, making it slow and turbulent. The air
spends longer time in the nasal cavity, so
that it can be humidified.
Openings into the Nasal Cavity
• One of the functions of the nose is to drain a variety of structures. They are;
 The paranasal sinuses drain into the nasal cavity. The frontal, maxillary and anterior
ethmoidal sinuses open into the middle meatus.
• The location of this opening is marked by the semilunar hiatus, a crescent-shaped groove
on the lateral walls of the nasal cavity.
• The middle ethmoidal sinuses empty out onto a structure called the ethmoidal bulla. This
is a bulge in the lateral wall formed by the middle ethmoidal sinus itself. The posterior
ethmoidal sinuses open out at the level of the superior meatus.
• The only structure not to empty out onto the lateral walls of the nasal cavity is the
sphenoid sinus. It drains onto the posterior roof.
Openings into the Nasal Cavity
 Nasolacrimal duct – acts to drain tears

from the eye. It opens into the inferior
meatus.
 Auditory (Eustachian) tube – opens

into the nasopharynx at the level of the
inferior meatus. It allows the middle
ear to equalise with the atmospheric air
pressure.
showing the various openings on the lateral wall of

the nasal cavity.
Gateways to the Nasal Cavity
• The cribriform plate is part of the ethmoid bone. It forms a portion of the roof of the nasal
cavity. It contains very small perforations, allowing fibres of the olfactory nerve to enter
and exit,
• At the level of the superior meatus, the sphenopalatine foramen is located. This hole
allows communication between the nasal cavity and the pterygopalatine fossa. The
sphenopalatine artery, nasopalatine and superior nasal nerves pass through here.
• The incisive canal is a pathway between the nasal cavity and the incisive fossa of the oral
cavity. It transmits the nasopalatine nerve and greater palatine artery.
• Small foramina in the lateral wall for Branch of infraorbital nerve (CNV2) and Branch of
greater palatine nerve to pass through
Vasculature
• The nose has a very rich vascular supply – this allows it to effectively change
humidity and temperature of inspired air.
• The nose receives blood from both the internal and external carotid arteries
• Internal carotid branches which include;
 Anterior ethmoidal artery
 Posterior ethmoidal artery
 These ethmoidal arteries are branch of the ophthalmic artery.

 They descend into the nasal cavity through the cribriform plate
Vasculature
• External carotid branches:
 Sphenopalatine artery
 Greater palatine artery
 Superior labial artery
 Lateral nasal arteries
• In addition to the rich blood supply, these

arteries form anastomoses with each other.
This is particularly prevalent in the
anterior portion of the nose .
Vasculature
• The veins of the nose tend to follow the arteries. They drain into the pterygoid
plexus, facial vein or cavernous sinus.
• In some individuals, a few nasal veins join with the sagittal sinus (a dural venous
sinus). This represents a potential pathway by which infection can spread from the
nose into the cranial cavity
INNERVATION
• The innervation of the nose can be functionally divided into special and general innervation.
• Special sensory innervation refers to the ability of the nose to smell. This is carried out by
the olfactory nerves. The olfactory bulb, part of the brain, lies on the superior surface of the
cribriform plate, above the nasal cavity. Branches of the olfactory nerve run through the
cribriform plate to provide special sensory innervation to the nose.
• General sensory innervation to the septum and lateral walls is delivered by the nasopalatine
nerve (branch of maxillary nerve) and the nasociliary nerve (branch of the ophthalmic
nerve). Innervation to the external skin of the nose is supplied by the trigeminal nerve.
Lateral view of the nasal septum showing relationship of the olfactory bulb and
cribriform plate
Clinical Relevance: Spread of Infection
• As the auditory tube connects the middle ear and upper respiratory tract, it is a path
by which infection can spread from the upper respiratory tract to the ear.
• Infection of the auditory tube causes swelling of the mucous linings, and the tube
becomes blocked. This results in diminished hearing.
Epistaxis
• Epistaxis is the medical term for a nosebleed.
• Due to the rich blood supply of the nose, this is a common occurrence.
• It is most likely to occur in the anterior third of the nasal cavity – this area is known
as the Kiesselbach area.
• The cause can be local (such as trauma), or systemic (such as hypertension).

Cribriform Plate Fracture
• A fracture of the cribriform plate can occur as a result of nose trauma.
• It is either fractured directly by the trauma, or by fragments of the ethmoid bone.
• A fractured cribriform plate can penetrate the meningeal linings of the brain, causing
leakage of cerebrospinal fluid.
• Exposing the brain to the outside environment like this increases the risks of meningitis,
encephalitis and cerebral abscesses.
• The olfactory bulb lies on the cribriform plate and can be damaged irreversibly by the
fracture. In this case, the patient may present with anosmia (loss of smell).
PARANASAL AIR SINUSES
INTRODUCTION
• The paranasal sinuses are air-filled extensions of the nasal cavity.
• There are four paired sinuses – named according to the bone in which they are located –
maxillary, frontal, sphenoid and ethmoid.
• Each sinus is lined by a ciliated pseudostratified epithelium, interspersed with mucus-

secreting goblet cells.
• The paranasal sinuses are formed during development by the nasal cavity eroding into the
surrounding bones.
• All the sinuses therefore drain back into the nasal cavity – openings to the paranasal
sinuses can be found on the roof and lateral nasal walls.
FUNCTION
• Lightening the weight of the head
• Supporting immune defence of the nasal cavity
• Humidifying inspired air
• Increasing resonance of the voice

FRONTAL SINUS
• There are two frontal sinuses located within the frontal bone of the skull.
• They are the most superior of the paranasal sinuses, and are triangular in shape
• Drainage is via the frontonasal duct.
• It opens out at the hiatus semilunaris, within the middle meatus of the nasal cavity
• Sensation is supplied by the supraorbital nerve (a branch of the ophthalmic nerve),

and arterial supply is via the anterior ethmoidal artery (a branch of the internal
carotid).
SPHENOID SINUSES
• The sphenoid sinuses are situated within the body of the sphenoid bone.
• They open out into the nasal cavity in an area supero-posterior to the superior cocha
– known as the spheno-ethmoidal recess.
• They are innervated by the posterior ethmoidal nerve (a branch of the ophthalmic
nerve), and branches of the maxillary nerve.
• They recieve blood supply from pharyngeal branches of the maxillary arteries.
ETHMOIDAL SINUSES
• There are three ethmoidal sinuses located within the ethmoid bone
 Anterior – Opens onto the hiatus semilunaris (middle meatus)
 Middle – Opens onto the lateral wall of the middle meatus
 Posterior – Opens onto the lateral wall of the superior meatus
• They are innervated by the anterior and posterior ethmoidal branches of the
nasociliary nerve and the maxillary nerve.
• The anterior and posterior ethmoidal arteries are responsible for arterial supply.
MAXILLARY SINUSES
• The maxillary sinuses are the largest of the sinuses.
• They are located laterally and slightly inferiorly to the nasal cavities.
• They drain into the nasal cavity at the hiatus semilunaris, underneath the frontal
sinus opening.
• This is a potential pathway for spread of infection – fluid draining from the frontal
sinus can enter the maxillary sinus.
The conchae have been removed, showing the various openings on the
lateral wall of the nasal cavity.
Clinical Relevance – Transsphenoidal Surgery
• The sphenoid bone shares a close anatomical relationship with the pituitary gland.
• Indeed, the pituitary can be accessed surgically by passing instruments through the
sphenoid bone and sinus.
• This type of surgery is known as endoscopic trans-sphenoidal surgery (ETSS), and is

the usual treatment of choice for pituitary adenomas.
• It allows for the surgical management of pituitary pathology without the need for a
more extensive craniotomy.
The transsphenoidal approach to pituitary surgery.
Sinusitis
• As the paranasal sinuses are continuous with the nasal cavity, an upper respiratory
tract infection can spread to the sinuses.
• Infection of the sinuses causes inflammation (particularly pain and swelling) of the
mucosa, and is known as sinusitis.
• If more than one sinus is affected, it is called pansinusitis.
• The maxillary nerve supplies both the maxillary sinus and maxillary teeth, and so
inflammation of that sinus can present with toothache.

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NASAL CAVITY & PARANASAL AIR SINUSES

MISS UMEANO, A.V

• The nose is an olfactory and respiratory organ.

• It consists of nasal skeleton, which houses the nasal cavity.

• The nasal cavity has four functions, They are;

 Warm and humidify the inspired air.

 Vestibule – the area surrounding the anterior

 Respiratory region – lined by a ciliated

Sagittal section of the nasal cavity.

• There are three conchae – inferior, middle

 Inferior meatus – between the inferior

• The function of the conchae is to increase

 Nasolacrimal duct – acts to drain tears

 Auditory (Eustachian) tube – opens

showing the various openings on the lateral wall of

 These ethmoidal arteries are branch of the ophthalmic artery.

• In addition to the rich blood supply, these

• The cause can be local (such as trauma), or systemic (such as hypertension).

• It is either fractured directly by the trauma, or by fragments of the ethmoid bone.

• Each sinus is lined by a ciliated pseudostratified epithelium, interspersed with mucus-

• Lightening the weight of the head

• Supporting immune defence of the nasal cavity

• Humidifying inspired air

• Increasing resonance of the voice

• Drainage is via the frontonasal duct.

• Sensation is supplied by the supraorbital nerve (a branch of the ophthalmic nerve),

• This type of surgery is known as endoscopic trans-sphenoidal surgery (ETSS), and is

• If more than one sinus is affected, it is called pansinusitis.

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