Download Paranasal Sinuses: Anatomy and Function

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
1
Case Report—1000B.C.
2
Sinus Anatomy Overview
7 bones
4 paired sinuses
4 turbinates
3 meati
Drainage system
Nervous supply
Vascular supply
Related structures
3
Embryology
Maxilloturbinal
Ethmoturbinal
Middle turbinate
Superior turbinate
Supreme turbinate
Agger nasi
Uncinate process
Ethmoid infundibulum
Sinuses
4
Maxillary
Ethmoid
Sinus
Development
5
6
Pediatric Sinuses
Bony Structure
Ethmoid
Maxilla
Palatine
Lacrimal
Pterygoid plate of
Sphenoid
Nasal
Inferior Turbinate
7
Arterial Supply
External Carotid
Maxillary A.
Sphenopalatine
Internal Carotid
Ophthalmic A.
Ant. Ethmoid
Post. Ethmoid
Supraorbital
Supratrochlear
8
Innervation
9
Neurovascular Supply
10
Sinus Drainage Schema
11
Ethmoid Sinus
Development
Present at birth
 Anterior/Posterior
 Variability

Structure
Volume/shape
 Roof
 Lateral wall

12
Ethmoid Roof
•Anterior 2/3
•Posterior 1/3
Keros I
Keros II
Keros III
13
Ethmoid
Cells
14Supraorbital, Frontal Bulla, Concha Bullosa, Haller’s, Onodi Cells
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 Process
Anterior/Posterior Ethmoid Arteries
Osteomeatal complex
15
Basal/Ground
Lamella
16
Basal/Ground Lamella
Of the Middle Turbinate
The Agger Nasi Cell
17
Ethmoid Bulla
Uncinate Process
Hiatus Semilunaris
18
Ethmoid Infundibulum
19
Suprabullar/Retrobullar Recess
20
Ethmoid Arteries
21
Osteomeatal Complex
22
Middle meatus
Maxillary Sinus Ostium
Anterior Ethmoid
Drainage
Maxillary Sinus
Development
Present at birth
 Biphasic growth
 Level of the floor

Structure
Volume & shape
 Walls, floor, roof

23
Maxillary Sinus
24
Maxillary
Sinus
25
Maxillary Sinus
Related Structures
Fontanelles
 Natural ostium

Haller’s Cells &Sinusitis
 Osteomeatal complex

Accessory Ostium
 Nasolacrimal duct

26
Fontanelles
27
Natural Ostium
-Haller’s cells
Accessory Ostium
28
Nasolacrimal Duct
29
Frontal Sinus
Development


Frontal bone at birth
Age 5
Structure



Volume and shape
Ostium
Walls

Anterior vs. posterior
Related Structures

30
Frontal recess
Frontal Sinus
Ostium
Frontal recess
Boundaries
Dumbbell shape
Sinus Lateralis
Frontal Bulla
31
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


32
Relation to sella turcica
Sellar and postsellar relationships
Sphenoid Sinus Pneumatization
33
Sphenoid Sinus
Sphenoid Sinus
34
Sphenoid Sinus
35
Sphenoid Sinus
Ostium



Size (.5-4mm)
Location (sinus floor, anterior nasal floor, anterior
sinus wall, superior turbinate, cribiform plate)
Bony dehiscence
Related Structures



36
Sphenoethmoidal recess
Sphenoid rostrum
Onodi cell
Sphenoid Ostium
Sphenoethmoid Recess
Sphenoid Rostrum
37
The Onodi Cell
38
Microscopic Anatomy
Mucosa

Cilliated columnar epithelial cells
Anatomy
 Beat frequency
 Inhibitory effects of contact


Noncilliated columnar cells
Distribution
 Function


39
Basal cells
Microscopic Anatomy—Cont’d
Goblet Cells
Glycoproteins—viscosity and elasticity
 Innervation (para=thick, symp=thin)

Basement membrane

Submucosal glands

40
Distribution
Microscopic Anatomy
41
Mucous Blanket
Two layers
Superficial layer
 Sol layer

Function
Superficial layer traps bacteria and
particulate matter.
 Enzymes, antibodies, immune cells

42
Mucociliary Transport
Directional Flow of Mucous

Toward the choanae
Ostium drainage—a stubborn beast

Hilding, MD
Contact inhibition
Haller’s cells
 Surgery

43
Mucociliary Transport
44
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
45
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)



46
NO produced primarily in sinuses
Toxic to bacteria, fungi, viruses
Increases cilliary motility
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.
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