Paranasal Sinuses: Anatomy and Function

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Paranasal Sinuses Anatomy and Function

• Glen T. Porter, MD
• Francis B. Quinn, MD
• UTMB Department of Otolaryngology
• Galveston, TX
• January 2002

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Case Report1000B.C.
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Sinus Anatomy Overview
7 bones 4 paired sinuses 4 turbinates 3
meati Drainage system Nervous supply Vascular
supply Related structures
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Embryology
Maxilloturbinal Ethmoturbinal Middle turbinate
Superior turbinate Supreme turbinate Agger
nasi Uncinate process Ethmoid infundibulum Sinuses
Maxillary Ethmoid
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Sinus Development
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Pediatric Sinuses
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Bony Structure
Ethmoid Maxilla Palatine Lacrimal Pterygoid plate
of Sphenoid Nasal Inferior Turbinate
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Arterial Supply
External Carotid Maxillary A.
Sphenopalatine Internal Carotid Ophthalmic A.
Ant. Ethmoid Post. Ethmoid
Supraorbital Supratrochlear
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Innervation
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Neurovascular Supply
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Sinus Drainage Schema
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Ethmoid Sinus

• Development
• Present at birth
• Anterior/Posterior
• Variability
• Structure
• Volume/shape
• Roof
• Lateral wall

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Ethmoid Roof

• Anterior 2/3
• Posterior 1/3
• Keros I
• Keros II
• Keros III

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Ethmoid Cells
Supraorbital, Frontal Bulla, Concha Bullosa,
Hallers, Onodi Cells
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Ethmoid SinusRelated Structures

• Basal Lamella of the Middle Turbinate
• Three planes
• Agger nasi cell
• Childhood sinus
• Ethmoid Bulla
• Hiatus Semiluninaris/Superior Hiatus Semilunaris
• Suprabullar/retrobullar recesses (Sinus
  Lateralis)
• Ethmoid Infundibulum/Uncinate Process
• Anterior/Posterior Ethmoid Arteries
• Osteomeatal complex

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Basal/Ground Lamella
Basal/Ground Lamella Of the Middle Turbinate
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The Agger Nasi Cell
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Ethmoid Bulla Uncinate Process Hiatus
Semilunaris
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Ethmoid Infundibulum
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Suprabullar/Retrobullar Recess
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Ethmoid Arteries
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Osteomeatal Complex Middle meatus Maxillary
Sinus Ostium Anterior Ethmoid Drainage
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Maxillary Sinus

• Development
• Present at birth
• Biphasic growth
• Level of the floor
• Structure
• Volume shape
• Walls, floor, roof

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Maxillary Sinus
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Maxillary Sinus
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Maxillary Sinus

• Related Structures
• Fontanelles
• Natural ostium
• Hallers Cells Sinusitis
• Osteomeatal complex
• Accessory Ostium
• Nasolacrimal duct

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Fontanelles
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Natural Ostium -Hallers cells Accessory
Ostium
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Nasolacrimal Duct
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Frontal Sinus

• Development
• Frontal bone at birth
• Age 5
• Structure
• Volume and shape
• Ostium
• Walls
• Anterior vs. posterior
• Related Structures
• Frontal recess

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Frontal Sinus
Ostium Frontal recess Boundaries Dumbbell
shape Sinus Lateralis Frontal Bulla
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Sphenoidal Sinus

• Development
• Arise within the nasal capsule (no pouch)
• Age 3 begins to pneumatize
• Structure
• Volume/variable pneumatization
• Wall thickness
• Position within the sphenoid
• Relation to sella turcica
• Sellar and postsellar relationships

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Sphenoid Sinus Pneumatization
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Sphenoid Sinus
Sphenoid Sinus
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Sphenoid Sinus
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Sphenoid Sinus

• Ostium
• Size (.5-4mm)
• Location (sinus floor, anterior nasal floor,
  anterior sinus wall, superior turbinate,
  cribiform plate)
• Bony dehiscence
• Related Structures
• Sphenoethmoidal recess
• Sphenoid rostrum
• Onodi cell

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Sphenoid Ostium Sphenoethmoid Recess Sphenoid
Rostrum
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The Onodi Cell
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Microscopic Anatomy

• Mucosa
• Cilliated columnar epithelial cells
• Anatomy
• Beat frequency
• Inhibitory effects of contact
• Noncilliated columnar cells
• Distribution
• Function
• Basal cells

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Microscopic AnatomyContd

• Goblet Cells
• Glycoproteinsviscosity and elasticity
• Innervation (parathick, sympthin)
• Basement membrane
• Submucosal glands
• Distribution

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Microscopic Anatomy
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Mucous Blanket

• Two layers
• Superficial layer
• Sol layer
• Function
• Superficial layer traps bacteria and particulate
  matter.
• Enzymes, antibodies, immune cells

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Mucociliary Transport

• Directional Flow of Mucous
• Toward the choanae
• Ostium drainagea stubborn beast
• Hilding, MD
• Contact inhibition
• Hallers cells
• Surgery

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Mucociliary Transport
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Function of Paranasal Sinuses

• Humidifying and warming inspired air
• Regulation of intranasal pressure
• Increasing surface area for olfaction
• Lightening the skull
• Resonance
• Absorbing shock
• Contribute to facial growth

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New Frontiers

• Sleep apnea and the sinuses
• Humidification contributes up to 6.9mm Hg serum
  pO2
• Mouth breathers noted to have decreased end-tital
  CO2increased serum CO2apneas (high baseline)
• Nitric Oxide (NO)
• NO produced primarily in sinuses
• Toxic to bacteria, fungi, viruses
• Increases cilliary motility

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Case Report

• 39 yom with h/o sinus disease c/o headache,
  rhinorrhea.
• PMHx of sinus surgery years ago
• ROS reveals h/o two episodes of meningitis in
  past few years
• PE right superior nasal mass. S/p FESS. Clear
  rhinorrhea.

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References

• Anon, Jack B., et al, Anatomy of the Paranasal
  Sinuses, Theime, New York, c1996.
• Bhatt, Nikhil J., Endoscopic Sinus Surgery
  New Horizons, Singular Publishing Group, Inc.,
  San Diego, c1997.
• Bailey, Byron J., et al, Head Neck Surgery
  -- Otolaryngology, Lippincott Williams Wilkins,
  Philadelphia, c2001.
• Lundberg, J., Weitzberg, E. Nasal Nitric
  Oxide in Man. Thorax 1999 54(10)947-952.
• McCaffrey, Thomas V., Rhinologic Diagnosis
  and Treatment, Thieme, New York, c1997.
• Marks, Steven C. Nasal and Sinus Surgery,
  W.B. Saunders Co., Philadelphia, c2000.
• Navarro, Joao A.C., The Nasal Cavity and
  Paranasal Sinuses, Springer, Berlin, c2001.
• Watelet, J.B., Cauwenberge P. Van, Applied
  Anatomy and Physiology of the Nose and Paranasal
  Sinuses. Allergy 1999 54, Supp 5714-25.