Paranasal Sinus 2002 01 Slides
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Transcript of Paranasal Sinus 2002 01 Slides
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Paranasal Sinuses: Anatomy and Function
Glen T. Porter, MD
Francis B. Quinn, MD
UTMB 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 turbinate Superior turbinate Supreme turbinate
Agger nasiUncinate processEthmoid infundibulumSinuses Maxillary Ethmoid
Embryology
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SinusDevelopment
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6Pediatric Sinuses
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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
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Ethmoid Sinus
DevelopmentPresent at birthAnterior/PosteriorVariability
StructureVolume/shapeRoofLateral 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 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
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Maxillary Sinus
DevelopmentPresent at birthBiphasic growthLevel of the floor
StructureVolume & shapeWalls, floor, roof
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Maxillary Sinus
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Maxillary Sinus
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Maxillary Sinus
Related StructuresFontanellesNatural ostium
Haller’s Cells &SinusitisOsteomeatal complex
Accessory OstiumNasolacrimal duct
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Fontanelles
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Natural Ostium -Haller’s cellsAccessory 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 Boundaries
Dumbbell 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
MucosaCilliated columnar epithelial cells
AnatomyBeat frequency Inhibitory effects of contact
Noncilliated columnar cellsDistributionFunction
Basal cells
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Microscopic Anatomy—Cont’d
Goblet CellsGlycoproteins—viscosity and elasticity Innervation (para=thick, symp=thin)
Basement membraneSubmucosal glands
Distribution
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Microscopic Anatomy
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Mucous Blanket
Two layersSuperficial layerSol layer
FunctionSuperficial layer traps bacteria and
particulate matter.Enzymes, antibodies, immune cells
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Mucociliary Transport
Directional Flow of MucousToward the choanae
Ostium drainage—a stubborn beastHilding, MD
Contact inhibitionHaller’s cellsSurgery
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Mucociliary Transport
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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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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 ago
ROS reveals h/o two episodes of meningitis in past few years
PE: 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.