Transcript Nose and Paranasal Sinuses

Kristina Fatima Louise P. Garcia
Group 5A1




Develops as a diverticula of the lateral nasal wall
Extends to the maxilla, ethmoid, frontal and
sphenoid bones
Reach maximum size at puberty and contribute to
the definitive shape of the face
The maxillary sinus is the only sinus routinely
present at birth
Blood Supply: Paranasal Sinuses
Conchae, Meatus and
Septum 
sphenopalatine branch of
the internal maxillary
artery
Ethmoidal and Frontal
Sinuses and Roof of
the Nose  anterior and
posterior ethmoidal
branches of the
ophthalmic artery
Blood Supply: Paranasal Sinuses
Maxillary Sinus  a
branch of superior
labial artery;
infraorbital and
alveolar branches of
the internal maxillary
artery
Sphenoid Sinus 
pharyngeal branch of
the internal maxillary
artery
Nerve Supply
1. infraorbital nerve
2. posterior superior
alveolar nerve
3. pterygopalatine
ganglion
(parasympathetic)
4. greater palatine
nerve
5. lesser palatine nerve
6. cut nasopalatine
nerve
7. nerve of the
pharyngeal canal
•
All of the nerves are sensory branches of V2.
•
The pterygopalatine ganglion is suspended from
V2 by two sensory roots. Since the ganglion is
parasympathetic, there are preganglionic
neurons feeding into it from the facial nerve
(greater petrosal branch) that synapse at this
point then continue onward as postganglionic
neurons.
•
Their destination is the lacrimal nerve and reach
there by rejoining the maxillary nerve through a
sensory root, hopping onto the zygomatic nerve
(V2), running up the lateral side of the orbit to
jump onto the lacrimal nerve (V1) and then to
the lacrimal gland to produce tears.

Olfaction
 Chemical Theory
 Undulation Theory
 Sinuses have no obvious physiologic function.

Airway Resistance
 Variations in nasal resistance are due primarily to
changes in the erectile tissues of the turbinates
Physiology

Air Conditioning
 Inspired air is warmed (or cooled) to near body
temperature and its relative humidity is brought to
near 100 percent.

Air Purification
 Hairs or vibrissae
 Solubility of gases
Physiology

Mucociliary Function
 Transport of foreign particles is carried out via action
of cilia moving the mucous blanket with its
entrapped particles

Pulmonary Correlations

Speech Modification
Acute Sinusitis

Clinical Picture
 Signs and symptoms depend
upon the sinuses involved
Maxillary = maxillary sinus and the adjacent midface and temple
Ethmoid = over bridge of the nose and medial canthus of the eye
Frontal = over the anterior wall and floor of the frontal sinus with pain radiating to
the medial canthus
Sphenoid = non-specific, marked by dull, aching pressure located at the center
of the skull and radiating to the occiput
Acute Sinusitis

Diagnostics
 Rhinoscopy or nasal endoscopy
 Sinus radiograph
Acute Sinusitis
CT Scan
MRI
Acute Sinusitis

Management
 Conservative: antibiotics, analgesics and
decongestants
 Surgical: maxillary sinus puncture following
decongestion and topical anesthesia of the nasal
mucosa
 Sharp puncture, Blunt puncture, Beck puncture


Chronic inflammatory, allergic, traumatic,
neoplastic
Impaired ventilation of the ostiomeatal unit due
to stenosis and obstruction
 Poor drainage > swollen mucosa esp at the narrow
anatomical passages > recurrent bouts of
inflammation > persistent, chronic sinusitis

Diagnosis
 Rhinoscopy, Endoscopy
 Turbinate hyperplasia, pneumatized middle turbinate, concha
bullosa, change in appearance of ostiomeatal unit, change in
the nasal septum
 CT Scan

Treatment
 Decongestants, heat therapy, antibiotics, mucolytics
 Sinus surgery – definitive treatment
 Endoscopic sinus surgery



Mucocele – cystlike, mucus containing sac that can form
within the paranasal sinus
Pyocele – mucocele containing purulent material
(superinfection)
Caused by adhesions or mass lesions that obstruct drainage
from the paranasal sinus system
 Frontal > Ethmoid > Maxillary > Sphenoid

Obstruction > INC pressure on sinus wall > thinning of bone >
erosion of mass

Clinical Picture
 Frontal: isolated, tense swelling over the ant. wall of the frontal sinus,
inferolateral displacement of orbital contents
 Maxillary: swelling in the cheek area, upward displacement of orbital
contents
 Sphenoid: non-specific

Diagnostics
 Prior surgical history, clinical appearance
 CT, MRI

Treatment
 Surgical removal
Thank You!