Transcript Nasal Cavity

Nasal Cavity and
Pterygopalatine Fossa
R. Shane Tubbs, MS, PA-C, PhD
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Five major cartilages
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Piriform aperture
Anterior nasal spine
Nasal septum
Nasal bones
Nasal Cavity: Borders
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Roof: frontal,
ethmoid
(cribriform),
sphenoid, nasal
bones
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Floor: maxillary
and palatine
bones
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Medial: nasal
septum
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Lateral: nasal
conchae,
lacrimal,
maxillary,
palatine bones
Nasal Septum
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Perpendicular plate
Septal cartilage
Vomer
Medial crus of > alar
cartilage
Nasal crests of
maxillary, palatine,
and sphenoid bones
Nasal spine of frontal
bone
Vomeronasal Cartilage
Along inferior border
of septal cartilage
 Rudimentary in man
 Vomeronasal nerve of
Jacobson in lower
animals- pheromones
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Features
Bulla (bubble)
 Nasofrontal duct
 Uncinate process
 Semilunar hiatus
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Valve of Hasner
(Czech
Ophthalmologist
1819-1892)
 Iatrogenic closure
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Features
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Vestibule: skin/vibrissae,
sweat and sebaceous
glands
Upper 1/3
Lower 2/3
Limen (entrance) nasi
(lateral nasal cartilage)
Agger (mound) nasi
(ethmoid air cells)
Olfactory Nerves
~ 20 pairs
 Most commonly injured cranial nerve
 CSF rhinorrhea
 Do not regenerate in elderly
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Arterial Supply
Sphenopalatine
 Anterior ethmoidal
 Posterior ethmoidal
 Greater palatine
 Superior labial and lateral nasal branch of
facial
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Plexus Cavernosi Concharum
Nasal Veins/Lymphatics
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Veins: Drain via sphenopalatine foramen
into pterygoid plexus and some via
ethmoidal foramina to superior ophthalmic
vein
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Lymphatics: Majority join pharyngeal
plexus and thus drain into retropharyngeal
nodes
Paranasal Air Sinuses
Paranasal Air Sinuses
Function
 Named for the bones they occupy
 Paired
 Surrounded by diploic space of contiguous
bones
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Frontal Sinus
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Frontonasal ductsemilunar hiatus
Innervation:
supraorbital n.
Variation
Acromegaly
Eskimos
Related to anterior
cranial fossa
Tubbs et al. J
Neurosurgery, 2002
Ethmoid Sinus (3-18 pairs)
Named on the basis of their
openings
anterior: semilunar hiatus
middle: ethmoidal bulla or
directly into middle meatus
posterior: superior meatus
Innervation: anterior and
posterior ethmoidal nerves
and branches of
pterygopalatine ganglion
Sphenoid Sinus
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Sphenoethmoidal recess
Most variable cavity in the
body!
15% of all cases of
sinusitis
Ostium is 1.5 cm superior
to its floor
Innervation: Posterior
ethmoidal nerve and
branches of
pterygopalatine ganglion
Related to middle cranial
fossa
Maxillary Sinus
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Maxillary: semilunar
hiatus
Innervation: ant,
middle, posterior
superior alveolar
nerves, infraorbital
(V2)
Most commonly
infected sinus
Drains superiorly as
does sphenoid sinus
Antrum of Highmore (British
surgeon 1613-1685)
Pterygopalatine Fossa
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“A pyramidal space inferior to the apex of the orbit
and lateral to the nasal cavity”
~ 2 x 1 cm
Arteries: post sup alveolar, descending palatine,
pterygoid canal, pharyngeal, sphenopalatine
Maxillary nerve
Nerve of pterygoid canal (Vidian)
Pterygopalatine ganglion (posterior to middle
nasal concha)
Pterygopalatine nerves
Four canals: Vidian, vomerovaginal,
palatovaginal, greater palatine canal
 Two foramina: rotundum, sphenopalatine
 Two fissures: inferior orbital,
pterygomaxillary
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Pterygopalatine Fossa
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Lateral: pterygomaxillary fissure
Medial: perpendicular plate of palatine with
sphenopalatine foramen
Posterior: Pterygoid process with Vidian canal,
rotundum
Anterior: maxillae with inferior orbital fissure,
posterior superior alveolar foramen (lateral)
Roof: > wing sphenoid, superior orbital fissure
Inferior: pyramidal process, palatine canal (oral
cavity)
Pterygopalatine Ganglion
Parasympathetic root
 Sympathetic root
 Sensory root
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Distribution of Pterygopalatine
Ganglion
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Sphenoid sinus (pharyngeal
branch)
Posterior ethmoid cells
Nose
Hard and soft palate
Inner gingivae of maxillary
teeth
Palatine tonsil
Choana
Uppermost pharynx
Orbit
Vidian Nerve Course
Sluder’s neuralgia (pterygopalatine
neuralgia) excessive tearing, cluster HA
 Vidian neurectomy
 Crocodile tears
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