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Surgical anatomy of nose MAH
The document summarizes the anatomy of the nose. It describes the external nose, nasal cavity, and structures within including bones, cartilages, walls, openings, blood supply, nerves and lymph drainage. Key points are the pyramidal external nose composed of bones and cartilage, the nasal cavity divided into three regions and outlined by four walls, and various sinuses and structures that open into the nasal cavity.
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Surgical anatomy of nose MAH
- 1. Surgical Anatomy ofThe Nose M.A.H
- 2. The nose External nose Bonypart Carilagenous part Nasal cavity 1. floor 2.roof 3.lateral wall 4.medial (septal) wall
- 3. External nose:- - pyramidalin shape - it has root continous with forehead , and apex which is its free edge. - lateral surface of nose called dorsum nasi, which end below in rounded ala nasi . - external nose compose of : - - Bones - Hyline cartilage
- 4. Morphology of ExternalNose • The external nose has two elliptical orifices called the naris (nostrils), which are separated from each other by the nasal septum. • The lateral margin, the ala nasi, is rounded and mobile.
- 5. • Lobule the lowermobile portion of the nose • Nares symmetrically oval or elliptic and are directed obliquely toward the nasal tip. the axes of the nostrils intersect just below the tip. • Nasal Tip The nasal tip is the nasal surface area contained within four defining points, or landmarks, called tip defining points,the left and right domes, the supratip breakpoint, and the columellar breakpoint • Nasal Facets (The soft tissue triangles) span the area between the medial and lateral crura. This area of facial skin opposes vestibular skin and is devoid of cartilage. • Columella The columella derives its appearance from the skin and subcutaneous tissue covering the medial crura. As viewed from the profile, the columella should be visible and project 2 to 3 mm below the alar rim. The base of the columella is widened secondary to the flare of the medial crural footplates. • Alar Base Ideally, the width of the alar base corresponds to the width of the intercanthal distance. The width of the alar base is related to both the flare of the alae and the actual point of insertion at the alar crease
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- 7. Skeleton of ExternalNose Bonny part : - Nasal bone - Frontal process of maxilla - Nasal part of frontal bone Cartilaginous part : - Septal cartilage. - Lateral nasal cartilage. - Major alar cartilage. - minor alar cartilage.
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- 9. Nasal cartilages Septal cartilage •septal cartilage is quadrangular in shape. • It lays in the midline between the nasal bones, the perpendicular plate of the ethmoid superiorly, and the vomer and palate inferiorly. • The septal cartilage is a major support mechanism of the nose and projects anteriorly to form part of the dorsal profile.
- 10. Lateral cartilages • Theupper lateral cartilages comprise the middle third of the nose, or middle vault. • They are trapezoidal in shape from a lateral view, flaring out laterally • it represent a transition zone from the rigid nasal bones to the flexible lower lateral cartilages. • the nasal bones are attached to and overlap the cephalic borders of the upper lateral cartilages by 7–10 mm. • supported by Fibrous connections superior to the nasal bones, medial to the cartilaginous septum, and lateral to the pyriform aperture.
- 12. Alar cartilages • Theseare C-shaped cartilages typically divided into medial, middle, and lateral crura • These lower lateral cartilages typically overlap the upper lateral cartilages superiorly in the scroll region • Loose areolar tissue and fibrous attachments connect the upper and lower lateral cartilages.
- 13. • The medialcrura form the cartilaginous support for the columella • Aesthetically, only 2–4 mm of columellar show should be present below the alar margins from a profile View. Anything more than this reflects a “hanging columella” or alar retraction. • while any smaller distance represents columellar retraction.
- 15. Blood Supply ofthe External Nose • Blood supply of the nose derived from branches of both the ECA & ICA • The skin of the external nose is supplied by branches of the ophthalmic and the maxillary arteries. • The skin of the ala and the lower part of the septum are supplied by branches from the facial artery.
- 17. Nerve Supply ofthe External Nose • The infratrochlear and external nasal branches of the ophthalmic nerve (CN V) and the infraorbital branch of the maxillary nerve (CN V).
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- 20. Internal valve The junctionof the upper lateral cartilages with the nasal septum forms the internal nasal valve. This valve angle should be between 10 and 15° for adequate nasal airflow
- 21. Nasal Cavity It has: 1. floor 2.roof 3.lateral wall 4.medial (septal) wall It has 3 region : 1. vestibular 2. olfactory 3. respiratory
- 22. Nasal vestibule:- - dilationinside aperture of nostril - bounded laterally by alar, and lower nasal cartilage. - lined with skin, coarse hair and sebaceous gland , sweet gland . - limited above and behind by curved elevation called limen nasi. Olfactory region :- limited to superior nasal concha opposite part of septem , interventing roof. Present in roof , less vascular and appear yellow in color. Respiratory region: The rest of cavity , very vascular red in color to warm the air.
- 23. The Floor ofNasal Cavity • Palatine process maxilla • Horizontal plate palatine bone
- 25. The Roof ofNasal Cavity • Narrow • It is formed – anteriorly beneath the bridge of the nose by the nasal and frontal bones, – in the middle by the cribriform plate of the ethmoid, – located beneath the anterior cranial fossa, – posteriorly by the downward sloping body of the sphenoid
- 26. The Medial Wallof Nasal Cavity The Nasal Septum • Divides the nasal cavity into right and left halves • It has osseous and cartilaginous & soft tissue parts • Nasal septum consists of 1- Bony septum :consists of the perpendicular plate of the ethmoid bone (superior), the vomer (inferior) 2- Septal cartilage (anterior) 3- Membranous septum : fibrous tissue attaching the septal cartilage to the medial crura Perpendicular Plate (ethmoid) Septal Cartilage Vomer Nerve supply of nasal septum : Anterior superior part by anterior ethmoidal nerve Posterior inferior part by sphenopalatine nerve
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- 28. The Lateral Wallsof Nasal Cavity - it is formed from : 1- medial surface of maxilla. 2- ethmoid bone : - superior concha - middle concha 3- inferior concha. 4- lacrimal bone. 5- perpendicular plate of palatine. 6- medial pterygoid plate.
- 29. The Lateral Wallsof Nasal Cavity Superior meatus and concha:- - it is shortest , shallowest of 3 meatus. - behind superior meatus is sphenopalatine from a men which open into ptergo palatine fossa. Middle concha and meatus :- - much larger articulated with perpendicular plate of palatine bone. - at its upper part occupy by elevation called bulla ethmaidal which contain middle ethmaidal air cells. The opening of maxillary sinus is situated below bulla ethmaidal near the posterior end of hiatus semilunaris. - hiatus semilunaris which leads upward and fore ward into curved chaunel called ethmaidal infundibalam , in which anterior ethmaid sinus open in infundibalam .frontal sinus open through infundibalam into anterior end of hiatus semilunaris Inferior conchar:- - articulate with nasal surface of maxilla. - extend to floor of nasal cavity . - it is largest of 3 meatus. - naso lacrimal duct open drainexcess tear from eye. Duct open 2cm . behind nostril.
- 30. The Lateral Wallsof Nasal Cavity 1. Inferior meatus: nasolacrimal duct 2. Middle meatus: • Maxillary sinus • Frontal sinus • Anterior ethmoid sinuses 3. Superior meatus: posterior ethmoid sinuses 4. Sphenoethmoidal recess: sphenoid sinus
- 31. Openings Into theNasal Cavity Nasolacrimal Canal drains into Inferior Meatus Sphenoid sinus opens into sphenoethmoidal recess Posterior ethmoidal air cells open into superior meatus Anterior & middle ethmoid air cells, maxillary and frontal sinuses open into middle meatus
- 33. Blood Supply tothe Nasal Cavity • From branches of the maxillary artery, one of the terminal branches of the external carotid artery. • The most important branch is the sphenopalatine artery. • The sphenopalatine artery anastomoses with the septal branch of the superior labial branch of the facial artery in the region of the vestibule. • The submucous venous plexus is drained by veins that accompany the arteries.
- 34. Blood Supply tothe Nasal Cavity Sphenopalatine a. Maxillary a. Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.
- 35. Nerve Supply ofthe Nasal Cavity • The olfactory nerves from the olfactory mucous membrane ascend through the cribriform plate of the ethmoid bone to the olfactory bulbs . • The nerves of ordinary sensation are branches of the ophthalmic division (V1) and the maxillary division (V2) of the trigeminal nerve.
- 36. Nerve Supply ofthe Nasal Cavity CN I – Olfactory Nerves (SVA) Anterior ethmoidal branch of V1 Posterior nasal branches of V2 Cut nasopalatine branch of V2 to septum
- 37. Lymph Drainage ofthe Nasal Cavity • The lymph vessels draining the vestibule end in the submandibular nodes. • The remainder of the nasal cavity is drained by vessels that pass to the upper deep cervical nodes.