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cartilages &
upper lip

NOSE
DR
...
SUPERFICIAL FATTY PANICULUS

consists of adipose/fatty tissue with interlacing
vertical fibrous septae which extends from the
dermis to the fibromuscular layer

FIBROUS SEPTAE -> divides tissue into
compartments

present throughout the nose but more on
glabella & supratip
2
...
DEEP FATTY TISSUE

layer of loose areolar fat, separating
fibromuscular layer from deeper layers so
called “INTRADONAL LIGAMENT”
4
...


INTERDONAL LIGAMENT

located in the tip region of nose wherein there
is transverse layer which connects the 2
medial pleura extend from the foot plate to
medial genu of donal segment
NASAL MUSCLES
ORIGIN
INSERTION
of

PROCERUS M
...
LATERAL
FIBERS
Perichondreum
of upper lateral

GLABELLAR SKIN
(Skin of lower
forehead between
eyebrows)
*both fuse below the
glabella & inserted
into eh glabellar skin
*antagonist to
depressor
> function of
transverse nasalis

ANOMALUS
NASI

ALAR
NASALIS/
PARS ALARIS
MUSCULI
NASALIS

DEPRESSOR
SEPTI NASI
MUSCLE

PARS
TRANSVERSA
MUSCULI
NASALIS

MEDIAL
PORTION OF
ORBICULARIS
ORIS

FRONTAL
PROCESS OF
MAXILLA

MAXILLA
ABOVE THE
LATERAL
INCISOR
TEETH

MAXILLARY
PEROSTEUM
ABOVE
CENTRAL &
LATERAL
INCISORS &
FROM
ANTERIOR
NASAL SPINE
MAXILLA
ABOVE &
LATERAL TO
INCISOR
FOSSA

>NASOLABIAL
FOLD
> ALA NASI
> SKIN & M
...

CIRCUMFERENCE
OF LATERAL
PLEURA

MEMBRANOUS
SEPTUM & FOOT
PLATES OF
MEDIAL PLEURA


Widens the
nostrils;
Draws
cartilage
downward &
laterally
opening
nostrils

Pulls nose
inferiorly

Ant
...
MEDIAL
FIBER
- transverse
aponeurosis &
perosteum of
nasal bones &
fuse with
lateral
counterpart to
form a central
muscle
covering the
dorsum of the
nose

LEVATOR LABII
SUPERIORIS
ALAEQUE NASI
> widens the
nostrils

Draws down
medial angle
of eyebrows
producing
transverse
wrinkles over
bridge of nose

COMPRESSOR
NARIUM
MINOR

Anterior
portion of
lower lateral
cartilage

SKIN NEAR
MARGIN OF
NOSTRILS

DILATOR
NARIS
ANTERIOR

Upper lateral
cartilage & alar
part of nasalis

Caudal margin of
lateral pleura &
lateral alar skin

NOSE consists of:
o EXTERNAL NOSE
o INTERNAL NOSE
EXTERNAL NOSE

Enlarges
circumference
of nasal
apperture



VEINS

follow the course of the arteries

Those @ the root empty INTO THE
OPTHALMIC VEINS & then into the
CAVERNOUS SINUS

Inflammation in this region >
FURUNCULOSIS & ERSIPELAS -> may
travel by means of this communication into
the intracranial circulation & send septic
emboli into the brain
...

LATERAL WALLS OF THE PYRAMID
- > MOBILE;
- > expand to form the wings (alae) > WHICH ARE
SUPPLIED WITH SEBACEOUS & SWEAT GLANDS
BASE
- > presents 2 elliptical orifices (NARES) > which are
SEPARATED FROM EACH OTHER by an
ANTEROPOSTERIOR SEPTUM called the COLUMNA
SMALL STIFF HAIRS (VIBRISSAE) > found along
the margins of the nares arrest the passage of foreign
substances that may be carried in DURING
INSPIRATION
...

ARTERIES

are derived FROM THE FACIAL > supplies
the SIDE OF THE NOSE, THE ALAR &
THE SEPTAL BRANCHES TO THE
SEPTUM & THE ALAE, & THE
OPTHALMIC ARTERY > which sends
branches to the root & the dorsum
...


FLOOR

represents its larger part & is much wider than
the roof
...


usually deflected from the median plane >
thus reducing the size of one nasal cavity &
increasing the other

FORMED BY:
POSTERIORLY -> by the vomer
ANTEROSUPERIORLY -> by the
pendicular plate of the ethmoid
ANTEROINFERIOLY -> by the septal
cartilage
-> as this cartilage extends
backward
it fits into the angle between the
ETHMOID & THE VOMER

TINY PROJECTIONS OR CRESTS OF THE
PALATINE, THE MAXILLARY, THE
FRONTAL, THE NASAL & THE
SPHENOID BONES form peripheral parts of
the bony septum

OLFACTORY NERVE SUPPLIES THE
UPPER PART OF THE SEPTUM

TERMINAL BRANCHES ARE
DISTRIBUTED OVER THE ENTIRE
SEPTAL AREA:
a) INTERIOR NASAL BRANCH
(OPTHALMIC NERVE)
b) LONG SPHENOPALATINE
(NASOPALATINE) > arises from the
PTERYGOPALATINE
(SPHENOPALATINE GANGLION) -> this
nerve travels downward & forward on the
septum its branches passing through the
incisive foramina to supply the mucous
membrane of the anterior part of the hard
palate
LATERAL WALL


























reveals 3 ELEVATIONS caused by the
SUPERIOR, the MIDDLE & the
INFERIOR CONCHAE (TURBINATE
BONES)
Below and lateral to each concha ->
corresponding nasal passage or meatus is
found
ABOVE THE SUPERIOR CONCHA
SPHENOETHMOIDAL recess > narrow
space into which the sphenoid sinus opens ->
SCROLL-SHAPED CONCHAE project in a
more or less horizontal direction from the
lateral wall so that their free margins point
downward & inward
SUPERIOR & THE MIDDLE CONCHAE
arise from THE ETHMOID BONE, but the
INFERIOR is an INDEPENDENT BONE
LATERAL NASAL WALL is formed by the
FRONTAL PROCESS OF MAXILLA, the
LACRIMAL BONE, the ETHMOID, the
NASAL SURFACE OF THE MAXILLA, the
INFERIOR NASAL CONCHA, the
PERPENDICULAR PLATE OF THE
PALATINE BONE & the MEDIAL
PTERYGOID PLATE OF THE SPHENOID

SUPERIOR CONCHA
THE SMALLEST
situated on the upper & back part of the lateral wall, its
anterior extremity lying beneath the MIDDLE OF
CRIBRIFORM PLATE OF THE ETHMOID BONE
does not overhang sufficiently to obscure the superior
meatus -> which forms the UPPER BOUNDARY
MIDDLE CONCHA
extends farther than the superior & has free anterior &
inferior borders
reaches as far forward as the anterior extremity of the
cribriform plate & overhangs & completely conceals
the middle meatus
INFERIOR CONCHA
AN INDEPENDENT BONE
articulates with the maxilla & the perpendicular plate of
the palatine, in this way forming part of the medial wall
of the maxillary sinus -> its overhanging free borders
covers the inferior meatus & almost reaches the floor of
the nasal cavity
POSTERIOR END lies about 1cm in front of the
PHARYNGEAL OSTIUM OF THE AUDITORY
(EUSTACHIAN) TUBE
...
-> its anterior end is about ¾
inch behind the orifice of the nostril
...

SUPERIOR MEATUS

A SHORT, NARROW FISSURE IN FRONT
OF WHICH THE POSTERIOR
ETHMOIDAL CELLS OPEN

MIDDLE MEATUS
o is situated below and lateral to the middle
concha & cannot be seen unless that concha
has been detached or displaced upward
...


The sphenoethmoid recess has been referred to
as the “ HIGHEST MEATUS” -> lies between
the superior concha & the roof of the nose;
into this space the sphenoid sinus opens
...

ANTERIOR APERTURE

IS A PEAR-SHAPED and is formed by the
nasal bones & the anterior border of the
maxilla that ends in the anterior nasal spine

POSTERIOR NARES (CHOANAE) – are
each bounded:
LATERALLY – internal pterygoid lamina
MEDIALLY – vomer
ABOVE – body of the sphenoid & ala of the
vomer
BELOW – horizontal plate of the palate

VESTIBULE OF THE NOSE – is the
dilation inside the nostril that is line by the
squamous epithelium & from the lower border
of which the vibrissae grow;
 is bounded above: BY A RIDGE
THAT SEPARATES IT FROM
THE ATRIUM -> a depressed area
in front of the middle meatus, which
in turn bounded by another ridge
called the agger nasi -> formed by
the superior turbinated crest on the
frontal process of the superior
maxilla

MUCOUS MEMBRANE

is continuous with all the cavities
communicating with it
...

RESPIRATORY PART OF THE NASAL
MUCOUS MEMBRANE enables the air to
obtain warmth and moisture in its passages
through the nose & it also accounts for the
manner in which the nasal cavity becomes
occluded in the early stages of a common cold
...


If the membrane becomes the seat
of chronic inflammation, the
upper part may become
edematous & protrude from the
ethmoidal region or from the
middle turbinate in the form of
polyp
...


This vessel enters the nasal cavity through the
sphenopalatine foramen

supply branches to the lateral wall, travels
downward & forward on the septum,
accompanied by its corresponding nerve
...




LYMPH DRAINAGE

This is accomplished by way of the deep
cervical nodes, following the path of the IJV



NERVES

The nerves associated with the nasal cavities
are derived from 2 sources:
1) OLFACTORY NERVES



2)








pass through the openings in the cribriform
plate of the ethmoid
SUPPLY THE MUCOUSMEMBRANE OF
THE UPPER THIRD (OLFACTORY
PORTION) OF THE NASAL CAVITIES
NONMEDULLATED FIBERS & PASS TO
THE OLFACTORY BULB
SENSORY NERVES
ARISE: OPTHALMIC BRANCH OF THE
TRIGEMINAL
OPTHALMIC NERVE -> by means of its
anterior ethmoidal branch -> gives off a
branch to the septum which runs downward
on the inner surface of the nasal bone over the
atrium & middle meatus
SUPPLIES: mucous membrane in this region
& the cutaneous lining of the vestibular part &
appears between the nasal bones & the upper
nasal cartilages to supply the skin
MAXILLARY NERVE -> aids in the
sensation of this part of the respiratory tract
via the pterygopalatine ganglion
...

 STRUCTURES SEEN:
1) POSTERIOR NARES
2) SEPTUM
3) MIDDLE TURBINATE
4) PART OF THE SUPERIOR & INFERIOR
TURBINATES
5) MIDDLE MEATUS
6) EUSTACHIAN TUBE
7) MUCOUS MEMBRANE OF THE ROOF
8) UPPER PART OF THE NASOPHARYNX
EPISTAXIS
 NOSE BLEEDS
 Vascularity of the nose is great, & trauma is frequent ->
which explains the frequency of the nose bleeds
 IF THE BLEEDING ORIGINATES FROM THE
ANTERIOR PORTION OF THE SEPTUM
(KIESSELBACH’S PLEXUS OR TRIANGLE) -> may
be stopped by pressure through the anterior nares
POLYPI
 have a predilection for the nasal fossae & may block the
nostrils, THUS INTERFERING WITH RESPIRATION
 may press outward, widen the nose & project through
the anterior or posterior nares
 have been known to press on the palate & encroach on
the mouth

PARANASAL SINUSES
 are irregular spaces or diverticula originating from buds
of mucous membrane that sprout from nasal cavities &
grow into the diploic layer of certain bones
 Each sinus take its name from the bone in which it is
situated:
1) MAXILLARY (ANTRUM OF
HIGHMORE)
2) FRONTAL
3) ETHMOID
4) SPHENOID
 These sinuses are enclosed in compact bone
 communicate with the nasal cavities with which their
mucous membranes are continuous & are filled with air
 communicate with the nasal cavities by means of narrow
orifices that may become occluded because of congested
mucous membrane
 membrane lining is covered with ciliated epithelium
MAXILLARY ANTRUM (ANTRUM OF
HIGHMORE)
 THE LARGEST OF THE PARANASAL SINUSES &
IS THE 1ST TO APPEAR
 Begins to develop about the 4th month of intrauterine
life, it continues to grow in the adult, acquiring its
maximum development in the 2nd or 3rd decade
 AVERAGE DIMENSIONS OF SINUS:

ANTEROPOSTERIOR
1 ¼ inches

TRANSVERSE
1 inch

VERTICAL
1½
inches
 Situated in the interior of the superior maxilla
 BASE of this pyramidal cavity is formed by the lateral
wall of the nasal cavity
 APEX extends to the zygomatic process
 ROOF is formed by the orbital wall -> which is
frequently ridged by the infraorbital canal
 FLOOR by the alveolar process
 IN FRONT OF THE PYRAMID IS BOUNDED BY
THE FACIAL SURFACE OF THE SUPERIOR
MAXILLA & BEHIND BY THE ZYGOMATIC
SURFACE OF THE SAME BONE
...

 The infraorbital nerves & vessels lie in the roof of the
sinus, & their branches to the incisor, the canine & the
premolar teeth descend in the anterolateral wall
...

 The floor formed by the alveolar margin is about ½ inch
below the nose, & in it are seen elevations produced by
the roots of some upper teeth -> THE MOST USUAL
BEING THE 1ST & THE 2ND MOLARS
...


At times the roots actually project into the
sinus, but as a rule they produce a bulge into
the floor & are separated from the cavity by a
thin layer of spongy bone
...


Such pockets may be inaccessible to treatment
& must be handled individually
 The nerves and the vessels to the molar teeth descend
into the lower part of the posterior wall of the
ANTRUM
...


INFECTION MAY TAKE PLACE
THROUGH THE UPPER MOLAR
ALVEOLI & BY WAY OF THE NOSE
...
-> SUCH GROWTHS
SHOULD BE TREATED BY
EXCISION OF THE SUPERIOR
MAXILLA
...


Carious teeth projecting into the sinus cavity
may also be the cause of such infections, or
extension from adjacent sinuses (FRONTAL,
SPHENOID, & ETHMOID) can be the
INCITING AGENT
...

THIS CAN BE DONE BY 4 METHODS:
1) VIA THE NATURAL OPENING
2) THROUGH THE
NASOANTRIAL WALL
3) OUTER ORAL WALL
APPROACH
4) DENTAL APPROACHES

FRONTAL SINUSES
BILATERALLY PLACVED CAVITIES OF
VARIABLE EXTENT SITUATED ANTERIORLY
BETWEEN THE 2 PLATES OF THE FRONTAL
BONE, HAVE BEEN CONSIDERED AS
EXTENSIONS OF THE ANTERIOR ETHMOID
CELLS
...

The septum thins as the sinus grow and at times may
even disappears BY ABSORPTION
...

IN ITS PERIPHERAL PARTS THERE ARE SMALL
PARTITIONS THAT FORM LOCULAE AND
PRODUCE AN IRREGULAR OUTLINE
...

POSTEROSUPERIOR WALL
II
...

FLOOR
POSTEROSUPERIOR WALL

IS THIN
CONTAIN NO DIPLOE
separates the sinus from the meninges & the
frontal convolutions of the brain
ANTERIOR WALL
o LOOKS ONTO THE FOREHEAD
o CONTAINS DIPLOE -> because of the
presence of these diploe -> infectious
processes involving the bone (osteomyelitis)
spread more readily in this wall than in the
posterior
FLOOR
o separates it from the orbit, the nose & the
anterior ethmoid sinuses
o Sinus opens into the nose via the
infundibulum -> a narrow canal that passes
between the anterior ethmoid air cells
o THE SINUS THAT OPENS INTO THE
HIATUS SEMILUNARIS
Due to close relationship of sinuses & their openings
-> AN INFECTION IN ONE SINUS CAN, &
USUALLY DOES, SPREAD TO ONE ANOTHER
IT IS NOT UNCOMMON FOR AN OPENING OF
THE MAXILLARY SINUS TO RECEIVE PUS
FROM THE FRONTAL & THE ANTERIOR
ETHMOID CELLS AS IT TRAVELS ALONG THE
HIATUS SEMILUNARIS
A fracture over the frontal sinus can be depressed
without injuring the cranial contents -> BUT SUCH
FRACTURE MAYBE ASSOCIATED WITH
EMPHYSEMA OF THE SURROUNDING TISSUES
DUE TO COMMUNICATION WITH THE NOSE
INFLAMMATION OF THE MUCOUS LINING OF
THE FRONTAL SINUS MAY BE SECONDARY TO
AN INFECTION IN THE NOSE; CONVERSELY,
WHEN PUS FORMS WITHIN THIS SINUS, IT MAY
DRAIN INTO THE NASAL FOSSA
...

o INTRANASAL OPERATION
for sinus disease is utilized by some & is
described under surgery of the ethmoid cells
o EXTRANASAL OR EXTERNAL
APPROACH is usually performed in the
following way:
THE EYBROW IS SHAVED

INCISION IS MADE, BEGINNING @
TEMPORAL BONE

extending to the middle of the roor of the
nose, then curving downward to the base of
the nasal bone

Soft parts are freed from the bone; & then 2
incisions are made in the periosteum
> 1ST is placed just above & parallel with the
supraorbital margin
> 2nd passes over the frontal process of the
maxillary bone
THESE 2 INCISIONS DO NOT MEET
...

Both sinuses have important relationships ABOVE,
BELOW, IN FRONT & LATERALLY
...


THIS CLOSE RELATIONSHIP CAUSES
THE OPTIC NERVE TO BE INVOLVED
SPHENOID -> rise to sudden loss of vision
(RETROBULBAR NEURITIS)
BELOW

bounded below by the nose
IN FRONT

wall of the sinus separates it from the ethmoid
air cells
LATERALLY

cavernous sinuses containing the ICA & THE
6TH NERVE ARE LOCATED
...
Closely adherent to the underlying
alar cartilages but loosely attached and
mobile over the upper lateral cartilages and
nasal bones
...

- Normally, the tip of the skin
contains many sebaceous glands
which decrease in number over
the lateral cartilages
...

Increase
sebaceous glands and SQ fat 
skin unpliable
...





















a small hook or curette is introduced
upon the anterior superior wall of
the nasal cavity
point of this curette is carried
downward & then forward &
outward toward the eye of the
involved side -> firmly pressed into
the ethmoid labyrinth & then drawn
forward & downward
posterior wall of the labyrinth is
entirely broken down
sphenoid sinus is located, entered &
its anterior wall removed
...

BOUNDARIES OF THESES SINUSES ARE
COMPLETED BY THE:
1) FRONTAL
2) PALATINE
3) SPHENOID BONES
4) SUPERIOR MAXILLA
HAVE BEEN DIVIDED ARBITRARILY INTO 3
SETS:
1) ANTERIOR ETHMOID SINUSES
2) MIDDLE ETHMOID SINUSES
3) POSTERIOR SINUSES
ANTERIOR ETHMOID SINUSES

open into the middle meatus on the floor of
the hiatus semilunaris
MIDDLE ETHMOID SINUSES

open into the middle meatus on the surface of
the bulla ethmoidalis
POSTERIOR SINUSES

into the superior meatus
Above the ethmoid sinuses are the MENINGES & THE
FRONTAL CONVOLUTIONS IN THE ANTERIOR
CRANIAL FOSSA
IN FRONT is the frontal sinus
BEHIND IS the SPHENOID
BELOW is the nose
LATERALLY, THE ORBIT
The ethmoid cells in each labyrinth may vary from 4
large cells to 17 small ones, the average number being 9
...
Cruz)
o Paired nasal bones rarely symmetrical;
quadrangular in shape; thicker above than
below
...
The vertical
(perpendicular) plate of the ethmoid is the
osseous support of the septum, ending at its
junction with the septal cartilage at the
terminal point of the inferior portion of
nasal bone
...
The depression of the profile
here is known as nasofrontal angle or
nasion
...

o Posterolateral border of the frontal process
of the maxilla with the corresponding
groove along lacrimal bone  lacrimal
groove containing lacrimal duct
...

- Protrudes in front of pyriform aperture;
antero-superior projecton is known as
the septal angle
...

- Caudal border of the septal cartilage
extends over the smooth surface of
nasal spine
...

- Most nasal humps are formed by the
dorsal border of the cartilage in
combination with its junction with the
upper lateral cartilage & nasal bones
...

(B) Nasal Cartilages:
- Constitute the largest part of the
external nasal structure – which is
anterior to the pyriform aperture and
constantly moved by the musculature
of the nose; & such constant motion
plays an important role in regulating
airflow through the nostrils
...

- The paired lateral cartilages are a caudal
continuation of the nasal bones,
although they are not anatomically
fused to these bones; roughly
triangular, attached to the medial
portion of the frontal process of the
maxilla and the medial aspect of the
nasal bones & lie in close proximity
(not fused) to the septal cartilage in the
midline
...
– a groove
(limen nasi) is : created which serves
as a landmark for incisions above the
vestibule
...

- Overlapping of upper end of lateral
cartilages & nasal bone established
during embryonic growth  nasal
bones develop from a membrane on
the surface of the cartilaginous nasal
capsule
...

This overlapping may extend from 2-3

mm to as much as 10mm
...

(C) Septum and Lateral Cartilages:
- Septal cartilage extends up under the
nasal bones for a distance approx
...

 With a sharp edge in the
regions of septal angle &
adjacent portion of its
dorsal
border,
but
becomes thicker at its
junction with vertical plate
of the ethmoid
...

- Caudal to the nasal bones, septal &
lateral cartilages are separated by the
narrow cleft & becomes obvious near
the septal angle
...
The narrow
edge formed by the relationship pf
lateral cartilages & septum is critical
during respiration
...

(D) Alar Cartilages:
- The tip & columella (lobule) is
supported normally by the paired
major alar cartilages or lower lateral
cartilages
...

Framework for the columella, & a
lateral component – lateral crus which
provides framework that along with
the skin, determining the shape of the
tip
...

True dome = formed by the lateral crus
where it arches immediately superior
& lateral to its junction with the medial
crus
...

The medial crura can be in close
proximity to each other, or separated
in a diastasis
...

- Lateral crura – extend from their
junction with the medial crura in a
posterolateral direction; lateral crura
not ass’n
...
– composed
of soft tissue & not cartilage

throughout most of its length
...

- Lateral crura of the alar cartilages
diverge in the supra tip area; leaving a
triangular area between them that
contains the septal angle
...

(E) Columella
- Nasolabial angle formed between lip
&base of columella
- Shape of columella determined by the
configuration of the septum in
combination with the medial crura of
the alar cartilages
...

(F) Membranous Septum:
- Joins the columella with the caudal
border of the septal cartilage
...
It provides flexibility &
resiliency of the lobule
...
During deep inspiration,
the orbicularis oris muscle contracts he
lips and the depressor septi nasi (with
Zygomaticus) acts to tense the
membranous septum and columella
...

The internal nares then dilate, allowing
air to flow into the nasal fossa
...

- A cavity lined with skin continuing
numerous hair follicles (interossae) &
sebaceous glands
...
Transition between skin and
mucosa occurs at the level of the sulcus
between upper border of the lateral
nasal cartilage
...

(H) Internal Nose:
- Past the transition nose (limen nasi),
the lateral wall of the nasal cavity is
lived with pseudostratified ciliated
columnar epithelium
...

Mucous membrane overlying the 3
lateral conchae is highly vascularized
with many venous networks that are
erectile in action
...

- Procerus – tension of the Frontalis muscle
of the forehead which shortens the nose
...

- Zygomaticus – exerts a pulling effect on
the orbicularis oris
...

 Nerve Supply:
- Sensory innervation of the external nose is
from 5th CN; nerve supply to the muscles of
the Facial expression – 7th CN
...
ethmoidal
nerve)
- Infraorbital nerve is a branch of maxillary
division of trigeminal- supplies sensation to
the lateral nasal and alar wall
...
It supplies
the inferoposterior mucosa of the nasal
wall septum
...
Sphenopalatine
foramen is just behind & above the posterior end of the
middle turbinate
...
& Int
...
A
parallel branch of Int
...

- Facial Artery (Ext
...


-

-

-

-

-

Int
...

A small branch of the ophthalmic artery –
Supraorbital artery contributes Blood
supply to the root of the nose
...

Sphenopalatine artery & descending
palatine artery supply most of the blood to
the internal nose
...

The nasal palatine branch is the terminal
portion of this artery, where it leaves the
submucosal region of the hard palate &
ascends to the nasal cavity through the
incisive canal
...
This artery supplies
a large part of the nasal cavity & is the last
of the terminal branches of the maxillary
arteries
...
Lateral wall is supplied by the
osteolateral nasal arterial branch of the
sphenopalatine artery
...
This artery also has a rich
anastomosis with the nasopalatine branch
of the major palatine artery

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