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Pasha Chapter 1 - Rhinology and Paranasal Sinuses > Anatomy of the Nose and Paranasal Sinuses > Flashcards

Anatomy of the Nose and Paranasal Sinuses Flashcards

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1
Q

Turbinates (Conchae)

A

Inferior, middle, superior, supreme
Covered by erectile mucosa
Increases interior surface area
Warms, moisturizes and filters airflow

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2
Q

Superior Meatus

A

Area under superior turbinate

Drainage pathway of sphenoid and posterior ethmoid sinuses

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3
Q

Middle Meatus

A

Area underneath middle turbinate

Drainage pathway of the frontal, anterior ethmoid and maxillary sinuses

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4
Q

Inferior Meatus

A

Area underneath the inferior turbinate

Contains orifice of nasolacrimal duct

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5
Q

Uncinate Process

A

Sickle-shaped bone covered by mucoperiosteum
Part of the ethmoid bone
Anteriorly attaches to lacrimal bone
Inferiorly attaches to inferior turbinate
Superiorly attaches to lamina papyracea (80%), skull base or middle turbinate

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6
Q

Ethmoid Infundibulum

A

Pyramidal space
Houses the drainage pathways of maxillary, anterior ethmoid and frontal sinuses
Seems synonymous with OMC from this description

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7
Q

Recess Terminalis

A

When the uncinate inserts superiorly into the lamina papyracea, a blind pouch in the infundibulum is formed. This is the name of that pouch

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8
Q

Semilunar Hiatus

A

Gap emptying the ethmoid infundibulum

Between uncinate process and ethmoid bulla

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9
Q

Sphenopalatine Foramen

A

Posterior to the inferior attachment of the middle turbinate

Contains SPA, sensory nerve fibers, secretomotor fibers (parasympathetics from vidian nerve to pterygopalatine ganglion)

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10
Q

Concha Bullosa

A 
Pneumatized turbinate (middle turb most common)
May obstruct nasal cavity or OMC
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11
Q

Paradoxical Middle Turbinate

A

Middle turbinate that “turns” medially instead of laterally

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12
Q

Ostiomeatal Complex (OMC)

A

Region of the anterior ethmoids that contains the ostia of maxillary, frontal and ethmoid sinuses, lateral to the middle turbinate

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13
Q

Nasal Fontanelles

A

Areas of lateral nasal wall where no bone exists
Located above the insertion of the inferior turbinate
May be the site of the accessory maxillary ostia

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14
Q

Draw the anatomy of the lateral nasal wall including vascular supply

A

See Page 3 of Pasha to confirm

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15
Q

Nasolacrimal Duct and Sac

A

Duct lateral to anterior uncinate process
Sac lateral to agger nasi
Sac opens into inferior meatus via Hasner’s valve

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16
Q

Where is Hasner’s Valve

A

Inferior meatus

3 - 6mm anterior to level of maxillary sinus ostium

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17
Q

When does the Frontal Sinus develop?

A

Last sinus to develop

Does not pneumatize until 5 - 6 years old

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18
Q

Volume of an adult Frontal Sinus

A

4 - 7 mL by age 12 - 20 years old

5 - 10% will be aplastic/hypoplastic

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19
Q

Drainage of Frontal Sinus

A

Frontal Recess
Drains into anterior middle meatus
Most commonly medial to uncinate (when uncinate attaches superiorly to skull base or middle turb)

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20
Q

Vasculature in Frontal Sinus

A

Supraorbital Artery
Anterior Ethmoid Artery
Ophthalmic Vein (to Cavernous Sinus)
Supraorbital Vein (to anterior facial veins)

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21
Q

Innervation of Frontal Sinus

A

Supraorbital Nerve (V1)

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22
Q

Frontal Recess

A 
Drainage between the frontal sinus and semilunar hiatus/middle meatus
Boundaries:
Posterior wall of agger nasi
Lamina papyracea
Middle Turbinate
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23
Q

Frontal Sinus Infundibulum

A

Space that drains into frontal recess

Superior to agger nasi

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24
Q

Foramina of Breschet

A

Small venules that drain sinus mucosa into dural veins

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25
Frontal Cells
Anterior ethmoid cells that pneumatize frontal recess May cause obstruction or pesistent disease Posterior to agger nasi 4 Types
26
Type I Frontal Cell
Single cell above agger nasi | Below floor of frontal sinus (infundibulum)
27
Type II Frontal Cell
Multiple Cells above agger nasi | May extend into the frontal sinus proper
28
Type III Frontal Cell
Single large cell that extends supraorbitally through the floor of the frontal sinus Attaches to the anterior table
29
Type IV Frontal Cell
Single isolated cell that is within the frontal sinus
30
When does the Maxillary Sinus Develop?
First do develop Biphasic growth: Age 3 Age 7 - 18
31
Volume of Adult Maxillary Sinuses
15mL | Largest paranasal sinus
32
Drainage of Maxillary Sinus
``` Ethmoid infundibulum (Middle meatus) 10 - 30% have accessory ostium ```
33
Vasculature of Maxillary Sinus
Branches of the maxillary artery | Corresponding veins to facial vein/pterygoid plexus
34
Innervation of Maxillary Sinus
Branches of Maxillary Nerve (V2)
35
Structures Adjacent to Maxillary Sinus
Lateral nasal wall Alveolar process of maxilla (contains second bicuspid and first and second molars) Orbital floor Posterior maxillary wall (contains pterygopalatine fossa housing maxillary artery, pterygopalatine ganglion, branches of V2)
36
When do the Ethmoid Sinuses develop?
3 - 4 cells present at birth Most developed paranasal sinus at birth) Formed from 5 ethmoturbinals Reach adult size by age 12 - 15 years old
37
Derivatives of First Ethmoturbinal
Agger Nasi | Uncinate
38
Derivative of Second Ethmoturbinal
Middle Turbinate
39
Derivative of Third Ethmoturbinal
Superior Turbinate
40
Derivative of Fourth - Fifth Ethmoturbinals
Supreme Turbinate
41
Volume of adult ethmoid sinuses
2 - 3 mL | Distributed among 10 - 15 aerated cells
42
Drainage of Ethmoid Sinuses
Anterior Cells: Into ethmoid infundibulum | Posterior Cells: Into superior meatus
43
Vasculature of the ethmoid sinuses
``` Anterior ethmoid artery Posterior ethmoid artery (from ophthalmic) Branches of SPA Maxillary veins Ethmoid veins (to cavernous sinus) ```
44
Distance relationship of anterior lacrimal crest, anterior/posterior ethmoid arteries and optic foramen
24/12/6 rule Anterior Lacrimal Crest to AEA: 24mm AEA to PEA: 12mm PEA to Optic Foramen: 6mm
45
Innervation of ethmoid sinuses
Anterior ethmoidal nerve Posterior ethmoidal nerve From nasociliary nerve (V1)
46
Structures adjacent to the ethmoid sinuses
Skull base Anterior ethmoidal artery (roof or anterior ethmoid cells) Nasal Cavity Orbit
47
Agger Nasi Cells
Most anterior or anterior ethmoid cells Found anterior and superior to middle turbinate attachment to lateral nasal wall Posterior wall of the agger nasi forms anterior wall of the frontal recess
48
Ethmoid Bulla
Largest of the anterior ethmoid cells Lies above the infundibulum Anterior ethmoid artery courses superior and posterior to this cell
49
Basal Lamella
Bony attachment of the middle turbinate to the lateral nasal wall Separates anterior and posterior ethmoids Anterior part inserts vertically into crista ethmoidalis Middle part inserts obliquely into lamina papyracea Posterior third attaches to the lamina horizontally
50
Onodi Cells
Ethmoid cells that pneumatize lateral or posterior to anterior wall of the sphenoid Commonly mistaken as sphenoid cells Optic nerve or carotid artery may indent into lateral wall
51
Haller Cells
Ethmoid cells that extend into the maxillary sinus above the ostium Pneumatize medial and inferior orbital walls
52
Lamina Papyracea
Lateral thin bony wall of ethmoid sinus Separates orbit from ethmoid cells Part of the medial orbital wall
53
Fovea Ethmoidalis
Roof of ethmoid sinus
54
Supraorbital Cell
Pneumatization of posterior orbital plate of the frontal bone Often forms septations in the frontal recess
55
Olfactory Fossa
Depression in anterior cranial cavity Floor formed by cribriform plate Olfactory cleft lies below
56
Keros Classification
Relationship between olfactory fossa and ethmoid roof (how deep is lateral lamella) Type 1: 1 - 3mm Type 2: 4 - 7mm Type 3: 8 - 16mm
57
Lamellae of Ethmoid Bone
1 - Uncinate Process 2 - Bulla Ethmoidalis 3 - Basal Lamella of Middle Turbinate 4 - Lamella of Superior Turbinate
58
Embryology of Sphenoid Sinus
Evagination of nasal mucosa into sphenoid bone | Reaches adult size at 12 - 18 years old
59
Volume of an adult sphenoid sinus
0.5 - 8 mL
60
Drainage of Sphenoid Sinus
Sphenoethmoidal Recess (SER)
61
Vasculature of the Sphenoid Sinus
Posterior Ethmoidal Artery Sphenopalatine Artery Maxillary Vein (to Pterygoid Plexus)
62
Innervation of Sphenoid Sinus
Posterior Ethmoidal Nerves (V1)
63
Structures adjacent to the sphenoid sinus
``` Pons Sella Turcica (and therefore Pituitary) Carotid Artery (Lateral wall, 25% dehiscent) Optic Nerve (Lateral wall, 5% dehiscent) Cavernous Sinus (laterally) V1, V2 Clivus Septal branch of the SPA (inferior aspect of the sphenoid os) ```
64
Piriform Aperture
Bony anterior opening to nasal cavity Bounded inferolaterally by maxilla Bounded superiorly by nasal bones
65
Upper Lateral Cartilage
Paired cartilage supporting nasal sidewall | Inferior to nasal bone
66
Lower Lateral Cartilage
Paired cartilage forming the alae Inferior to the lower lateral cartilage Composed of lateral and medial crura
67
Lesser Alar Cartilage
Also called sesamoid cartilages? | Small cartilaginous plates lateral to the lower lateral cartilages
68
Muscles attached to the external nose
``` Procerus Nasalis Dilator naris anterior Depressor septi Levator labii superioris alaeque nasi All innervated by VII ```
69
Components of Nasal Septum
Quadrangular Cartilage Perpendicular plate of the Ethmoid bone Vomer Nasal Crest (Maxillary and Palatine Bones) Anterior Nasal Spine (Bony projection anterior to piriform aperture)
70
Blood Supply to Nasal Septum
``` Anterior Ethmoid Artery Posterior Ethmoid Artery Sphenopalatine Artery Greater Palatine Artery Superior Labial Artery ```
71
Nasal Vestibule
Just inside the naris Anterior to the limen nasi (ridge that marks beginning of nasal cavity) Lined by keratinized stratified squamous epithelium Contains coarse hair-bearing skin inferiorly
72
Roof of Nasal Cavity
Bounded by nasal/frontal bone anteriorly | Bounded by cribriform plate and sphenoid face posteriorly
73
Floor of Nasal Cavity
Formed by palatine process of maxilla and horizontal plate of palatine bone Communicates with piriform aperture anteriorly Communicates with choana posteriorly
74
Sensory innervation to external nose
Nasal Dorsum: Supratrochlear, infratrochlear nerves (V1) Nasal Tip: External branch of anterior ethmoid nerve (V1) Malar, lateral nose, subnasal regions: Infraorbital nerve (V2)
75
Sensory innervation to Nasal Cavity
Anterosuperior Nasal Cavity: Internal nasal branch of anterior ethmoid nerve (V1) Posterosuperior Nasal Cavity: Posterior ethmoid nerve (V1) Posterior and Inferior Septum: Nasopalatine Nerve (V2) Posterior lateral wall, floor and roof: Greater Palatine Nerve (V1) Anterior septum, floor, lateral wall: Superior Alveolar Nerve (V2)
76
Branches of External Carotid Supplying the Nose
iMax > Descending Palatine Artery > Greater Palatine and lesser Palatine Arteries iMax > Sphenopalatine Artery > Medial (Nasoseptal) and Lateral nasal arteries Facial > Superior labial artery (columella, nasal septum, alar branches) Facial > Lateral nasal artery Facial > Angular artery (nasal sidewall, tip, dorsum)
77
Branches of Internal Carotid Supplying the Nose
Ophthalmic > Anterior ethmoid artery (lateral nasal wall and septum) Ophthalmic > Posterior ethmoid artery (superior turbinate and septum) Ophthalmic > Dorsal nasal artery (external nose)
78
Venous Drainage of Nose
Greater Palatine Vein > Posterior Facial Vein (EJ) and Cavernous Sinus Septal Vein > Anterior Facial Vein (IJ) Sphenopalatine Vein > Cavernous Sinus and Maxillary Vein (IJ) Anterior and Posterior Ethmoidal Veins > Opthalmic Veins (Cavernous Sinus) Angular Vein > Anterior Facial Vein (IJ) or Ophthalmic Veins (Cavernous Sinus)
79
Danger Triangle
Bounded by oral commissures and nasal bridge | Retrograde drainage from superficial veins may lead to intracranial extension of infection
80
Lymphatic Drainage of the Nose
External: Primarily to Level IB, root of nose drains to superficial parotid nodes Internal: Anterior nasal cavity drains superficially, then to IB, remainder drains to retropharyngeal and upper cervical nodes
81
Nasal Cycle Overview
Airflow regulated by volume of venous sinusoids in nasal erectile tissue (inferior turb and anterior septum) Hypothalamus also stimulates sympathetic tone via superior cervical sympathetic ganglia for vasoconstriction
82
Nasal Flow Formula
Pressure/Resistance | Flow may be laminar or turbulent
83
Sneeze Pathway
Allergens, ammonia, viral infections, exercise or other irritants stimulate trigeminal afferents Complex efferent input triggers: Slow inspiratory phase, glottic and velopharyngeal closure (increase subglottic pressure), sudden glottic opening (sneeze)
84
Asymmetric Congestive Response (Nasal Cycle)
Normal physiologic congestion/decongestion cycle | Alternates between nasal sides every 2 - 7 hours
85
Symmetric Congestive Response
Temporary bilateral congestion Induced by exercise, changes in body position, hyperventilation, cold air, sulfur, histamine, other irritants Lasts 15 - 30 minutes
86
Role of microvasculature in nasal congestion
Regulates volume, humidity and heat exchange
87
Resistance Vessels of the Nasal Mucosa
Arterioles and precapillary sphincters | Regulate blood flow to the nasal mucosa
88
Subepithelial Capillaries of the Nasal Mucosa
Fenestrated vessels | Allow for transport of solutes and fluids
89
Venous sinusoids of the nasal mucosa
Capacitance vessels | Determine blood volume and nasal congestion
90
Arteriovenous Anastomoses of the Nasal Mucosa
Regulate nasal blood flow | Allow blood to flow directly from resistance vessels to venous sinusoids
91
Sympathetic Regulation of Nasal Microvasculature
Provides vasoconstrictor tone to arteries and capacitance veins Primarily via norepinephrine Also via Neuropeptide Y (weak vasoconstrictor, enhances function of norepinephrine) Lastly via Avian Pancreatic Polypeptide (APP)
92
Parasympathetic Regulation of Nasal Microvasculature
Controls secretions, dilates resistance vessels Primarily via Acetylcholine Also using Vasoactive Intestinal Peptide (VIP) Also using Peptide Histamine Isoleucine (PHI)
93
Function of Nasal Mucociliary System
Humidification Filtering Eliminating debris and excess secretions from sinuses and nasal airway
94
Pattern of Nasal Mucociliary Flow
1cm/minute | Migration begins at floor of maxillary sinus > Natural Ostium > Nasal Cavity > Nasopharynx
95
Components of Nasal Mucociliary System
Ciliated, Pseudostratified Columnar Epithelium Double-Layered Mucous Blanket Mucus-Producing Glands
96
Location of Ciliated, Pseudostratified Columnar Epithelium within the nasal cavity
Anterior border begins at limen nasi
97
Double-Layered Mucous Blanket in the Nose
Deep: Less viscous, serous periciliary fluid (sol phase) Superficial: More viscous, mucous fluid (gel phase)
98
Mucus-Producing Glands in the Nose
``` Goblet cells (Columnar, basal nucleus, secretory granules at lumen end) Deep and superficial seromucinous glands (serous or mucous acini with cuboidal-lined duct complexes) Intraeptihelial glands (20 - 50 mucous cells around a single duct) ```
99
Major Composition of Nasal Mucus
``` 95% water 3% glycoproteins (mucin) 2% salts IgA Lysozymes (bacteriolytic) Lactoferrin (bacteriostatic) ```

Pasha Chapter 1 - Rhinology and Paranasal Sinuses (1 decks)

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