Nasal Cavity and Pterygopalatine Fossa

R. Shane Tubbs, MS, PA-C, PhD

Five major cartilages

Piriform aperture Anterior nasal spine Nasal septum Nasal bones

Nasal Cavity: Borders Roof: frontal,

ethmoid (cribriform), sphenoid, nasal bones

Floor: maxillary and palatine bones

Medial: nasal septum

Lateral: nasal conchae, lacrimal, maxillary, palatine bones

Nasal Septum Perpendicular plate Septal cartilage Vomer Medial crus of > alar

cartilage Nasal crests of

maxillary, palatine, and sphenoid bones

Nasal spine of frontal bone

Vomeronasal Cartilage

Along inferior border of septal cartilage

Rudimentary in man Vomeronasal nerve

of Jacobson in lower animals- pheromones

Features Bulla (bubble) Nasofrontal duct Uncinate process Semilunar hiatus

Valve of Hasner (Czech Ophthalmologist 1819-1892)

Iatrogenic closure

Features Vestibule: skin/vibrissae,

sweat and sebaceous glands

Upper 1/3 Lower 2/3 Limen (entrance) nasi

(lateral nasal cartilage) Agger (mound) nasi

(ethmoid air cells)

Olfactory Nerves

~ 20 pairs Most commonly injured cranial nerve CSF rhinorrhea Do not regenerate in elderly

Arterial Supply

Sphenopalatine Anterior ethmoidal Posterior ethmoidal Greater palatine Superior labial and lateral nasal branch of

facial

Plexus Cavernosi Concharum

Nasal Veins/Lymphatics

Veins: Drain via sphenopalatine foramen into pterygoid plexus and some via ethmoidal foramina to superior ophthalmic vein

Lymphatics: Majority join pharyngeal plexus and thus drain into retropharyngeal nodes

Paranasal Air Sinuses

Paranasal Air Sinuses

Function Named for the bones they occupy Paired Surrounded by diploic space of contiguous

bones

Frontal Sinus

Frontonasal duct- semilunar hiatus

Innervation: supraorbital n.

Variation Acromegaly Eskimos Related to anterior

cranial fossa Tubbs et al. J

Neurosurgery, 2002

Ethmoid Sinus (3-18 pairs)

Named on the basis of their openings

anterior: semilunar hiatus

middle: ethmoidal bulla or directly into middle meatus

posterior: superior meatus

Innervation: anterior and posterior ethmoidal nerves and branches of pterygopalatine ganglion

Sphenoid Sinus Sphenoethmoidal recess Most variable cavity in the

body! 15% of all cases of

sinusitis Ostium is 1.5 cm superior

to its floor Innervation: Posterior

ethmoidal nerve and branches of pterygopalatine ganglion

Related to middle cranial fossa

Maxillary Sinus Maxillary: semilunar

hiatus Innervation: ant,

middle, posterior superior alveolar nerves, infraorbital (V2)

Most commonly infected sinus

Drains superiorly as does sphenoid sinus

Antrum of Highmore (British surgeon 1613-1685)

Pterygopalatine Fossa “A pyramidal space inferior to the apex of the orbit

and lateral to the nasal cavity” ~ 2 x 1 cm Arteries: post sup alveolar, descending palatine,

pterygoid canal, pharyngeal, sphenopalatine Maxillary nerve Nerve of pterygoid canal (Vidian) Pterygopalatine ganglion (posterior to middle

nasal concha) Pterygopalatine nerves

Four canals: Vidian, vomerovaginal, palatovaginal, greater palatine canal

Two foramina: rotundum, sphenopalatine Two fissures: inferior orbital,

pterygomaxillary

Pterygopalatine Fossa Lateral: pterygomaxillary fissure Medial: perpendicular plate of palatine with

sphenopalatine foramen Posterior: Pterygoid process with Vidian canal,

rotundum Anterior: maxillae with inferior orbital fissure,

posterior superior alveolar foramen (lateral) Roof: > wing sphenoid, superior orbital fissure Inferior: pyramidal process, palatine canal (oral

cavity)

Pterygopalatine Ganglion

Parasympathetic root Sympathetic root Sensory root

Distribution of Pterygopalatine Ganglion

Sphenoid sinus (pharyngeal branch)

Posterior ethmoid cells Nose Hard and soft palate Inner gingivae of maxillary

teeth Palatine tonsil Choana Uppermost pharynx Orbit

Vidian Nerve Course

Sluder’s neuralgia (pterygopalatine neuralgia) excessive tearing, cluster HA

Vidian neurectomy Crocodile tears