Nose

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Nose Para nasal sinuses

• Dr. Ashraf Hussain

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• Had Cleopatra's nose been shorter, the whole
  face of the world would have changed.
• (Blaise Pascal  (1623 - 1662)
  French philosopher, mathematician, and physicist)

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NOSE

• External nose
• Bones
• Nasal cavity
• Mucous membrane
• Olfactory portion
• Respiratory portion
• Communications of nasal cavity

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• Floor
• Roof
• Lateral wall
• Medial wall

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Olfactory membrane Located on the roof of the
nasal cavity. Contains cells/receptors which are
in contact with the Olfactory bulb and nerve to
provide sense of smell. (5 of nasal cavity area)
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Relations of nasal cavity

• Important in the spread of infection
• Direct continuity with
• (i) the anterior cranial
• fossa (via the cribriform plate of the
  ethmoid bone)
• (ii) the nasopharynx and, through the
  pharyngotympanic tube, the middle ear
• (iii) the paranasal air sinuses
• (iv) the lacrimal apparatus and conjunctiva.

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Nasal Mucosa
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Cross section of nasal mucosal layer. Cilia is
beating
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Functions of Nose

• Olfaction
• Respiration
• Filtration of dust
• Humidification
• Elimination of secretions from paranasal sinuses
  and nasolacrimal ducts

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Arteries supplying the Nose

• External Carotid Artery
• -Sphenopalatine artery
• -Greater palatine artery
• -Ascending pharyngeal artery
• -Posterior nasal artery
• -Superior Labial artery
• Internal Carotid Artery
• -Anterior Ethmoid artery
• -Posterior Ethmoid artery

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Blood supply

• The upper part of the nasal cavity receives its
  arterial supply from the ethmoidal branches of
  the ophthalmic artery, a branch of the internal
  carotid.
• The sphenopalatine branch of the maxillary
  artery, a terminal of the external carotid,
  supplies the lower part of the cavity.

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• Just within the vestibule of the nose, on the
  anteroinferior part of the septum, it links with
  a septal branch of the facial artery and it is
  from this zone, Littles area, that 90 of
  nose-bleeds occur.

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BLOOD SUPPLY OF MEDIAL WALL OF NOSE
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BLOOD SUPPLY OF LATERAL WALL OF NOSE
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Kesselbachs Plexus/Littles Area -Anterior
Ethmoid (Opth) -Superior Labial A
(Facial) -Sphenopalatine A (IMAX) -Greater
Palatine (IMAX) Woodruffs Plexus -Pharyngeal
Post. Nasal AA of Sphenopalatine A (IMAX)
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Epistaxis
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venous drainage

• Veins accompany the arteries
• The veins drain downwards into the facial vein
• and upwards to the ethmoidal tributaries of
  the ophthalmic veins.

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Innervation

• Sense of smell is via the olfactory nerve, which
  sends microscopic fibers from the olfactory bulb
  through the cribiform plate to reach the top of
  the nasal cavity.
• General sensory innervation is by branches of the
• Trigeminal nerve (V1 V2)
• Nasociliary nerve (V1)
• Nasopalatine nerve (V2)
• Posterior nasal branches of Maxillary nerve (V2)

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• The entire nasal cavity is innervated by
  autonomic fibers.
• Sympathetic innervation to the blood vessels of
  the mucosa causes them to constrict, while the
  control of secretion by the mucous glands is
  carried on postganglionic parasympathetic nerve
  fibers originating from the facial nerve.

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Lymphatics
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• Lymph from anterior regions of the nasal cavities
  drains forward onto the face by passing around
  the margins of the nares. These lymphatics
  ultimately connect with the submandibular nodes.
• Lymph from posterior regions of the nasal cavity
  and the paranasal sinuses drains into upper deep
  cervical nodes. Some of this lymph passes first
  through the retropharyngeal nodes.

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Clinical features

• Nasal Fractures
• Epistaxis
• Rhinitis
• Deviated nasal septum
• Nasal polyps
• Boil on nose

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Danger area of the face
The skin of the external nose and its surrounds
contains many sebaceous glands and hair follicles
which may become blocked and infected

Facial veins, which may become secondarily
infected, communicate directly with the
ophthalmic veins and hence with the cavernous
sinus. For this reason, this zone is often known
as the danger area of the face.
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Deviated Nasal Septum

• The septum is frequently deviated to one or other
  side, interfering both with inspiration and with
  drainage of the nose and accessory sinuses.

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Pathology

• Deviation
• Usually in cartilagenous part
• Different shapes
• C shaped
• S shaped
• Spur
• At junction of cartilage and bone

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Symptoms

• Nasal obstruction
• Nasal deformity
• Sense of smell and taste are disturbed
• Recurrent epistaxis

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Nasal Polyp

• Smooth glistening grape like masses
• Pale but Protruding polyp may appear pink
• Insensitive to probing
• Do not bleed on touch
• Multiple and bilateral
• Broadening of nose
• Increased intercanthal distance

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Paranasal air sinuses

• Air filled spaces in bones
• Frontal
• Ethmoidal
• Sphenoidal
• Maxillary

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Sinuses
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Functions of sinuses

• Warm and humidify inspired air
• Resonance of voice
• Reduce the weight of skull

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Guess what?
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Guess what?
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