paranasal sinus-2002-01-slides
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Paranasal Sinuses: Anatomy and FunctionGlen T. Porter, MD
Francis B. Quinn, MDUTMB Department of Otolaryngology
Galveston, TX
January 2002
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Case Report—1000B.C.
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7 bones4 paired sinuses4 turbinates3 meatiDrainage systemNervous supplyVascular supplyRelated structures
Sinus Anatomy Overview
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MaxilloturbinalEthmoturbinal
Middle turbinateSuperior turbinateSupreme turbinate
Agger nasiUncinate processEthmoid infundibulumSinuses
MaxillaryEthmoid
Embryology
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SinusDevelopment
6 Pediatric Sinuses
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EthmoidMaxillaPalatineLacrimalPterygoid plate of
SphenoidNasal Inferior Turbinate
Bony Structure
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Arterial Supply
External CarotidMaxillary A.
SphenopalatineInternal CarotidOphthalmic A.
Ant. EthmoidPost. Ethmoid
SupraorbitalSupratrochlear
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Innervation
10Neurovascular 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 IKeros IIKeros III
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Ethmoid Cells
Supraorbital, Frontal Bulla, Concha Bullosa, Haller’s, Onodi Cells
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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 ProcessAnterior/Posterior Ethmoid ArteriesOsteomeatal complex
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Basal/GroundLamella Basal/Ground Lamella
Of 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 ComplexMiddle meatusMaxillary Sinus OstiumAnterior EthmoidDrainage
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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
! Haller’s Cells &Sinusitis! Osteomeatal complex
! Accessory Ostium! Nasolacrimal duct
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Fontanelles
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Natural Ostium-Haller’s 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 SinusOstiumFrontal recess
BoundariesDumbbell shape
Sinus LateralisFrontal Bulla
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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
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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 OstiumSphenoethmoid RecessSphenoid 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 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
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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 drainage—a stubborn beast! Hilding, MD
Contact inhibition! Haller’s cells! Surgery
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Mucociliary Transport
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Function of Paranasal Sinuses
Humidifying and warming inspired airRegulation of intranasal pressureIncreasing surface area for olfactionLightening the skullResonanceAbsorbing shockContribute 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
CO2—increased serum CO2—apneas (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 agoROS reveals h/o two episodes of meningitis in past few yearsPE: 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 57:14-25.