Lateral wall nose

1. Anatomy of Lateral Wall of
Nose(Osteomeatal Complex)
Capt Tin Tun Aung
BC 68824 SAMA 39902
PG1.ORL.HNS
1

2. Introduction
• Nose is generally for breathing, the design of its cavity results in
warming and moistening the inspired air,since the odors are air
brone,olfactory receptors are placed in the nose.
• Nose consists of external nose and internal nose (nasal cavity).
• Internal nose is divided into right and left nasal cavities by nasal
septum
2

3. • Each nasal cavity communicates with the exterior through naris or nostril
and with the nasopharynx through posterior nasal aperture or the choana.
• Each nasal cavity consists of skin-lined portion—the vestibule and
mucosa-lined portion—the nasal cavity proper.
• The anterior and inferior part of the nasal cavity is called vestibule.
• The vestibule is lined by skin and contains many sebaceous glands, hair
follicles and hairs called vibrissae.
3

4. • The upper limit of vestibule on the lateral wall is marked by limen nasi (also
called nasal valve).
• Nasal valve is bounded by;
Laterally – the lower border of upper lateral cartilage and
fibrofatty tissue and anterior end of inferior
turbinate,
Medially – cartilagenous nasal septum,
Caudally – floor of pyriform aperture.
• Each nasal cavity has lateral wall, medial wall(nasal septum),roof and floor.
4

5. Lateral wall of Nose
• The lateral nasal wall is irregular owning to the presence of three shelf
like bony projections called chonchae.
• The conchae or turbinates increase the surface area of nose for effective
air-conditioning of inspired air.
5

6. 6

7. • The lateral nasal wall separates the nose:
- from above,the ethmoidal air sinuses
- from the maxillary sinus below
- from the lacrimal groove and nasolacrimal canal in front.
• The lateral wall of nasal cavity is formed partly by bones and partly by
cartilages and soft tissues
7

8. • The bony part of lateral nasal wall is made up of:
- Nasal bone
- Frontal process of maxilla - Lacrimal bone
- Labyrinth of ethmoid bone with superior and middle conchae and uncinate process
- Inferior nasal concha
- Perpendicular plate of palatine bone
- Medial pterygoid plate of sphenoid bone
8

9. 9

10. • The cartilagienous part of lateral nasal wall is formed by:
- lateral process of upper lateral cartilage
- lower lateral or alar cartilage
- lesser alar or sesamoid cartilages, and fibrofatty tissues
10

11. • Lateral wall sub divided into three parts;
-A small depressed area in the anterior part is called the vestibule, which
is lined by modified skin containing short,stiff, curved hairs called
vibrissae.
-The middle part is known as atrium of the middle meatus.
-The posterior part contains the conchae.
(spaces separating the conchae are called meatuses)
11

12. 12

13. Turbinates and Meatuses
Nasal turbinates are curved bony projections directed downwards and
medially.Meatus of nose are passages beneath the overhanging conchae or
turbinates.Each meatus communicated freely with nasal cavity proper.
13

14. Inferior turbinate and Meatus
It is an independent bone and below it into the inferior meatus open
nasolacrimal duct guarded at its terminal end by a mucosal valve called
Hasner’s Valve
14

15. Middle turbinate
It is a projection from medial surface of the ethmoidal labrynth. It is
attached to the lateral wall by a bony lamella called ground or basal
lamella. Its attachment is not straight(S- shaped manner).
15

16. In anterior third ,it lies surgital plane and is attached to the lateral edge
of cribriform plate.
In middle third, it lies in frontal plane and is attached to lamina
papyracea.
In posterior third, it runs horizontally and forms root of middle meatus
and is attached to lamina papyracea and medial wall of maxillary sinus.
16

17. The middle meatus
-lies underneath the middle concha.
-It has the following features-
(a) The ethmoid bulla –rounded elevation
(b) The hiatus semilunaris-a deep semicircular sulcus below the bulla.
(c) The infundibulum- a short passage at the anterior end of the hiatus.
(d) The opening of frontal air sinus- at the anterior part of the hiatus
semilunaris.
(e) Opening of the maxillary sinus –at the posterior part of semilunaris.
(f) The opening of the middle ethmoidal air sinus at the upper margin of
bulla
17

18. 18

19. • The atrium of the middle meatus is shallow depression just in front of
the middle meatus and above the vestibule of the nose.
• It is limited above by a faint ridge of mucus membrane, the aggar
nasi,running forwards and downwards from the upper end of anterior
border of the middle turbinate.
19

20. Osteomeatal complex (OMC)
• Have defined as a complex including the maxillary sinus ostium, ethmoid
infundibulum and middle meatus; in other words, as the final site of drainage from the
frontal and maxillary sinuses and anterior ethmoidal cells. OMC is composed of five
structures.
• 1)Maxillary ostium - drainage channel of the maxillary sinus.
• 2)Infundibulum - common channel that drains the ostia of the maxillary antrum
• and anterior ethmoid air cells to the hiatus semilunaris.
• 3)Ethmoid bulla - a single air cell that projects over the hiatus semilunaris.
20

21. • 4)Uncinate process - hook like process that arises from the posteromedial aspect of
• the nasolacrimal duct and forms the anterior boundary of the
• hiatus semilunaris.
• 5)Hiatus semilunaris - final drainage passage; a region between the ethmoid bulla
• superiorly and free edge of the uncinated process.
• OMC is divided into anterior and posterior. Space infront of basal lamella is anterior
OMC, while the space behind the basal lamella of middle turbinate containing the posterior
ethmoidal cells is referred to as the posterior ethmoidal complex. The anterior and posterior
OMC has separate drainage systems. So, when the disease is limited to the anterior OMC,
the ethmoid cells can be opened and disease tissue removed as far as the basal lamella
(Dhingra, 2017).
21

22. Boundaries
• Anteriorly-the unit is open communication with the anterior nasal
cavity.The agger nasi and atrium of the middle meatus also
have an antreosuperior, and anterior relation to the
complex.
• Superiorly-is limited by the basal lamella.
• Posteriorly-the basal lamella continues along the length of the
middle turbinate and forms the posterior border of space.
22

23. • Inferiorly-an opening communication with the middle meatus.The
drained contents will travel in the meatus along the
superior
border of the inferior concha,which form the floor of the
middle meatus.
• Medially-is limited by the body of the middle concha.
• Laterally-by the lamina papyracea of the ethmoid sinuses.
23

24. 24

25. Figure 2.3 Osteomeatal complex (Dhingra, 2017)
25

26. Superior Turbinate
-It is a projection from the medial surface of ethmoidal labyrinth.
-It is a small concha is situated posterior and superior to the middle turbinate.
Superior Meatus
-It is a space below the superior turbinate.
-Posterior ethmoidal cells open into it.
26

27. • Sphenoethmoidal Recess
-It is situated above the superior turbinate .
-and sphenoidal sinus opens into it.
27

28. Blood supply of lateral wall of the nose
Internal carotid system
-anterior and posterior ethmoidal arteries(branches of ophthalmic artery).
External carotid system
-posterior lateral nasal branches from sphenoplatine arteries
(branches of maxillary artery)
-greater palatine artery (from maxillary artery)
-Nasal branches of anterior,superior dental artery(from infraorbital artery)
-Branches of facial artery
28

29. 29

30. 30

31. Venous drainage
• The vein form a plexus which drains anteriorly into the facial vein,
• Posteriorly into the pharyngeal plexus of vein,
• From middle part to the pterygoid plexus of vein.
31

32. Lymphatic drainage
• Anterior half of the lateral wall pass to the submandibular nodes.
• The posterior half ,to the retropharyngeal and upper deep cervical
nodes.
32

33. Nerve supply of the nose:
• Olfaction: olfactory nerve to olfactory mucosa.
• Sensory: branches from trigeminal nerve: anterior ethmoidal of
ophthalmic nerve, sphenopalatine and greater palatine of maxillary
nerve.
• Autonomic: sympathetic from deep petrosal nerve and
parasympathetic from facial nerve (superficial petrosal) to form the
vidian nerve to sphenopalatine nerve to the nasal mucosa.
33

34. Thank you
34