Nasal Cavity and Pterygopalatine Fossa
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Transcript of Nasal Cavity and Pterygopalatine Fossa
Nasal Cavity and Pterygopalatine Fossa
R. Shane Tubbs, MS, PA-C, PhD
Five major cartilages
Piriform aperture Anterior nasal spine Nasal septum Nasal bones
Nasal Cavity: Borders Roof: frontal,
ethmoid (cribriform), sphenoid, nasal bones
Floor: maxillary and palatine bones
Medial: nasal septum
Lateral: nasal conchae, lacrimal, maxillary, palatine bones
Nasal Septum Perpendicular plate Septal cartilage Vomer Medial crus of > alar
cartilage Nasal crests of
maxillary, palatine, and sphenoid bones
Nasal spine of frontal bone
Vomeronasal Cartilage
Along inferior border of septal cartilage
Rudimentary in man Vomeronasal nerve
of Jacobson in lower animals- pheromones
Features Bulla (bubble) Nasofrontal duct Uncinate process Semilunar hiatus
Valve of Hasner (Czech Ophthalmologist 1819-1892)
Iatrogenic closure
Features Vestibule: skin/vibrissae,
sweat and sebaceous glands
Upper 1/3 Lower 2/3 Limen (entrance) nasi
(lateral nasal cartilage) Agger (mound) nasi
(ethmoid air cells)
Olfactory Nerves
~ 20 pairs Most commonly injured cranial nerve CSF rhinorrhea Do not regenerate in elderly
Arterial Supply
Sphenopalatine Anterior ethmoidal Posterior ethmoidal Greater palatine Superior labial and lateral nasal branch of
facial
Plexus Cavernosi Concharum
Nasal Veins/Lymphatics
Veins: Drain via sphenopalatine foramen into pterygoid plexus and some via ethmoidal foramina to superior ophthalmic vein
Lymphatics: Majority join pharyngeal plexus and thus drain into retropharyngeal nodes
Paranasal Air Sinuses
Paranasal Air Sinuses
Function Named for the bones they occupy Paired Surrounded by diploic space of contiguous
bones
Frontal Sinus
Frontonasal duct- semilunar hiatus
Innervation: supraorbital n.
Variation Acromegaly Eskimos Related to anterior
cranial fossa Tubbs et al. J
Neurosurgery, 2002
Ethmoid Sinus (3-18 pairs)
Named on the basis of their openings
anterior: semilunar hiatus
middle: ethmoidal bulla or directly into middle meatus
posterior: superior meatus
Innervation: anterior and posterior ethmoidal nerves and branches of pterygopalatine ganglion
Sphenoid Sinus Sphenoethmoidal recess Most variable cavity in the
body! 15% of all cases of
sinusitis Ostium is 1.5 cm superior
to its floor Innervation: Posterior
ethmoidal nerve and branches of pterygopalatine ganglion
Related to middle cranial fossa
Maxillary Sinus Maxillary: semilunar
hiatus Innervation: ant,
middle, posterior superior alveolar nerves, infraorbital (V2)
Most commonly infected sinus
Drains superiorly as does sphenoid sinus
Antrum of Highmore (British surgeon 1613-1685)
Pterygopalatine Fossa “A pyramidal space inferior to the apex of the orbit
and lateral to the nasal cavity” ~ 2 x 1 cm Arteries: post sup alveolar, descending palatine,
pterygoid canal, pharyngeal, sphenopalatine Maxillary nerve Nerve of pterygoid canal (Vidian) Pterygopalatine ganglion (posterior to middle
nasal concha) Pterygopalatine nerves
Four canals: Vidian, vomerovaginal, palatovaginal, greater palatine canal
Two foramina: rotundum, sphenopalatine Two fissures: inferior orbital,
pterygomaxillary
Pterygopalatine Fossa Lateral: pterygomaxillary fissure Medial: perpendicular plate of palatine with
sphenopalatine foramen Posterior: Pterygoid process with Vidian canal,
rotundum Anterior: maxillae with inferior orbital fissure,
posterior superior alveolar foramen (lateral) Roof: > wing sphenoid, superior orbital fissure Inferior: pyramidal process, palatine canal (oral
cavity)
Pterygopalatine Ganglion
Parasympathetic root Sympathetic root Sensory root
Distribution of Pterygopalatine Ganglion
Sphenoid sinus (pharyngeal branch)
Posterior ethmoid cells Nose Hard and soft palate Inner gingivae of maxillary
teeth Palatine tonsil Choana Uppermost pharynx Orbit
Vidian Nerve Course
Sluder’s neuralgia (pterygopalatine neuralgia) excessive tearing, cluster HA
Vidian neurectomy Crocodile tears