05 nose anatomy

7/28/2019 05 Nose Anatomy

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Anatomy of Nose & Sinus1. external nose

- Bony part : 2 nasal bone

- Cartilaginous part

a. upper lateral cartilage

b. lower lateral cartilage (alar cartilage)c. septal cartilage

d. accessory cartilage


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-Keystone area

-Skeletal Anatomy


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- Tip support mechanism

- Arterial Supply of Nose


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-external nose blood supply

Arterial supply

1). External carotid a.

- facial a. :

angular br., alar br.,

septal br., external nasal br.

2). Internal carotid a.

- ophthalmic a. :

dorsal nasal br.

2. nasal septum


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- 7 parts

1) the vomer (below)

2) perpendicular plate of the ethmoid bone (post)

3) quadriangular(septal) cartilage (ant)

4) nasal crest of maxillary & palatine bone

5) anterior nasal spine

: formed by the midline fusion

of the palatal processes of maxilla

6) membranous septum

: memb. connecting columella to septal cartilage

7) columella : medial crura of the greater alar cartilage


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3. lateral nasal wall

Turbinates: inferior, middle, superior, supreme

Meatus: inferior, middle, superior

Inferior meatus: Hasners valve

Middle meatus: opening of frontal, ant. ethmoid, & maxillary sinusSuperior meatus: post. ethmoid & sphenoid sinus


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4. middle meatus

5. nasal ostium


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6. nasal valve

Nasal valve: most resistant portion

Upper lateral cartilage, septum, anterior part of inferior

turbinate

. Septal valve: soft tissue of middle turbinate and septum


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7. Acoustic rhinometry Cross section

8. Artery of lateral nasal wall & septum

ICA: anterior and posterior ethmoid artery

ECA: sphenopalatine artery- posterior superolateral / posterior inferolateral /

anterior inferolateral a. / greater palatine a. / superior labial a. /

septal branch


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9. Blood Supply of Inf. Turbinate

9. Kiesselbachs area


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10. Woodruffs plexus

11. Nerves of nose


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Autonomic nerve

Sympathetic nerve

: vasoconstricture

: noradrenaline(NA), neuropeptide Y(NPY), avian pancreaqtic

polypeptide(APP)

Parasympathetic nerve

: secretion, vvasodilatation

: acetylcholine, vasoactive intestinal polypeptide(VIP), peptide histidine

isoleucine(PHI),nitro oxide(NO)

Sensory nerve

trigeminal nerve (C V)

: protective reflaex (sneezing, secretion, BP)

: substance P, neuropeptide K, calcitonin gene-related peptide(CGRP)

olfactory nerve (C I)

12. paranasal sinus


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13 Ostiomeatal Unit(OMU)

.

14. Development of Paranasal sinus

15. Possible Functions of Sinus

Air conditioning

Pressure damping

Reduction of skull weight

Heat insulation


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Flotation of skull in water

Increasing the olfactory area

Mechanical rigidity

Vocal resonance and diminution of auditory feedback

16. Lamella

1st lamella Uncinate process

2nd lamella Bulla

3rd lamella Middle turbinate

4th lamella Superior turbinate 5th lamella Supreme turbinate

-17. Sphenoid sinus

1

45 3

2


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-18. Optic Nerve & Internal Carotid Artery

19. normal CT

1)lacrimal fossa and duct


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20. endoscopic finding

1)inferior turbinate

2) middle turbinate

-Paradoxical MT


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3)uncinate process

4) Ethmoidal bulla

5) Superior turbinate


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6) Double middle turbinate

7) Inferior turbinate polyp

8)septal perforation


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Physiology of Nose & Sinus

1. Function of nose

1. Respiratory function

2. Olfactory function

3. Voice resonance

2. Respiratory function

?

Respiratory passage Control of inspired air

( )

( ) Control of temperate & humidification

Maximal distribution Air cleaning & protection

mucous blanket

ciliary movement

neural reflex : reflex apnea, sneezing

2. Respiration


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Nasal air flow

. Inspiratory flow: laminar flow

. Expiratory flow: turbulent flow

. Velocity of flow: central > lateral

3. Nasal resistance

Disturbance of air flow in airway

Nose : 50 % of total airway resistance

Complex anatomy of nose, mucous seretion

Nasal alae

Nasal cavum

Nasal valve : most resistant portion

4. Nasal resistance increase

Hyperventilation

Supine position

Cold air

Alcohol

Rhinitis except atropy

Aspirin, diuretics, pill antihypertensive drug

Sympathetic antagonist

4. Nasal resistance decreased

Exercise

Erect position

Sympathomimetics

Rebreathing

Atrophic rhinitis

PGE2

5. Nasal cycle

Alternative increase or decrease of nasal resistance

80 % of normal adult, short cycle in children

Blood volume change of capacitance vessel

Controlled by autonomic nerve system


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Insensible

0.5 - 3 hours/cycle

Allergy, infection, exercise, hormone, pregnancy, emotion, posture

6. Nasal Blood Vessel

Resistant vessels (arterioles, precapillary spincter)

: control of blood flow to nasal mucosa

Exchange(nutrient) vessels (capillary bed, AV anastmosis)

: filtration and absorption of fluid

Capacitance vessels (AV anastmosis, vein, venous sinusoid)

: determines nasal patency by tones of vessels

: nasal cycle

7. Paradoxical nasal obstruction

Septal deviation

Nasal obstruction in concave site

Adaptation of convex site

Increased resistance in concave site by nasal cycle

nasal obstruction in concave site

8. Rhinomanometry

(nasal resistance)

.


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9. Acoustic rhinometry

(Cross section)

10. Control of temperature & humidification

Temperature : 35 0C

Humidity : 95% saturation in inspired air

100% in expiration

capillary and submucous gland

11. Composition of secretion

Mucous

mucin

Serous

lysozyme(LZ), lactoferrin(LF)

secretory leukocyte protease inhibitor,

s-Ig A, albumin

12. Mucociliary transport


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13.

14. Nasal secretion transport

14. Abnormality of cilia


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15. Structure

200 / cell

Length : 6 7 m, Diameter : 0.2- 0.3 m

Deeper into mucus layer < 0.5 m

Axoneme : the structure of a cilium mainly composed of microtubules (9+2 or 9

+ 2 structures) surrounded with cell membrane

9 + 2 VS 9 + 0

Inner microtubule : direction

Inner arm : bending form

Outer arm : frequency

16. Functions of cilia

Clearing mucus and debris from airway

Circulate spinal fluid in the ventricle of the brain

Contribute to the movement of the ovum in the fallopian tube

Control left-right asymmetry in embryonic node

17. Primary ciliary disease

Cilia beat frequency : 5 -20 Hz

Primary ciliary dyskinesia (PCD)

Cilia microstructure defect

Cilia with decreased or total absence of motility

Sinusitis, chronic bronchitis, bronchiectasis, and male infertility

Katargener syndrome

PCD + Sinus inversus

18. Cilia beat Effective phase

maximum velocity : 1 mm/s

maximum arc : 110

2-3 X faster than recovery

stroke


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Resting phase

Recovery phase

close to the cell surface

clockwise sweep from above

CBF increase : all phase are shortened (especially resting phase)

19. Factors affecting CBF

Increase Decrease

Purinergic receptor agonist

adrenergic receptor antagonist

prostaglandin E1, E2, F2a

Purinergic receptor antagonist

Local anesthesia (lidocane)

Temperatue (< 5 0C, > 40 0C)

Histamine

acetylcholine, methacholine

topical steroid

20. Olfaction

Cribriform plate , septum, middle & sup. Turbinate

21. Olfactory epithelium PCCE

Cribriform plate , septum, middle & sup. turbinate

9+2 dynein arm .

Bowmans glands in lamina propria


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Bipolar cell, microvilli, supporoting cell, basal cells

05 nose anatomy

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