NOSE

Nose and Paranasal Sinuses

  • Introduction to the anatomy and function of the nose and surrounding sinuses.

The Facial Skeleton

  • Importance of understanding the bony facial skeleton:

    • Critical in trauma management.

    • Assist in diagnosis and treatment of inflammatory diseases of the facial skeleton.

External Nose

  • Various structures defining the appearance:

    • Nasal bone

    • Lateral nasal cartilage

    • Frontal process of maxilla

    • Lateral crus of alar cartilage

    • Minor alar cartilage (accessory)

    • Medial crus of alar cartilage

    • Fatty tissue

Nasal Cavities

  • Components within the nasal cavities:

    • Nasal Vestibule

    • Nasal Septum

    • Nasal Valve

    • Lateral nasal wall

    • Choana

    • Medial crus of alar cartilage

Nasal Cavity

  • Cavity divided into right and left halves by nasal septum.

    • Opens anteriorly through nostrils (anterior nares)

    • Opens posteriorly into the nasopharynx (posterior nasal aperture)

Bony Skeleton of the Nose

  • Roof:

    • Anterior: Nasal part of the frontal bone + Nasal bone

    • Middle: Cribriform plate of the ethmoid bone

    • Posterior: Body of the sphenoid bone

  • Floor:

    • Anterior: Palatine process of the maxilla

    • Posterior: Horizontal plate of the palatine bone

  • Medial wall (nasal septum):

    • Postero-inferior: Vomer

    • Superiorly: Perpendicular plate of the ethmoid bone

    • Antero-inferior: Septal cartilage

Lateral Wall of the Nose

  • Divided into three areas: A. VestibuleB. Nasal conchae and meatuses: 1. Conchae covered with mucous membrane (superior, middle, inferior nasal conchae)2. Meatuses (depressions): superior, middle, inferior meatuses- Superior meatus receives posterior ethmoidal air sinus opening.

Nasal Drainage and Blood Supply

  • Arterial supply:

    1. Sphenopalatine artery (branch from maxillary artery)

    2. Septal branch of the superior labial artery (from facial artery)

    3. Ascending branch of the greater palatine artery (from maxillary artery)

    4. Anterior and posterior ethmoidal branches of the ophthalmic artery

  • Kieselbach's plexus: Common site for epistaxis (nosebleeds).

Nerve Supply

  • Innervation details:

    • Anterior ethmoidal nerve

    • Posterior ethmoidal nerve

    • Various branches from the ophthalmic and maxillary nerves

Paranasal Air Sinuses

  • Definition: Air-filled spaces surrounding nasal cavity; functions include warming, humidifying inspired air, reducing skull weight, adding voice resonance.

  • Types of sinuses:

    1. Maxillary sinus (inside maxilla)

    2. Frontal sinus (between frontal bone plates)

    3. Sphenoid sinus (inside sphenoid body)

    4. Ethmoid sinus (in lateral ethmoid bone)

Symptoms and Diagnosis of Nasal Conditions

  • Common complaints:

    1. Nasal obstruction

    2. Discharge

    3. Epistaxis

    4. Specific allergy history

    5. Headaches

    6. Olfactory dysfunction

    7. Facial pressure/pain

Clinical Examination Techniques

  • PCR: Anterior and posterior rhinoscopy

  • Nasal endoscopy: Main modern examination method for detailed assessment.

Imaging Techniques

  • Conventional radiographs

  • Computed Tomography (CT)

  • Magnetic Resonance Imaging (MRI)

  • Ultrasound

Tumors of the Nose and Sinuses

  • Benign tumors include inverted papilloma and osteomas.

  • Malignant tumors: predominantly epithelial (e.g., squamous cell carcinoma).

  • Symptoms of sinonasal tumors often manifest late; include obstructive symptoms and facial pain.

Malformations of the Nose

  • Conditions like choanal atresia & frontobasal dysraphias can impact airflow and develop secondary complications

  • Surgical interventions may be necessary for cases like choanal atresia to alleviate airway obstruction.