Nose and paranasal sinuses extra shortened Dr. lama khaled El Banna Faculty of Oral and Dental Medicine Al – Azhar University

1. Nose and paranasal sinuses
Ehab ZAYYAN, MD, PhD

2. Temporal fossa

3. Infratemporal fossa

4. Pterygopalatine fossa
A small space behind and below the orbital
cavity
• Pterygomaxillary fissure → infratemporal
fossa (laterally)
• Sphenoplatine foramen → nasal cavity
(medially)
• Foramen rotundum → skull (superiorly)
• Inferior orbital fissure → orbit (anteriorly)

7. Pterygopalatine fossa

8. Pterygopalatine fossa

11. Maxillary nerve (V2)
• Trigeminal ganglion
• Passes in the lateral wall of the cavernous sinus
• Leaves the skull through foramen rotundum to
enter the pterygopalatine fossa
• Enters the orbit by the inferior orbital fissure to
become the infraorbital nerve
→ infraorbital groove → infraorbital canal →
infraorbital foramen

14. Pterygopalatine Ganglion
• A parasympathetic ganglion
• Placed in the PPF
• Preganglionic secretomotor fibers:
Superior salivatory nucleus of the facial
nerve → sensory root of the facial nerve
→ GSPN → joined by the deep petrosal
nerve to form the nerve of the pterygoid
canal (Vidian nerve) → ganglion

16. Pterygopalatine Ganglion
• Postganglionic fibers:
1. Reach the maxillary nerve by its
ganglionic branches → zygomatic nerve
→ zygomaticotemporal nerve → lacrimal
nerve → lacrimal gland
2. Greater and lesser palatinal nerves to the
palatine glands
3. Nasal nerves to nasal glands
4. Pharyngeal branch to the nasopharynx

18. • Sympathetic preganglionic fibers reach
the ganglion via the ICA plexus → deep
petrosal nerve → vidian nerve
• They pass without interruption through the
ganglion and emerge in the orbital
branches.

20. External nose
• Root and tip
• Nostrils (nares): are the external orifices of
the nose. Bounded laterally by the ala and
medially by the nasal septum
Nasal skeleton:
• Nasalis bones
• Frontal processes of the maxillae
• Nasal part of the frontal bone
• Upper and lower nasal cartilages
• Septal cartilage

24. Nasal cavity
• From the nostrils till the choana
• Divided into right and left by the nasal
septum
• Floor: palatine process of the maxilla and
horisontal plates of the palatine bones
• Roof: body of the sphenoid, cribriform
plate of the ethmoid, frontal bone, nasal
bone, nasal cartilages

26. Lateral nasal wall
• Superior, middle and inferior
conchae. The area below each
concha is called meatus

27. Meatus Sinuses
Superior meatus Sphenoid sinus
Posterior ethmoid cells
Middle meatus Frontal sinus
Maxillary sinus
Anterior ethmoid cells
Inferior meatus Nasolacrimal duct

33. Nasolacrimal duct

35. • Within the nostril in front of the atrium is
the vestibule. It is lined by modified skin
and short curved hair called the vibrissae

38. MEDIAL NASAL WALL

39. Medial nasal wall

40. • The mucous membrane lines the nasal
cavity except the vestibule. There are two
types of mucous membranes:
1. Olfactory mucosa
2. Respiratory mucosa

41. 1. olfactory mucous membrane: lines the
superior surface of the superior concha and the
sphenoethmoidal recess. It also lines the
corresponding part of the nasal septum

42. • The axons of the fibers pass through the
openings in the cribriform plates of the ethmoid
bone and end in the olfactory bulb

43. 2. The respiratory mucous membrane:
• Lines the rest of the nasal cavity.
• Its function is to warm, moisten and clean
the inspired air.
• Warming: venous plaxus in the
submucosa
• Moisture: mucous by the glands and
goblet cells
• Ciliary action….

44. Nerve supply of the nasal cavity
• The olfactory nerve: arise from special
olfactory cells in the olfactory mucous
membrane
• Nerves of general sensation: derived
from opthalmic and maxillary divisions of
the trigeminal nerve:

48. Sympathetic innervation:
• T1-T3 → SCSG → ICA plexus → deep
petrosal nerve → vidian nerve → PPG
Parasympathetic innervation:
• Superior salivatory nucleus → facial nerve
→ GSPN → vidian nerve → PPG → nasal
branches through the sphenopalatine
foramen

50. Blood supply of the nasal cavity
ECA
1. Sphenopalatine artery (maxillary artery)
2. Greater palatinal artery branch in the incisive
canal (maxillary artery)
3. Superior labial branch of the facial artery
ICA
4. Anterior ethmoid artery (ophthalmic artery)
5. Posterior ethmoid artery (ophthalmic artery)

51. Third part of the maxillary artery in
the PPF

54. Kiesselbach area (Little area) of the
nasal septum
• The area of the septum about 1 cm
posterior to the nares. It is very rich in
blood supply and a common site of
epistaxis.
1. Anterior ethmoid artery
2. Sphenopalatine artery
3. Greater palatinal artery
4. Septal branch of facial artery

56. Paranasal sinuses
• Cavities found in the interior of the maxilla,
frontal,sphenoid and ethmoid bones.
• Lined with mucoperiostium and filled with
air.
• The mucous produced by the glands in the
mucous membranes is moved into the
nose by the ciliary action of the columnar
cells.
• The function of the sinuses is to act as
resonators of the voice and to reduce the

57. Paranasal sinuses

68. Osteomeatal complex
• The most commonly
infected structure in the
sinuses
• Can be obstructed and
inflammed easily with even
minimal edema
• Can not be examined by
anterior rhinoscopy but
with endoscopy
• Can not be evaluated by
conventional radiology but
needs CT

69. Anatomic variations
Foreign body
Mucociliary dysfunction
Allergy
Infections
Local inflammation
↓
Obstruction of the osteomeatal complex
↓
Sinusitis