Nose and pns 25.04.16 dr.sithandandhakumar
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Transcript of Nose and pns 25.04.16 dr.sithandandhakumar
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ANATOMY OF NOSE&
PARANASAL SINUS
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Objectives Anatomy of external nose & osseocartilaginous framework
Anatomy of septum & lateral nasal wall
Anatomy of paranasal sinuses
Functions of nose & paranasal sinuses
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External nose Pyramidal in shape
Root up and the base directed downwards
Bony part
Cartilaginous part-upper lateral cartilage lower lateral ( alar ) cartilage sesamoid cartilages septal cartilage
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Internal nose Nasal septum divides the internal nose into right and left nasal
cavities
Communicate with the exterior through anterior nares (nostrils)
Communicate posteriorly with the nasopharynx through choanae
Anterior and inferior skin-lined portion – vestibule
Posterior mucosa-lined portion - nasal cavity proper
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Nasal valve Laterally by the lower border of upper lateral cartilage
and fibro fatty tissue & anterior end of inferior turbinate
Medially by the cartilaginous nasal septum
Caudally by the floor of pyriform aperture
Area of maximum airflow resistance in the nasal cavity
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Nasal septum Columellar septum
Membranous septum
Septum proper-perpendicular plate of ethmoid -vomer - quadrangular cartilage
Other bones make very small contributions, include crest of nasal bones, crests of palatine and maxilla nasal spine of frontal bone ,the anterior nasal spine of maxillarostrum of sphenoid, and
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Lateral nasal valve
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Ostiomeatal complex
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Blood supply of nose
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Nerve supply
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Paranasal sinuses Anterior group
Posterior group
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Maxillary sinus(Antrum of Highmore)
first to develop in human fetus
Largest paranasal sinus (15 ml capacity in adult)
It occupies the body of maxilla
Pyramidal shape. The base faces towards lateral wall of nose and apex is directed laterally into the zygomatic process
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FRONTAL SINUS Situated above and deep to the supraorbital margin
It lies between the inner and outer tables of the lower part of frontal bone
Ostium of frontal sinus is situated in its floor and opens into the frontal recess
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ETHMOID SINUS Thin walled air cavities in lateral masses of ethmoid bone.
They vary in number (3–18)
Lie between upper third of lateral nasal wall and the medial wall of orbit
Clinically they are divided into two groups: anterior and posterior
Anterior ethmoid group opens into the middle meatus
Posterior ethmoid group opens into the superior meatus and some in sphen oethmoidal recess
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Sphenoid sinus Two sphenoid sinuses, one on each side are rarely symmetrical
They occupy body of sphenoid bone
Are separated by a thin bony septum, which is usually obliquely situated
The ostium, which is situated in the upper part of anterior wall, drains into spheno ethmoidal recess
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Agger nasi cells: These are most anterior of anterior ethmoid cells and lie in close proximity of frontal recess
They are situated just anterior to anterosuperior attachment of middle turbinate
Ground (Basal) lamella: This bony insertion of middle turbinate into the skull base and lateral nasal wall separates anterior from posterior ethmoid cells
Ground lamella can be divided into three parts Anterior one-third inserts into lamina cribrosamiddle one-third (oblique anterosuperior to postero inferior course) into lamina papyracea posterior one-third horizontal part inserts into lateral nasal wall
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Haller cells: These ethmoid cells extend into the roof of maxillary sinus in the region of maxillary sinus ostium
Onodi cells: These are posterior ethmoid cells and extend either laterally or superiorly along the sphenoid sinus
The optic nerve can lie within them
Onodi cells must be recognized during the endoscopic sinus surgery on posterior ethmoid to avoid optic nerve injury.
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FUNCTIONS OF PARANASAL SINUSES RESPIRATION
OLFACTION
PROTECTION OF LOWER AIRWAYS
VOCAL RESONANCE
HUMIDIFICATION OF AIR