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