pns anatomy

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7 bones4 paired sinuses4 turbinates3 meatiDrainage systemNervous supplyVascular supplyRelated structures

Sinus Anatomy Overview

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MaxilloturbinalEthmoturbinal Middle turbinate Superior turbinate Supreme turbinate

Agger nasiUncinate processEthmoid infundibulumSinuses Maxillary Ethmoid

Embryology

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SinusDevelopment

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EthmoidMaxillaPalatineLacrimalPterygoid plate of

SphenoidNasal Inferior Turbinate

Bony Structure

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Arterial Supply

External Carotid Maxillary A. SphenopalatineInternal 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

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 IKeros IIKeros III

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Ethmoid Cells

Supraorbital, Frontal Bulla, Concha Bullosa, Haller’s, Onodi Cells

Ethmoid Sinus—Related 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/GroundLamella

Basal/Ground LamellaOf the Middle Turbinate

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The Agger Nasi Cell

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Ethmoid BullaUncinate 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

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

Maxillary Sinus

Related Structures Fontanelles Natural ostium

Haller’s Cells &Sinusitis Osteomeatal complex

Accessory Ostium Nasolacrimal duct

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Fontanelles

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Natural Ostium -Haller’s cellsAccessory Ostium

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Nasolacrimal Duct

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 SinusOstiumFrontal recess Boundaries

Dumbbell shape

Sinus LateralisFrontal Bulla

Sphenoidal Sinus

DevelopmentArise 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

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 OstiumSphenoethmoid RecessSphenoid Rostrum

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The Onodi Cell

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 Anatomy—Cont’d

Goblet Cells Glycoproteins—viscosity and elasticity Innervation (para=thick, symp=thin)

Basement membrane Submucosal glands

Distribution

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Microscopic Anatomy

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 drainage—a stubborn beast Hilding, MD

Contact inhibition Haller’s cells Surgery

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Mucociliary Transport

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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