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02 The Nose and The Associated Structures

The nose has several important functions including smell, breathing, filtering air, and draining secretions. It is divided into an external nose and nasal cavities. The nasal cavities contain structures like the nasal septum, nasal conchae, and paranasal sinuses. The nose has blood supply from several arteries and drains into veins. It is innervated by nerves that provide sensation. Common clinical issues involving the nose include nasal fractures, sinusitis, and epistaxis.

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68 views72 pages

02 The Nose and The Associated Structures

The nose has several important functions including smell, breathing, filtering air, and draining secretions. It is divided into an external nose and nasal cavities. The nasal cavities contain structures like the nasal septum, nasal conchae, and paranasal sinuses. The nose has blood supply from several arteries and drains into veins. It is innervated by nerves that provide sensation. Common clinical issues involving the nose include nasal fractures, sinusitis, and epistaxis.

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malaths757
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We take content rights seriously. If you suspect this is your content, claim it here.
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NOSE

Functions of the nose and the nasal cavities are,

• Olfaction (sense of smell)


• Respiration
• Filtration of the dust in the inspired air (vibrissae)
• Humidification and warming of the inspired air
• Reception of the secretions from the paranasal
sinuses and nasolacrimal ducts
Nose is divisible into two parts

• External nose
• Nasal cavity
EXTERNAL NOSE

– Dorsum
– Root
– Apex
– Nares (nostrils, anterior nasal apertures)
– Alae of the nose
External nose has bony and cartilaginous parts

Bones contributing to the structure of the external


nose
– Nasal bones
– Frontal process of maxilla
– Nasal part of frontal bone
External nose has bony and cartilaginous parts

Bones contributing to the structure of the external nose


– Nasal bones
– Frontal process of maxilla
– Nasal part of frontal bone

Cartilages contributing to the structure of the external nose


– Lateral cartilages (paired)
– Alar cartilages (paired)
– Septal cartilage (single)
NASAL CAVITIES

• Nasal septum separates the right and left nasal


cavities

• Nasal septum is composed of three structures:


– Perpendicular plate of the ethmoid bone
– Vomer
– Septal cartilage
CLINICAL NOTE

Nasal fractures

• Due to its prominence, the nasal fractures are common

• Usually nasal deformity is visible and epistaxis occurs

• Severe direct trauma may lead to the fracture of the


cribriform plate of the ethmoid bone
– If there is a tear of the cerebral meninges, cerebrospinal fluid
rhinorrhea may be observed
– May lead to anosmia due to damage to the olfactory nerves
CLINICAL NOTE

Deviation of the nasal septum

• May be due to birth injury or trauma in any age

• Common cause of sinusitis due insufficient


ventilation and drainage of the sinuses

• Can be surgically repaired


Each nasal cavity is divided into

– Olfactory area (upper 1/3)


– Respiratory area (lover 2/3)
Posteriorly, nasal cavities communicate with the
nasopharynx through two openings called choana
Each choana is bordered by,

• Vomer (medial)
• Medial lamina of the pterygoid process of the
sphenoid bone (lateral)
• Horizontal plate of the palatine bone (inferior)
• Body of sphenoid bone (superior)
Walls of the nasal cavity
• Roof
Anterior to posterior
– nasal bone
– frontal bone
– cribriform plate of the ethmoid bone
– body of the sphenoid bone

• Floor
Floor is formed by the hard palate
– Palatine process of maxilla
– horizontal plate of the palatine bone.
Walls of the nasal cavity (continued)

• Lateral
Anterior to posterior
– frontal process of maxilla
– lacrimal bone
– superior nasal concha (of the ethmoid bone), middle nasal
concha (of the ethmoid bone), inferior nasal concha
– perpendicular plate of the palatine bone
– medial lamina of the pterygoid process.

• Medial
– Formed by the nasal septum
The medial wall has a smooth surface, whereas the
lateral wall is uneven due to the existance of the
nasal conchae

– The spaces between the nasal conchae and the lateral wall
of the nasal cavity are called the meatus.
• Superior nasal meatus
• Middle nasal meatus
• Inferior nasal meatus
• Middle nasal meatus is antero-superiorly continuous
with the opening named ethmoidal infundibulum which
is continuous with the semilunar hiatus.
– Frontal sinus opens into the semilunar hiatus
– Maxillary sinus opens into the posterior end of the semilunar
hiatus

• Superior to the semilunar hiatus lies the ethmoid bulla


which contains the middle ethmoid air cells.
• Posterior ethmoid air cells open into the superior nasal
meatus

• Sphenoid sinus opens into the sphenoethmoid recess


Arterial supply of the nose

– Sphenopalatine artery (from maxillary)


– Anterior and posterior ethmoid arteries (from ophthalmic)
– Greater palatine artery (from descending palatine)
– Superior labial artery (from facial)
– Lateral nasal artery (from facial)
• Kiesselbach’s area

– Lies on the anterior part of each side of the nasal septum


– This area is rich in capillaries
– Here, all five arteries supplying the nose constitute an
extensive network of anastomoses
– This area is often where profuse bleeding from the nose
occurs
Veins of the nose
• There is a rich network of veins deep to the mucosa
of the nose
– This venous network is important in warming the air
before it enters the trachea and the lungs

• Veins drain into


– Sphenopalatine vein
– Facial vein
– Ophthalmic vein
Nerves of the nose

– Nasopalatine nerve (from maxillary nerve)


– Greater palatine nerve (from maxillary through the
pterygopalatine ganglion)

– Anterior and posterior ethmoidal nerves (brs of


nasociliary nerve of the ophthalmic nerve-V1)
Nerves of the nose (continued)

• Within the epithelium of the olfactory region lies the


olfactory cells (neurons)
• The peripheral processes of these cells terminate
under the mucosa and are sensitive to odour
molecules in the air
• Central processes forms the olfactory nerves (CN I)
• Olfactory nerves pass through the cribriform plate of
the ethmoid bone to reac to the olfactory bulb
CLINICAL NOTE

Rhinitis

• Swelling and inflamation of the mucosa due to the upper


respiratory tract infections or allergic reactions.

• Infections may spread to


– Paranasal sinuses
– Middle ear through the pharyngotympanic tube
– Nasopharynx
– Lacrimal apparatus and conjunctiva
– Anterior cranial fossa through the cribriform plate
CLINICAL NOTE

Epistaxis
• Bleeding of the nose is called epistaxis
• Is common due to the rich blood supply of the mucosa
• The bleeding usually occurs at the Kisselbach’s area (anterior
part of the nasal septum).
• May be due to trauma, hypertension or infections
• Mild epistaxis is often due to the tearing of the veins, while
profuse bleeding may occur as a result of rupture of the
arteries
PARANASAL SINUSES
• Air filled spaces lying within the bones around the
nasal cavity.
• The inner surface of the sinuses is covered by the
mucosa.
• They are named according to the bones they are
located in.
• Frontal sinuses
• Ethmoid sinuses
• Sphenoid sinuses
• Maxillary sinuses
Frontal sinus

• Lie within the inner an outer plates of the frontal bone,


posterior to the supercilliary arches and the root of the nose.

• The opening of the sinus is called the frontonasal duct.

• Drains into the middle meatus through the semilunar hiatus.

• Blood supply comes from the ophthalmic artery.

• Venous drainage is into the ophthalmic and supraorbital


veins.

• Innervation is through the ophthalmic nerve (V1).


Ethmoid sinuses

• Several ethmoid air cells (3-15) collectively are called


the ethmoid sinuses.

• Ethmoid air cells form three groups:


– Anterior group ------ opens into the middle meatus
– Middle group ---------- opens into the middle meatus
– Posterior group -------- opens into the superior meatus
Ethmoid sinuses (continued)

• Blood supply is from the maxillary and ophthalmic arteries.


• Veins drain into the sphenopalatine, ant. and post. ethmoidal
veins.
• Innervated by the ophthalmic nerve.
Sphenoid sinus

• Situated within the body of the sphenoid bone


• Sinuses of each side is seperated by a bony septum
• Drains into the sphenoethmoidal recess
• Blood supply is from the ophthalmic arteries
• Veins drain into the post. ethmoidal veins
• Innervated by the ophthalmic nerve
Maxillary sinus

• Lies within the body of the maxilla


• Maxillary opening drains into the middle meatus
through the semilunar hiatus
• Arterial supply is from the branches of the maxillary
artery
• Veis drain into the facial, infraorbital an the greater
palatine veins
• Innervated by the maxillary nerve
CLINICAL NOTE
Sinusitis
• Infection from the nasal cavity may easily spread to
the sinuses
• Resulting inflamation and swelling of the mucosa of
the sinus(es) may lead to local pain
• Swelling may block the opening of sinus and
obstruct the drainage
CLINICAL NOTE
Maxillary sinusitis
• Maxillary sinuses are the most commonly infected
sinuses
• Due to the edema, its opening may be obstructed
• The close relation of the maxillary molar teeth with
the maxillary sinuses may cause problems during the
removal of a molar tooth
– Due to its thin wall, a broken root may be forced into the
maxillary sinus

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