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& PA R A N A S A L

dr. Oscar Djauhari, Sp.THT-KL
Presented by:
Annisa Tri Handayani (2011730010)
Clerkship of Ear Nose Throat Head and Neck Department
Regional Hospital R. Syamsudin SH

ExternalN ose
Pyramidal shape
Skeleton partly bony and partly

cartilaginous and membranous

Nasal bones
Narrow and thicker above
Wider and thinner below
Articulate firmly above with the nasal part

of the frontal bone with each other

laterally with the nasal process of the

ExternalN ose (2)

Inferior: the upper lateral cartilages

continuous with the cartilaginous septum.

The lobule of the nose is formed mostly

by the lower lateral cartilages, which

consist of a medial and lateral crus.
There are several small cartilages within
the nasal ala.
The chief arterial supply of the nose is from

the facial artery through the angular artery

and superior labial arteries. Venous
drainage is similar, with a component

N asalCavity
= nasal fossae
Nasal septum nasal septal cartilage,

nasal crest of the maxilla, nasal crest of

the palatine bone, the vomer, and the
perpendicular plate of the ethmoid bone.
The lateral nasal wall nasal turbinates
The meatus are situated below the

corresponding turbinates

Lateral nasal wall. 1. frontal sinus; 2. middle nasal concha; 3.

middle nasal meatus; 4. agger nasi; 5. atrium of middle nasal
concha; 6. limen; 7. vestibule; 8. inferior nasal meatus; 9. incisive
canal; 10. palatine process of maxilla; 11. s0ft palate; 12.
pharyngeal recess; 13. eustachian tube orifice; 14. torus tubarius;
15. adenoid; 16. sphenoid sinus, 17. sphenoid sinus opening; 18.
sphenoethmoidal recess; 19. inferior nasal concha; 20. superior

Nasal septum. 1, Perpendicular plate; 2, cribriform plate; 3,

crista galli; 4, frontal bone; 5, nasal bone; 6, septal cartilage; 7,
medial crus; 8, anterior nasal spine; 9, incisive canal; 10, palatine
process; 11, perpendicular plate; 12, postnasal spine; 13,
horizontal plate; 14, lateral pterygoid plate; 15, medial pterygoid

Blood Supply ofN asalCavity

The arterial supply is from:
Internal carotid sources through the anterior

and posterior ethmoid arteries

External carotid source through the
sphenopalatine artery.
The greater palatine vessels
The septal branch of the superior labial artery

These form an important anastomotic

network in the anterior septum known as

the Kiesselbach plexus, which accounts
for most nosebleeds.

Type ofParanasalSinuses
Frontal sinus
Ethmoid sinus
Maxillary sinus
Sphenoid sinus

Located in the frontal bone
Its floor forming the medial portion of the orbital roof
Bounded behind by the anterior cranial fossa
Inflammations can give rise to serious complications

because of its close proximity to the orbit and cranial

Orbital cellulitis
Epidural or subdural abscess

Two, three, or even more frontal sinuses on a side have

been reported, and some persons have no frontal sinus.

Ethm oid Sinuses

Pyramid-shaped and a labyrinthine system of small,

pneumatized sinus cavities that are separated from

one another by thin bony walls
Superior and medial to the maxillary sinus are the
ethmoid air cells
Anterior ethmoid cells anterior and below: open into the

infundibulum of the middle meatus

Posterior ethmoid cells posterior and above: into the
superior meatus

They lie on either side of the superior halves of the

nasal cavities and are separated from the orbits by

the laminae papyraceae.

Sphenoid Sinuses
Located at the approximate center of the skull above

the nasopharynx.
Its posterior wall is formed by the clivus.
It relates laterally to the cavernous sinus, the internal carotid

artery, and cranial nerves II VI, and it is very closely related

to the optic canal.
The optic nerve and the internal carotid artery may run directly
beneath the mucosa of the lateral wall of the sphenoid sinus

Superiorly by the sella tursica and pituitary

The anterior and middle is cranial fossae
The degree of pneumatization of the sphenoid sinus

varies an important factor in surgical approaches to

the pituitary gland.

M axillary Sinuses
The largest of the paranasal sinuses
The anterior wall forms the facial surface of the maxilla
The posterios wall borders the infratemporal fossa
The medial wall constitutes the lateral wall of the nasal

The floor of the sinus is the alveolar process
The superior wall serves as the orbital floor

The infraorbital nerve crosses the orbital floor to

exit the anterior portion of the maxilla via the

infraorbital foramen.

D rainage ofParanasalSinuses
Meatus superior
Located below the superior turbinate and above the medial

Drainage the posterior ethmoid sinuses and sphenoid

Meatus media
Located between the medial turbinate and inferior turbinate
Drainage the frontal sinus, maxillary sinus, and anterior

ethmoid sinus

Meatus inferior
Situated below the inferior turbinate
The biggest meatus
An orifice of the ipsilateral naso-lacrimal duct.

Paranasal sinuses. 1, Nasal septum; 2, frontal sinus; 3, nasal

cavities; 4, ethmoidal cells; 5, middle nasal concha; 6, middle
nasal meatus; 7, maxillary sinus; 8, inferior nasal concha; 9,
hard palate.

O steom eatalCom plex

A small constricted region which is prone to

Contained in the middle third of lateral wall of
the nose, in the meatus medius, there orifice
channel of maxillaryy sinus, frontal sinus,
anterior ethmoid sinuses.
5 structures:
Maxillary ostium
Ethmoidal bullae
Uncinate process
Hiatus semilunaris

Physiology ofParanasal
Acting as resonating chambers for

the voice
Moisturize and humidify ambient air
Lightening the weight of the facial

Physiology ofthe N ose and ParanasalSinuses

Respiratory function air

Fonetic function
Static and mechanic function
lightening the weight of facial
skeleton, protection
Nasal reflex