nasal cavity and pterygopalatine fossa
DESCRIPTION
Nasal Cavity and Pterygopalatine Fossa. R. Shane Tubbs, MS, PA-C, PhD. columella. Five major cartilages. Piriform aperture Anterior nasal spine Nasal septum Nasal bones. Nasal Cavity: Borders. Roof: frontal, ethmoid (cribriform), sphenoid, nasal bones - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/1.jpg)
Nasal Cavity and Pterygopalatine Fossa
R. Shane Tubbs, MS, PA-C, PhD
![Page 2: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/2.jpg)
![Page 3: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/3.jpg)
Five major cartilages
![Page 4: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/4.jpg)
Piriform aperture Anterior nasal spine Nasal septum Nasal bones
![Page 5: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/5.jpg)
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
![Page 6: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/6.jpg)
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
![Page 7: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/7.jpg)
Vomeronasal Cartilage
Along inferior border of septal cartilage
Rudimentary in man Vomeronasal nerve
of Jacobson in lower animals- pheromones
![Page 8: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/8.jpg)
![Page 9: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/9.jpg)
![Page 10: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/10.jpg)
Features Bulla (bubble) Nasofrontal duct Uncinate process Semilunar hiatus
![Page 11: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/11.jpg)
![Page 12: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/12.jpg)
Valve of Hasner (Czech Ophthalmologist 1819-1892)
Iatrogenic closure
![Page 13: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/13.jpg)
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)
![Page 14: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/14.jpg)
Olfactory Nerves
~ 20 pairs Most commonly injured cranial nerve CSF rhinorrhea Do not regenerate in elderly
![Page 15: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/15.jpg)
![Page 16: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/16.jpg)
![Page 17: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/17.jpg)
![Page 18: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/18.jpg)
Arterial Supply
Sphenopalatine Anterior ethmoidal Posterior ethmoidal Greater palatine Superior labial and lateral nasal branch of
facial
![Page 19: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/19.jpg)
![Page 20: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/20.jpg)
![Page 21: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/21.jpg)
Plexus Cavernosi Concharum
![Page 22: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/22.jpg)
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
![Page 23: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/23.jpg)
Paranasal Air Sinuses
![Page 24: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/24.jpg)
![Page 25: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/25.jpg)
![Page 26: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/26.jpg)
![Page 27: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/27.jpg)
Paranasal Air Sinuses
Function Named for the bones they occupy Paired Surrounded by diploic space of contiguous
bones
![Page 28: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/28.jpg)
Frontal Sinus
Frontonasal duct- semilunar hiatus
Innervation: supraorbital n.
Variation Acromegaly Eskimos Related to anterior
cranial fossa Tubbs et al. J
Neurosurgery, 2002
![Page 29: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/29.jpg)
![Page 30: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/30.jpg)
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
![Page 31: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/31.jpg)
![Page 32: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/32.jpg)
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
![Page 33: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/33.jpg)
![Page 34: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/34.jpg)
![Page 35: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/35.jpg)
![Page 36: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/36.jpg)
Maxillary Sinus Maxillary: semilunar
hiatus Innervation: ant,
middle, posterior superior alveolar nerves, infraorbital (V2)
Most commonly infected sinus
Drains superiorly as does sphenoid sinus
![Page 37: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/37.jpg)
![Page 38: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/38.jpg)
![Page 39: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/39.jpg)
Antrum of Highmore (British surgeon 1613-1685)
![Page 40: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/40.jpg)
![Page 41: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/41.jpg)
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
![Page 42: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/42.jpg)
Four canals: Vidian, vomerovaginal, palatovaginal, greater palatine canal
Two foramina: rotundum, sphenopalatine Two fissures: inferior orbital,
pterygomaxillary
![Page 43: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/43.jpg)
![Page 44: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/44.jpg)
![Page 45: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/45.jpg)
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)
![Page 46: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/46.jpg)
![Page 47: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/47.jpg)
![Page 48: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/48.jpg)
Pterygopalatine Ganglion
Parasympathetic root Sympathetic root Sensory root
![Page 49: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/49.jpg)
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
![Page 50: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/50.jpg)
![Page 51: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/51.jpg)
![Page 52: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/52.jpg)
![Page 53: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/53.jpg)
![Page 54: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/54.jpg)
![Page 55: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/55.jpg)
![Page 56: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/56.jpg)
![Page 57: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/57.jpg)
Vidian Nerve Course
![Page 58: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/58.jpg)
Sluder’s neuralgia (pterygopalatine neuralgia) excessive tearing, cluster HA
Vidian neurectomy Crocodile tears
![Page 59: Nasal Cavity and Pterygopalatine Fossa](https://reader033.vdocument.in/reader033/viewer/2022061614/56814fee550346895dbdbb78/html5/thumbnails/59.jpg)