Surgical Anatomy of the Nose, Paranasal Sinuses, and Pterygopalatine Fossa
The nose is part of the upper portion of the upper respiratory tract and is divided into the external nose and the nasal cavity, from which the paranasal sinuses originate and extend. The external nose is that portion of the nose that emerges from the fac
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Surgical Anatomy of the Nose, Paranasal Sinuses, and Pterygopalatine Fossa JOAO
A.
CALDAS NAVARRO
in nasal shapes depend on the nasal contours, which are determined externally by the root, spine and nasal apex. The entrance of the nostril usually has an The nose is part of the upper portion of the upper oval shape, and in this region, there are several vibrespiratory tract and is divided into the external rissae, described as small hairs with tactile and pronose and the nasal cavity, from which the paranasal tective functions for the nose vestibule. sinuses originate and extend. The external nose is The term nasal pyramid is used because of the trithat portion of the nose that emerges from the face, angular pyramidal shape of the external nose. The and it is formed by an osteocartilaginous skeleton base of the pyramid is formed by the nostrils, and based on the frontal processes, maxillary palatines the corners are formed by the nasal spine; the rims and nasal bones. The cartilaginous portion is formed are implanted in the frontal and maxillary palatine by two pairs of large cartilage pieces (the superior processes, and the root originates from the junction and inferior lateral cartilages) and a variable number of the corners at the upper portion of the nasal of smaller or accessory cartilages. These pieces of bones. cartilage are attached to the nasal septal cartilage at The internal or nasal surface of the lateral nasal each side of the median sagittal plane (Fig. 2.1). The wall forms a triangle with its base inferior. The conarrangement of these anatomical elements keeps the cave nostril, covered by vibrissae, is found in this air pathway open at the aditus or nasal vestibules, inferior part (the vestibular region). Immediately which are externally seen as the nostrils. Differences above the nostril is what looks like an open arch to the nasal limen, a localized accumulation of fibrous tissue in the mucosa; the limen is the superior limit of the inferior alar cartilage. Just above the limen is an open regular area, the nasal aditus, which is anterior to the insertion of the middle and inferior nasal turbinates (Fig. 2.2). This region is formed by a very hard bone corresponding to the frontal process of the maxilla. The nostrils, formed by the inferior alar cartilages, are extremely motile and work as a valve system that is bordered internally and superiorly by the nasallimens [8,11,12,15,25,29,34]. The nasal cavity is described as a frustum pyramid with a larger inferior base (floor) and a smaller superior base (roof). It has a medial (septal) and a lateral (orbital) wall. It is divided into right and left nasal cavities by the nasal septum. Thus, the septum is the common medial wall of both cavities. The pyriform recess of the nasal cavity is bordered by the maxilla through its frontal and palatine processes. These processes meet in the median sagittal plane to form the anterior nasal spine; the frontal Fig. 2.1. The external nose. 1, Nasal bone; 2, superior lateral processes articulate medially with the two
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