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Paranasal Sinuses:

Anatomy and Function

Glen T. Porter, MD

Francis B. Quinn, MD, FACS

The University of Texas Medical Branch

Department of Otolaryngology

Galveston, Texas

Grand Rounds Presentation

January 2002

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Case Report1000B.C.

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7 bones

4 paired sinuses

4 turbinates

3 meati

Drainage system

Nervous supply

Vascular supply

Related structures

Sinus Anatomy Overview

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Maxilloturbinal

Ethmoturbinal

Middle turbinate Superior turbinate

Supreme turbinate

Agger nasi

Uncinate process

Ethmoid infundibulum

Sinuses

Maxillary Ethmoid

Embryology

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Sinus

Development

6 Pediatric Sinuses

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Ethmoid

Maxilla

Palatine

Lacrimal

Pterygoid plate of

Sphenoid

Nasal

Inferior Turbinate

Bony Structure

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Arterial Supply

External Carotid

Maxillary A.

Sphenopalatine

Internal 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

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 I

Keros II

Keros III

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Ethmoid

Cells

Supraorbital, Frontal Bulla, Concha Bullosa, Hallers, Onodi Cells

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Ethmoid SinusRelated

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/Ground

Lamella Basal/Ground Lamella

Of the Middle Turbinate

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The Agger Nasi Cell

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Ethmoid Bulla

Uncinate 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

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

Hallers Cells &Sinusitis

Osteomeatal complex

Accessory Ostium

Nasolacrimal duct

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Fontanelles

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Natural Ostium

-Hallers 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 Sinus

Ostium

Frontal recess

Boundaries

Dumbbell shape

Sinus Lateralis

Frontal Bulla

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Sphenoidal Sinus

Development

Arise 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 Ostium

Sphenoethmoid Recess

Sphenoid 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 AnatomyContd

Goblet Cells

Glycoproteinsviscosity 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 drainagea stubborn beast

Hilding, MD

Contact inhibition

Hallers cells

Surgery

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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 CO2increased serum CO2apneas (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.