medical science

1. Surgical Anatomy of The Nose
M.A.H

2. The nose
External nose
Bony part
Carilagenous
part
Nasal cavity
1. floor 2.roof 3.lateral wall
4.medial (septal)
wall

3. External nose:-
- pyramidal in shape
- it has root continous with
forehead , and apex which
is its free edge.
- lateral surface of nose called
dorsum nasi, which end
below in rounded ala nasi .
- external nose compose of :
- - Bones
- Hyline cartilage

4. Morphology of External Nose
• The external nose has
two elliptical orifices
called the naris
(nostrils), which are
separated from each
other by the nasal
septum.
• The lateral margin, the
ala nasi, is rounded and
mobile.

5. • Lobule
the lower mobile portion of the nose
• Nares
symmetrically oval or elliptic and are directed obliquely toward the
nasal tip. the axes of the nostrils intersect just below the tip.
• Nasal Tip
The nasal tip is the nasal surface area contained within four
defining points, or landmarks, called tip defining points,the left
and right domes, the supratip breakpoint, and the columellar
breakpoint
• Nasal Facets (The soft tissue triangles)
span the area between the medial and lateral crura. This area of
facial skin opposes vestibular skin and is devoid of cartilage.
• Columella
The columella derives its appearance from the skin and
subcutaneous tissue covering the medial crura. As viewed from
the profile, the columella should be visible and project 2 to 3
mm below the alar rim. The base of the columella is widened
secondary to the flare of the medial crural footplates.
• Alar Base
Ideally, the width of the alar base corresponds to the width of
the intercanthal distance. The width of the alar base is related
to both the flare of the alae and the actual point of insertion at
the alar crease

6. Tip defining points

7. Skeleton of External Nose
Bonny part :
- Nasal bone
- Frontal process of maxilla
- Nasal part of frontal bone
Cartilaginous part :
- Septal cartilage.
- Lateral nasal cartilage.
- Major alar cartilage.
- minor alar cartilage.

8. External Nose

9. Nasal cartilages
Septal cartilage
• septal cartilage is quadrangular in
shape.
• It lays in the midline between the
nasal bones, the perpendicular
plate of the ethmoid superiorly,
and the vomer and palate
inferiorly.
• The septal cartilage is a major
support mechanism of the nose
and projects anteriorly to form
part of the dorsal profile.

10. Lateral cartilages
• The upper lateral cartilages
comprise the middle third of the
nose, or middle vault.
• They are trapezoidal in shape from
a lateral view, flaring out laterally
• it represent a transition zone from
the rigid nasal bones to the
flexible lower lateral cartilages.
• the nasal bones are attached to
and overlap the cephalic borders
of the upper lateral cartilages by
7–10 mm.
• supported by Fibrous connections
superior to the nasal bones,
medial to the cartilaginous
septum, and lateral to the
pyriform aperture.

12. Alar cartilages
• These are C-shaped cartilages
typically divided into medial,
middle, and lateral crura
• These lower lateral cartilages
typically overlap the upper
lateral cartilages superiorly in
the scroll region
• Loose areolar tissue and
fibrous attachments connect
the upper and lower lateral
cartilages.

13. • The medial crura form
the cartilaginous support
for the columella
• Aesthetically, only 2–4
mm of columellar show
should be present below
the alar margins from a
profile View. Anything
more than this reflects a
“hanging columella” or
alar retraction.
• while any smaller
distance represents
columellar retraction.

15. Blood Supply of the External Nose
• Blood supply of the nose derived from
branches of both the ECA & ICA
• The skin of the external nose is supplied by
branches of the ophthalmic and the maxillary
arteries.
• The skin of the ala and the lower part of the
septum are supplied by branches from the
facial artery.

17. Nerve Supply of the External Nose
• The infratrochlear and external nasal
branches of the ophthalmic nerve (CN V)
and the infraorbital branch of the
maxillary nerve (CN V).

19. Nasal valves
External valve

20. Internal valve
The junction of the
upper lateral cartilages
with the nasal septum
forms the internal nasal
valve. This valve angle
should be between 10
and 15° for adequate
nasal airflow

21. Nasal Cavity
It has :
1. floor
2.roof
3.lateral wall
4.medial (septal) wall
It has 3 region :
1. vestibular
2. olfactory
3. respiratory

22. Nasal vestibule:-
- dilation inside aperture of nostril
- bounded laterally by alar, and lower nasal cartilage.
- lined with skin, coarse hair and sebaceous gland ,
sweet gland .
- limited above and behind by curved elevation called
limen nasi.
Olfactory region :-
limited to superior nasal concha opposite part of septem ,
interventing roof. Present in roof , less vascular and
appear yellow in color.
Respiratory region:
The rest of cavity , very vascular red in color to warm the
air.

23. The Floor of Nasal Cavity
• Palatine process maxilla
• Horizontal plate
palatine bone

25. The Roof of Nasal Cavity
• Narrow
• It is formed
– anteriorly beneath the bridge
of the nose by the nasal and
frontal bones,
– in the middle by the
cribriform plate of the
ethmoid,
– located beneath the anterior
cranial fossa,
– posteriorly by the downward
sloping body of the sphenoid

26. The Medial Wall of Nasal Cavity
The Nasal Septum
• Divides the nasal cavity into
right and left halves
• It has osseous and
cartilaginous & soft tissue
parts
• Nasal septum consists of
1- Bony septum :consists of the
perpendicular plate of the
ethmoid bone (superior), the
vomer (inferior)
2- Septal cartilage (anterior)
3- Membranous septum : fibrous
tissue attaching the septal
cartilage to the medial crura
Perpendicular
Plate (ethmoid)
Septal
Cartilage
Vomer
Nerve supply of nasal septum :
Anterior superior part by anterior ethmoidal
nerve
Posterior inferior part by sphenopalatine nerve

27. The Nasal Septum

28. The Lateral Walls of Nasal Cavity
- it is formed from :
1- medial surface of
maxilla.
2- ethmoid bone :
- superior concha
- middle concha
3- inferior concha.
4- lacrimal bone.
5- perpendicular plate of
palatine.
6- medial pterygoid plate.

29. The Lateral Walls of Nasal Cavity
Superior meatus and concha:-
- it is shortest , shallowest of 3 meatus.
- behind superior meatus is sphenopalatine
from a men which open into ptergo palatine
fossa.
Middle concha and meatus :-
- much larger articulated with perpendicular
plate of palatine bone.
- at its upper part occupy by elevation called
bulla ethmaidal which contain middle
ethmaidal air cells. The opening of maxillary
sinus is situated below bulla ethmaidal near the
posterior end of hiatus semilunaris.
- hiatus semilunaris which leads upward and
fore ward into curved chaunel called ethmaidal
infundibalam , in which anterior ethmaid sinus
open in infundibalam .frontal sinus open
through infundibalam into anterior end of
hiatus semilunaris
Inferior conchar:-
- articulate with nasal surface of maxilla.
- extend to floor of nasal cavity .
- it is largest of 3 meatus.
- naso lacrimal duct open drainexcess tear from
eye. Duct open 2cm . behind nostril.

30. The Lateral Walls of Nasal Cavity
1. Inferior meatus:
nasolacrimal duct
2. Middle meatus:
• Maxillary sinus
• Frontal sinus
• Anterior ethmoid sinuses
3. Superior meatus:
posterior ethmoid sinuses
4. Sphenoethmoidal recess:
sphenoid sinus

31. Openings Into the Nasal Cavity
Nasolacrimal Canal drains into
Inferior Meatus
Sphenoid sinus opens into
sphenoethmoidal recess
Posterior ethmoidal air cells
open into superior meatus
Anterior & middle ethmoid air
cells, maxillary and frontal
sinuses open into middle
meatus

33. Blood Supply to the Nasal Cavity
• From branches of the maxillary artery, one of the
terminal branches of the external carotid artery.
• The most important branch is the sphenopalatine
artery.
• The sphenopalatine artery anastomoses with the
septal branch of the superior labial branch of the
facial artery in the region of the vestibule.
• The submucous venous plexus is drained by veins
that accompany the arteries.

34. Blood Supply to the Nasal Cavity
Sphenopalatine a.
Maxillary a.
Netter, Frank H., Atlas of Human Anatomy. Ciba-Geigy Corporation, Summit, N.J. 1993. Plate 35.

35. Nerve Supply of the Nasal Cavity
• The olfactory nerves from the olfactory
mucous membrane ascend through the
cribriform plate of the ethmoid bone to the
olfactory bulbs .
• The nerves of ordinary sensation are branches
of the ophthalmic division (V1) and the
maxillary division (V2) of the trigeminal nerve.

36. Nerve Supply of the Nasal Cavity
CN I – Olfactory Nerves (SVA)
Anterior ethmoidal
branch of V1
Posterior nasal
branches of V2
Cut nasopalatine
branch of V2 to
septum

37. Lymph Drainage of the Nasal Cavity
• The lymph vessels draining the vestibule end
in the submandibular nodes.
• The remainder of the nasal cavity is drained by
vessels that pass to the upper deep cervical
nodes.