Paranasal Sinuses: Anatomy and Function - PowerPoint PPT Presentation

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Paranasal Sinuses: Anatomy and Function

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Agger nasi cell. Childhood sinus. Ethmoid Bulla. Hiatus Semiluninaris/Superior Hiatus Semilunaris ... The Agger Nasi Cell. 18. Ethmoid Bulla. Uncinate Process ... – PowerPoint PPT presentation

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Title: Paranasal Sinuses: Anatomy and Function


1
Paranasal Sinuses Anatomy and Function
  • Glen T. Porter, MD
  • Francis B. Quinn, MD
  • UTMB Department of Otolaryngology
  • Galveston, TX
  • January 2002

2
Case Report1000B.C.
3
Sinus Anatomy Overview
7 bones 4 paired sinuses 4 turbinates 3
meati Drainage system Nervous supply Vascular
supply Related structures
4
Embryology
Maxilloturbinal Ethmoturbinal Middle turbinate
Superior turbinate Supreme turbinate Agger
nasi Uncinate process Ethmoid infundibulum Sinuses
Maxillary Ethmoid
5
Sinus Development
6
Pediatric Sinuses
7
Bony Structure
Ethmoid Maxilla Palatine Lacrimal Pterygoid plate
of Sphenoid Nasal Inferior Turbinate
8
Arterial Supply
External Carotid Maxillary A.
Sphenopalatine Internal Carotid Ophthalmic A.
Ant. Ethmoid Post. Ethmoid
Supraorbital Supratrochlear
9
Innervation
10
Neurovascular Supply
11
Sinus Drainage Schema
12
Ethmoid Sinus
  • Development
  • Present at birth
  • Anterior/Posterior
  • Variability
  • Structure
  • Volume/shape
  • Roof
  • Lateral wall

13
Ethmoid Roof
  • Anterior 2/3
  • Posterior 1/3
  • Keros I
  • Keros II
  • Keros III

14
Ethmoid Cells
Supraorbital, Frontal Bulla, Concha Bullosa,
Hallers, Onodi Cells
15
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

16
Basal/Ground Lamella
Basal/Ground Lamella Of the Middle Turbinate
17
The Agger Nasi Cell
18
Ethmoid Bulla Uncinate Process Hiatus
Semilunaris
19
Ethmoid Infundibulum
20
Suprabullar/Retrobullar Recess
21
Ethmoid Arteries
22
Osteomeatal Complex Middle meatus Maxillary
Sinus Ostium Anterior Ethmoid Drainage
23
Maxillary Sinus
  • Development
  • Present at birth
  • Biphasic growth
  • Level of the floor
  • Structure
  • Volume shape
  • Walls, floor, roof

24
Maxillary Sinus
25
Maxillary Sinus
26
Maxillary Sinus
  • Related Structures
  • Fontanelles
  • Natural ostium
  • Hallers Cells Sinusitis
  • Osteomeatal complex
  • Accessory Ostium
  • Nasolacrimal duct

27
Fontanelles
28
Natural Ostium -Hallers cells Accessory
Ostium
29
Nasolacrimal Duct
30
Frontal Sinus
  • Development
  • Frontal bone at birth
  • Age 5
  • Structure
  • Volume and shape
  • Ostium
  • Walls
  • Anterior vs. posterior
  • Related Structures
  • Frontal recess

31
Frontal Sinus
Ostium Frontal recess Boundaries Dumbbell
shape Sinus Lateralis Frontal Bulla
32
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

33
Sphenoid Sinus Pneumatization
34
Sphenoid Sinus
Sphenoid Sinus
35
Sphenoid Sinus
36
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

37
Sphenoid Ostium Sphenoethmoid Recess Sphenoid
Rostrum
38
The Onodi Cell
39
Microscopic Anatomy
  • Mucosa
  • Cilliated columnar epithelial cells
  • Anatomy
  • Beat frequency
  • Inhibitory effects of contact
  • Noncilliated columnar cells
  • Distribution
  • Function
  • Basal cells

40
Microscopic AnatomyContd
  • Goblet Cells
  • Glycoproteinsviscosity and elasticity
  • Innervation (parathick, sympthin)
  • Basement membrane
  • Submucosal glands
  • Distribution

41
Microscopic Anatomy
42
Mucous Blanket
  • Two layers
  • Superficial layer
  • Sol layer
  • Function
  • Superficial layer traps bacteria and particulate
    matter.
  • Enzymes, antibodies, immune cells

43
Mucociliary Transport
  • Directional Flow of Mucous
  • Toward the choanae
  • Ostium drainagea stubborn beast
  • Hilding, MD
  • Contact inhibition
  • Hallers cells
  • Surgery

44
Mucociliary Transport
45
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

46
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

47
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.

48
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49
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 5714-25.
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