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Respiratory system. Nose 1. 2. 3. 4. 5. Respiratory system – an overview Embryonic development of the respiratory system Respiratory passages – structure principles Nose: external nose nasal cavity Paranasal sinuses SPLANCHNOLOGY Respiratory system Respiratory system, systema respiratorium gas exchange – negative pressure breathing conducting portion – respiratory tract respiratory portion – lungs voice formation (phonation) – larynx olfaction (sense of smell) – nasal cavity Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY The air passages Conducting portion – respiratory tract: Upper respiratory tract nasal cavity pharynx Lower respiratory tract larynx trachea bronchi – external and internal distributing bronchioles Respiratory portion – lungs respiratory bronchioles alveolar ducts alveolar sacs alveoli Conditioning of the air: warming moistening removal of particulate materials Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Embryonic development Embryogenesis of the upper respiratory tract – origin: ectoderm of the foregut epithelium and nasal glands, nasopharynx endoderm of the foregut epithelium and glands of oropharynx and hypopharynx mesenchyme bony and cartilaginous frameworks o nasal prominences Nose: frontonasal prominence root two medial nasal prominences nasal dorsum and apex two lateral nasal prominences sidewalls and alae nasi nasal (olfactory) placode nostrils Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Embryonic development Embryogenesis of the lower respiratory tract – 3rd week of pregnancy: respiratory diverticulum (lung bud) blind-ended sac larynx and trachea lung buds Larynx: epithelium – endoderm of the foregut cartilages and muscles – splanchnic mesoderm Prof. Dr. Nikolai Lazarov 5 SPLANCHNOLOGY Embryonic development Embryogenesis of the lungs: lung buds bronchial buds – Hox genes bronchi and bronchioles – 4th mo. alveolar ducts and sacs – 6th mo. endodermal epithelium mesenchymal elements maturation of lungs: Prof. Dr. Nikolai Lazarov 6 SPLANCHNOLOGY Nose Nose – nasus (Gr. rhis, rhinos): both respiratory and olfactory organ role in “forming” the timbre of the voice Anatomical parts: external nose, nasus externus nasal cavity, cavitas nasi Prof. Dr. Nikolai Lazarov 7 SPLANCHNOLOGY External nose External nose, nasus externus: side at the middle and upper parts of the face generally pyramidal in shape human trait – different types: straight, humpy and saddle nose Anatomical parts: base, basis nasi lateral side wings, alae nasi dorsum, dorsum nasi root, radix nasi free tip, apex nasi nostrils, nares columella Prof. Dr. Nikolai Lazarov 8 SPLANCHNOLOGY External nose framework Bony framework – piriform aperture: nasal bones, ossa nasalia frontal processes of maxilla Cartilaginous framework, cartilagines nasi: unpaired septal cartilage, cartilago nasi septi paired: lateral nasal cartilage, cartilago nasi lateralis major alar cartilage, cartilago alaris major minor alar cartilages, cartilagines alares minores cartilagines nasales accessoriae Prof. Dr. Nikolai Lazarov 9 SPLANCHNOLOGY External nose sidewall Nasal musculature – rudimentary muscles: the procerus, m. procerus the nasalis, m. nasalis m. depressor septi nasi m. apicis nasi – variable m. compressor nares m. levator labii superioris alaequae nasi Connective tissue Skin: fine hairs sweat glands numerous large sebaceous glands Prof. Dr. Nikolai Lazarov 10 SPLANCHNOLOGY External nose – clinical relevance crooked nose, rhinoscoliosis saddle nose, rhinolordosis humpy nose, rhinokyphosis rhinophyma nasal bone trauma and fracture squamous cell carcinoma nasal anomalies Prof. Dr. Nikolai Lazarov 11 SPLANCHNOLOGY Nasal cavity Nasal cavity, cavum (cavitas) nasi: vestibule, vestibulum nasi nasal cavity proper, cavum nasi proprium Nasal septum, septum nasi: bony part, pars ossea vomer lamina perpendicularis ossis ethmoidalis pars cartilaginea cartilago septi nasi cartilagines alares majores organum vomeronasale (Jacobsoni) – pheromones Kiesselbach’s area membranous part, pars membranacea nasal septum deviation, deviatio septi nasi Prof. Dr. Nikolai Lazarov 12 SPLANCHNOLOGY Vestibule of the nasal cavity Nasal cavity, cavum (cavitas) nasi: entrance – nostrils, nares shape – racial trait exit – posterior nasal apertures, choanae Nasal vestibule, vestibulum nasi: limen nasi agger nasi regio cutanea stiff hairs, vibrissae sweat and sebaceous glands transition area stratified squamous pseudostratified epithelium seromucous glands absent sweat and sebaceous glands Prof. Dr. Nikolai Lazarov 13 SPLANCHNOLOGY Nasal cavity proper Nasal cavity proper, cavitas nasalis ossea: bone skeleton – walls floor, inferior – hard palate roof, superior wall: o nasal bone o ethmoid bone o sphenoid bone medial wall – nasal septum lateral wall: o o o o o o maxilla lacrimal bone ethmoid labyrinth palatine bone sphenoid bone conchae nasales, superior, media et inferior Prof. Dr. Nikolai Lazarov 14 SPLANCHNOLOGY Nasal cavity proper Nasal mucous membrane: medial wall respiratory segment, regio respiratoria olfactory segment, regio olfactoria Lateral wall nasal conchae nasal meatuses: o o o o o meatus nasi superior meatus nasi medius meatus nasi inferior meastus nasi communis meatus nasopharyngeus openings of the paranasal sinuses: o recessus sphenoethmoidalis o hiatus semilunaris, infundubulum, plica lacrimalis Prof. Dr. Nikolai Lazarov 15 SPLANCHNOLOGY Nasal cavity proper Nasal mucous membrane: medial wall respiratory segment, regio respiratoria olfactory segment, regio olfactoria Lateral wall nasal conchae nasal meatuses: o o o o o meatus nasi superior meatus nasi medius meatus nasi inferior meastus nasi communis meatus nasopharyngeus openings of the paranasal sinuses: o recessus sphenoethmoidalis o hiatus semilunaris, infundubulum, plica lacrimalis Prof. Dr. Nikolai Lazarov 16 SPLANCHNOLOGY Nasal cavity proper Microscopic anatomy: olfactory segment – 5-10 mm2; yellowish-brown olfactory mucosa, tunica mucosa o olfactory epithelium – • receptor (olfactory) cells • supporting cells (sustentacular) • basal cells – stem cells • brush cells o lamina propria • olfactory (Bowman’s) glands absent submucosa, tela submucosa Prof. Dr. Nikolai Lazarov 17 SPLANCHNOLOGY Nasal cavity proper Microscopic anatomy: respiratory segment, regio respiratoria – 1-3 mm lamina epithelialis – ciliated, pseudostratified columnar epithelium – five cell types: o o o o o ciliated cells goblet cells brush cells small granule cells basal cells lamina propria o nasal glands – seromucous, tubular o venous plexuses, stratum cavernosum plexus cavernosi concharum epistaxis o Kiesselbach’s area, locus Kiesselbachi o broad lymphatic network – lymphatic nodules Prof. Dr. Nikolai Lazarov 18 SPLANCHNOLOGY Blood supply of the nose External nose: facial artery ophthalmic artery Nasal cavity: respiratory segment sphenopalatine artery (external carotid artery) olfactory segment anterior and posterior ethmoidal arteries (internal carotid artery) Venous drainage: facial and ophthalmic veins Lymphatic drainage: deep neck lymph nodes (internal jugular vein) retropharyngeal lymph nodes Prof. Dr. Nikolai Lazarov 19 SPLANCHNOLOGY Innervation of the nose Sensory innervation – trigeminal nerve: ophthalmic nerve nasal nerve maxillary nerve infraorbital nerve, infratrochlear nerve (root), anterior ethmoidal nerve posterior nasal nerves Autonomic innervation: sympathetic carotid plexus parasympathetic pterygopalatine ganglion Prof. Dr. Nikolai Lazarov 20 SPLANCHNOLOGY Paranasal sinuses, sinus paranasales sinus sinus sinus sinus maxillaris (antrum Highmori) frontalis ethmoidalis sphenoidalis Prof. Dr. Nikolai Lazarov 21 SPLANCHNOLOGY Paranasal sinuses, sinus paranasales sinus maxillaris – developed in newborns sinus frontalis – during the 2nd year of life sinus ethmoidalis – 3-4 years after birth sinus sphenoidalis pneumatization – around 20 years Prof. Dr. Nikolai Lazarov 22 SPLANCHNOLOGY Maxillary sinus, sinus maxillaris maxillary sinus (antrum of Highmore): the largest air sinuses pyramidal cavity in the maxillary body hiatus maxillaris hiatus semilunaris drainage meatus nasi medius Prof. Dr. Nikolai Lazarov 23 SPLANCHNOLOGY Frontal sinus, sinus frontalis frontal sinus, sinus frontalis: two sinuses in the frontal bone septum sinuum frontalium ductus nasofrontalis – 12-16 mm drainage infundibulum of the meatus nasi medius Prof. Dr. Nikolai Lazarov 24 SPLANCHNOLOGY Ethmoidal sinus, sinus ethmoidalis Cellulae ethmoidales – 10 (5-16): cellulae ethmoidales anteriores 2-3 in number drainage meatus nasi medius cellulae ethmoidales medii, incl. bulla ethmoidalis 3-4 in number drainage meatus nasi medius cellulae ethmoidales posteriores 4-5 in number drainage meatus nasi superior (meatus nasi supremus) Prof. Dr. Nikolai Lazarov 25 SPLANCHNOLOGY Sphenoidal sinus, sinus sphenoidalis Sinus sphenoidales: two sinuses within the sphenoid bone body septum sinuum sphenoidalium apertura sphenoidalis drainage sphenoethmoidal recess Prof. Dr. Nikolai Lazarov 26 SPLANCHNOLOGY Clinical significance sinus infection – sinusitis paranasal sinus tumors, cysts sinus drainage spread to adjacent structures Prof. Dr. Nikolai Lazarov 27 SPLANCHNOLOGY rhinencephalon (nose-brain) Thank you ... Prof. Dr. Nikolai Lazarov 28