Arteries of the nose. Blood supply and lymph drainage of the nasal cavity

External nosenasus externus, includes the root, dorsum, apex and wings of the nose.

External nose anatomy

The root of the nose,radix nasi, separated from the forehead by a notch - nose bridge.

The lateral sides of the outer nose are connected along the midline and form the back of the nose,dorsum nasi, and the lower parts of the sides are nose wings,alae nasi.

Downward, the back of the external nose passes into the top of the noseapex nasi.

The wings of the nose with their lower edges limit nostrils,nares... Along the midline, the nostrils are separated from each other by the movable (membranous) part of the nasal septum.

The outer nose has a bony and cartilaginous skeleton, formed by the nasal bones, the frontal processes of the upper jaws and several hyaline cartilages. The root of the nose, the upper part of the back and sides of the outer nose have a bony skeleton, and the middle and lower parts of the back and sides are cartilaginous.

Cartilage of the nose

Cartilage of the nose: lateral nasal cartilage, cartilago nasi laterdlis, large cartilage of the wing of the nose, cartildgo alaris major, small cartilage of the wing, cartilagines aldres minores, accessory nasal cartilage, cartilagines nasdles accessoriae, cartilage of the septum of the nose, cartildgo septi ndsi.

Mucous membrane of the nose

tunica mucosa nasi, tightly fused with the periosteum and perichondrium of the walls of the nasal cavity. In the mucous membrane of the nasal cavity, the olfactory region is isolated, regio olfactoria, and the respiratory area, regio respiratoria. The olfactory region includes a part of the nasal mucosa, covering the right and left upper nasal concha and part of the middle ones, as well as the corresponding upper part of the nasal septum. The rest of the nasal mucosa belongs to the respiratory area.

Vessels and nerves of the nasal mucosa

The mucous membrane of the nasal cavity is supplied with blood by the branches of the sphenoid-palatine artery from the maxillary artery, paired anterior and posterior ethmoid arteries from the ophthalmic artery. Venous blood from the mucous membrane flows through the sphenoid-palatine vein, which flows into the pterygoid plexus. Lymphatic vessels from the nasal mucosa are directed to the submandibular and submental lymph nodes. Sensitive innervation of the mucous membrane of the nasal cavity (anterior part) is carried out by the branches of the anterior ethmoid nerve from the nasal ciliary nerve. The posterior part of the lateral wall and septum of the nasal cavity is innervated by the branches of the nasopalatine nerve and the posterior nasal branches from the maxillary nerve. The glands of the nasal mucosa are innervated from the pterygopalatine node, the posterior nasal branches and the nasopalatine nerve from the autonomic nucleus of the intermediate nerve (part of the facial nerve).

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In childhood, as a rule, up to 5 years, the nasal septum is not curved, and in the future, due to the uneven growth of the bone and cartilaginous parts of the nasal septum, its pronounced deviation occurs to varying degrees. In adults, more often in men, the curvature of the nasal septum is observed in 95% of cases.

The upper wall of the nasal cavity in the anterior sections is formed by the nasal bones, in the middle section - by the ethmoid plate of the ethmoid bone (lamina cribrosa ossis ethmoidals). This is the narrowest part of the roof of the nasal cavity - only a few millimeters wide. The upper wall is very thin, and with careless surgical interventions in the nasal cavity, damage to this thin plate with the occurrence of nasal liquorrhea is possible. With an associated infection, inflammation of the meninges is possible. The upper wall is permeated with a large number (25-30) of small holes, passing into the nasal cavity fibers of the olfactory nerve (fila olphactoria) and the vein accompanying the ethmoid artery (a. Ethmoidals) - a source of possible profuse nosebleeds.

The lower wall of the nasal cavity delimits the nasal cavity from the oral cavity. It is formed by the palatine process of the upper jaw and the horizontal plate of the palatine bone. The width of the bottom of the nasal cavity in an adult is 12-15 mm, in a newborn - 7 mm.

Posteriorly, the nasal cavity communicates through the choanae with the nasal part of the pharynx; in a newborn, choanas have a triangular or rounded shape measuring 6x6 mm2, and by the age of 10 they double. In young children, the nasal passages are narrowed by the turbinates. The inferior turbinate fits tightly to the bottom of the nasal cavity, therefore, in young children, even a slight inflammation of the nasal mucosa leads to a complete shutdown of nasal breathing, a disorder of the sucking act.

The mucous membrane of the nasal cavity lines two conventionally distinguished zones - olfactory and respiratory. The respiratory region (regio respiratoria) captures the lower parts of the nasal cavity (from the bottom of the nose to the upper parts of the middle concha and opposite the lower part of the nasal septum). The mucous membrane of the respiratory zone is firmly connected with the underlying bone and cartilage formations.

The thickness of the mucous membrane of the respiratory zone is about 1 mm. The submucosa is absent. The mucous membrane of the nasal cavity is formed by cells of the ciliated epithelium, as well as a large number of goblet and basal cells. On the surface of each cell of the ciliated epithelium there are 200-300 cilia, which perform 160-250 vibrations per minute. These cilia oscillate in the direction of the posterior portions of the nasal cavity, towards the choanas. In inflammatory processes, metaplasia of the cells of the ciliated epithelium into the goblet is possible. Basal cells contribute to the regeneration of the nasal mucosa.

Normally, the nasal mucosa releases about 500 ml of fluid during the day, which is necessary for the normal functioning of the nasal cavity. In inflammatory processes, the secretion capacity of the nasal mucosa increases many times. Under the lining of the mucous membrane of the nasal concha is a tissue consisting of a plexus of small and large blood vessels - a "ball" of dilated veins, reminiscent of cavernous tissue. The walls of the veins are richly supplied with smooth muscle cells, which are innervated by the fibers of the trigeminal nerve and, under the influence of stimulation of its receptors, can contribute to the filling or emptying of the cavernous tissue, mainly of the inferior turbinates.

In the anteroinferior part of the nasal septum, a special zone with an area of ​​about 1 cm2 can be distinguished, where there is a large accumulation of arterial and especially venous vessels. This bleeding area of ​​the nasal septum is called the "Kisselbach site", it is from this area that nosebleeds most often occur.

The olfactory region (regio olphactoria) captures the upper parts of the middle shell, the entire upper shell and the upper part of the nasal septum located opposite it. Axons (non-fleshy nerve fibers) of the olfactory cells in the form of 15-20 thin nerve filaments pass through the openings of the ethmoid plate into the cranial cavity and enter the olfactory bulb. Dendrites of the second neuron approach the nerve cells of the olfactory triangle and reach the subcortical centers. Further, from these formations, the fibers of the third neuron begin, reaching the pyramidal neurons of the cortex - the central parts of the olfactory analyzer near the paraterminal gyrus.

Blood supply to the nasal cavity

The blood supply to the nasal cavity is carried out by the branches of the maxillary artery (a.ta-xilaris). From it departs the wedge-palatine artery (a. Sphenopalatina), entering the nasal cavity through the hole of the same name approximately at the level of the posterior end of the middle shell. It gives branches for the lateral wall of the nose and the nasal septum, through the incisal canal anastomoses with the great palatine artery (a. Palatina major) and the artery of the upper lip (a. Labia sup.). In addition, the anterior and posterior ethmoid arteries (aa. Etmoidalia), extending from the superior ocular artery (a. Ophtalmica sup.), Which is a branch of the internal carotid artery (a. Carotis int.), Penetrate into the nasal cavity.

1 - kisselbach place

Thus, the blood supply to the nasal cavity is carried out from the system of the internal and external carotid arteries, therefore, the ligation of the external carotid artery does not always lead to stopping persistent nosebleeds.

The veins of the nasal cavity are located more superficially relative to the arteries and form several plexuses in the mucous membrane of the nasal concha and the nasal septum, one of which is the Kisselbach place. In the posterior portions of the nasal septum, there is also an accumulation of venous vessels of a larger diameter.

The outflow of venous blood from the nasal cavity goes in several directions. From the posterior parts of the nasal cavity, venous blood enters the pterygoid plexus associated with the cavernous sinus (sinus cavernosus), located in the middle cranial fossa, therefore, if an infectious process occurs in the nasal cavity and nasal part of the pharynx, infection may spread into the cranial cavity.

From the anterior parts of the nasal cavity, venous blood enters the veins of the upper lip (w. Labiales), angular veins (w. Angulares), which also penetrate the cavernous sinus through the superior orbital vein. That is why, with a boil located at the entrance to the nose, it is also possible for the infection to spread into the cranial cavity, the middle cranial fossa.

The presence of a connection between the anterior and posterior veins of the ethmoid labyrinth with the veins of the orbit can cause the transition of the inflammatory process from the ethmoid labyrinth to the contents of the orbit. In addition, one of the branches of the anterior veins of the ethmoid labyrinth, passing through the ethmoid plate, penetrates into the anterior cranial fossa, anastomosing with the veins of the pia mater. Due to the dense venous network with numerous anastomoses in the border areas, it is possible to develop such severe complications as thrombophlebitis of the maxillofacial region, thrombosis of the veins of the orbit, thrombosis of the cavernous sinus, and the development of sepsis.

Lymphatic vessels

Lymphatic vessels drain lymph into the posterior parts of the nasal cavity, penetrate into the nasal part of the pharynx, bypassing the pharyngeal openings of the auditory tubes from above and below, and penetrate into the pharyngeal lymph nodes located between the prevertebral fascia with its own fascia of the neck in loose tissue. Some of the lymphatic vessels from the nasal cavity are sent to the deep cervical nodes. Suppuration of lymph nodes during inflammatory processes in the nasal cavity, paranasal sinuses, and also in the middle ear in childhood can lead to the development of pharyngeal abscesses. Metastases in malignant neoplasms of the nasal cavity and ethmoid labyrinth also have a certain localization due to the peculiarities of the lymph outflow: first, metastases appear in the pharyngeal lymph nodes, later an increase in lymph nodes along the internal jugular vein is observed.

Innervation of the nasal mucosa

Innervation of the nasal mucosa, in addition to the olfactory nerve, is carried out by the sensitive fibers of the optic and maxillary nerves (branch of the trigeminal nerve). The peripheral branches of these nerves, innervating the region of the orbit and teeth, anastomose with each other, therefore, pain may radiate from some zones innervated by the trigeminal nerve to others (for example, from the nasal cavity to the teeth and vice versa).

In the nasal cavity, there are departments:

Vestibule of the nasal cavity, vestibulum nasi

The actual nasal cavity, cavitas nasi propria

Areas of the nose:

1. Olfactory region, regio olfactoria - the area of ​​the mucous membrane within the upper turbinates, the upper part of the middle turbinates and the upper third of the nasal septum (contains olfactory receptors)

2. Respiratory region, regio respiratoria - a section of the mucous membrane from the lower wall of the nasal cavity to the middle of the middle turbinate.

Innervation of the nasal cavity:

A. Afferent innervation is provided by:

Anterior ethmoidal nerve, n.ethmoidalis anterior (from the nasal nerve, from the optic nerve). This nerve, through the hole of the same name, leaves the orbit into the cranial cavity, and then through the lattice plate enters the nasal cavity, where its nasal branches, rami nasales, innervate the mucous membrane of the anterior parts of the nasal cavity (septum and lateral wall) and the skin of the apex of the nose.

· The posterior ethmoidal nerve, n.ethmoidalis posterior - through the hole of the same name leaves the orbit (from the nasal nerve, from the optic nerve) innervates the mucous membrane of the posterior ethmoidal cells and the sphenoid sinus.

· Internal nasal branches, rr.nasales interni (branches of the maxillary nerve - V pair of FMN) go to the mucous membrane of the anterior parts of the nasal cavity.

· Posterior nasal branches, rr. nasales posteriores (branches of the maxillary nerve - V pair of FMN) pass into the nasal cavity through the wedge-palatine opening, innervate the mucous membrane of the posterior nasal cavity with fibers of general sensitivity. The largest branch of the posterior nasal branches is the nasopalatine nerve, n. nasopalatinus, passes forward along the nasal septum and passes through the incisal canal into the oral cavity.

B. Specific (olfactory) innervation

· I pair of cranial nerves - nn.olfactorii.

C. Sympathetic innervation is provided from the superior cervical node of the sympathetic trunk along the periarterial plexus (along the anterior and posterior ethmoid arteries and from the ophthalmic artery; along the lateral posterior nasal and posterior septal arteries from the sphenoid-palatine artery, the latter being a branch of the maxillary artery).

D. Parasympathetic innervation is provided from the pterygopalatine ganglion, ganglion pterygopalatinum. The preganglionic fiber is the large petrosal nerve, n.petrosus major (branch n.facialis, VII pair of FMN), which fits the pterygopalatine node through the pterygoid canal. Postganglionic branches depart from the node: medial and lateral superior posterior nasal nerves, rr.nasales posteriors superiors mediales et laterales penetrate through the pterygo-palatine opening together with sensitive branches and innervate the glands of the mucous membrane; lower posterior nasal branches, rr. nasales posteriores inferiores are branches of the greater palatine nerve, pass in the palatine canal and innervate the glands of the mucous membrane of the lower parts of the nasal cavity. It is important to note the importance of the pterygopalatine node and its connection: The node is located in the pterygo-palatine fossa. On its neurons, the parasympathetic preganglionic fibers of the large stony nerve end, which originate from the superior salivary nucleus. Part of the postganglionic fibers formed by the axons of this node, as part of the posterior nasal and palatine nerves, are directed to the glands of the nasal mucosa and hard palate, as well as to the lacrimal gland.

The nasal cavity has communications with other cavities through which the neurovascular structures pass:

1. Pterygo-palatine opening, foramen sphenopalatinum, nasal posterior superior medial and lateral branches, rami nasales posteriors superiores mediales et laterales - branches of the pterygopalatine node.

2. Incisal canal, canalis incisivus - nasopalatine nerve (branch of the pterygo-palatine node)

3. Openings of the lattice plate, foramina laminae cribrosae - nn.olfactorii (I pair).

Holes open into the nasal cavity paranasal sinuses:

1. Maxillary (Gaimorova), sinus maxillaris - in the middle nasal passage

2. Frontal sinus, sinus frontalis - in the middle nasal passage

3. Cells of the ethmoid bone, cellulae ethmoidales

Front and middle - in the middle nasal passage

Back - in the upper nasal passage

4. Sphenoid sinus, sinus sphenoidalis - in the upper nasal passage.

Innervation of the paranasal sinuses:

Maxillary (Haimor's) sinus, sinus maxillaris:

A. Afferent innervation is provided by:

Branches anterior and posterior of the ethmoid nerve (nn.ethmoidales anterior et posterior) from n.nasociliaris from n.ophtalmicus

Rami ganglionares n.maxillaris (rami nasales posteriores superiores mediales et laterales, rami nasales posteriores inferiores, which transit through the pterygopalatine node).

Rami nasales interni from n.infraorbitalis from n.maxillaris

B. Sympathetic innervation is provided from the upper cervical node of the sympathetic trunk along the arteries that vascularize the sinus:

A.nasalis posterior lateralis from a.sphenopalatina, a.alveolaris anterior superior from a.infraorbitalis - branches of a.maxillaris from a.carotis externa.

A.ethmoidalis anterior from a.ophtalmica from a.carotis interna

C. Parasympathetic innervation is provided by ganglion pterygopalatinum (from n.petrosus major - n.facialis branch).

Frontal sinus, sinus frontalis.

N.ethmoidalis anterior from n.nasociliaris from n.ophtalmicus;

N.supraorbitalis et supratrochlearis from n.frontalis from n.ophtalmicus

B. Sympathetic innervation is provided from the ganglion cervicale superior truncus sympaticus along the arteries vascularizing the sinus:

· A. supraorbitalis et supratrochlearis from a.frontalis

· A. ethmoidalis anterior - branches of a.ophtalmica from a.carotis interna

Sphenoid sinus, sinus sphenoidalis.

A. Afferent innervation is provided by fibers:

N.ethmoidalis posterior from n.nasociliaris from n.ophtalmicus;

A.nasalis posterior lateralis from a.sphenopalatina;

A.canalis pterygoidea from a.palatina discendens;

A.meningea media - branches of a.maxillaris from a.carotis externa;

C. Parasympathetic innervation is carried out from ganglion pterygopalatinum (from n.petrosus major - branch n.facialis).

Ethmoid cells, cellulae ethmoidales

A. Afferent innervation is provided by fibers:

Nn.ethmoidales posterior et anterior from n.nasociliaris from n.ophtalmicus;

Rr.nasales interni from n.infraorbitalis from n.maxillaris

B. Sympathetic innervation is provided from the ganglion cervicale superior truncus sympaticus along the arteries supplying the sinus:

A.ethmoidales anterior et posterior a.ophtalmica from a.carotis interna;

A.sphenopalatina from a.maxillaris externa;

C. Parasympathetic innervation is carried out from ganglion pterygopalatinum (from n.petrosus major - branch n.facialis).

Before proceeding with the description of the respiratory system, we present a drawing for consideration.

The human respiratory system (top - sagittal section of the nasal cavity, mouth and larynx): 1 - nasal cavity; 2 - oral cavity; 3 - larynx; 4 - trachea; 5 - left main bronchus; 6 - left lung; 7 - right lung; 8 - segmental bronchi; 9 - right pulmonary arteries; 10 - right pulmonary veins; 11 - the right main bronchus; 12 - pharynx; 13 - nasopharyngeal passage.

Upper respiratory tract

The upper respiratory tract includes the nasal cavity, the nasal part of the pharynx, and the oral part of the pharynx.

The nose, according to E. Alcamo, consists of the outer part, which forms the nasal cavity.

The outer nose includes the root, bridge, tip, and wings of the nose. The root of the nose is located in the upper part of the face and is separated from the forehead by the bridge. The sides of the nose along the midline are joined to form the bridge of the nose. Down the back of the nose passes into the top of the nose, below the wings of the nose limit the nostrils. In the midline, the nostrils are separated by the membranous part of the nasal septum.

The outer part of the nose (outer nose) has a bony and cartilaginous skeleton formed by the bones of the skull and several cartilages.

The nasal cavity is divided by the nasal septum into two symmetrical parts that open in front of the face with nostrils. From the back, through the choanas, the nasal cavity communicates with the nasal part of the pharynx. The septum of the nose is membranous and cartilaginous in front, and bony in the back.

Most of the nasal cavity is represented by the nasal passages, with which the paranasal sinuses (air cavities of the bones of the skull) communicate. Distinguish between the upper, middle and lower nasal passages, each of which is located under the corresponding turbinate.

The upper nasal passage communicates with the posterior cells of the ethmoid bone. The middle nasal passage communicates with the frontal sinus, maxillary sinus, middle and anterior cells (sinuses) of the ethmoid bone. The lower nasal passage communicates with the lower opening of the nasolacrimal canal.

In the nasal mucosa, the olfactory region is distinguished - a part of the nasal mucosa covering the right and left upper nasal concha and part of the middle, as well as the corresponding section of the nasal septum. The rest of the nasal mucosa belongs to the respiratory area. The olfactory area contains nerve cells that perceive odorous substances from the inhaled air.

In the front part of the nasal cavity, called the vestibule of the nose, there are sebaceous, sweat glands and short coarse hair - vibrises.

Nasal cavity

Depending on the structural features of the mucous membrane of the nasal cavity, the respiratory and olfactory sections are distinguished.

Respiratory department occupies the area from the bottom of the nasal cavity to the middle of the middle turbinate. Above this border, the ciliated columnar epithelium is replaced by a specific olfactory epithelium. The respiratory part of the nasal cavity is characterized by a large thickness of the mucous membrane. Its subepithelial section contains numerous alveolar-tubular glands, which, by the nature of the secretion, are divided into mucous, serous and mixed. The respiratory part of the mucous membrane is characterized by the presence of cavernous plexuses in its thickness - varicose-dilated venous sheaths with a muscular wall, due to which they can contract in volume. The cavernous plexus (cavernous bodies) regulate the temperature of the air passing through the nasal cavity. Cavernous tissue is contained in the thickness of the mucous membrane of the inferior turbinates, located along the lower edge of the middle turbinate, in the posterior parts of the middle and superior turbinates.
In the olfactory department, in addition to the specific olfactory epithelium, there are supporting cells that are cylindrical, but lack cilia. The glands in this part of the nasal cavity secrete a more liquid secretion than the glands in the respiratory part.

Blood supply to the nasal cavity carried out from the system of the external and internal carotid arteries. The main palatine artery originates from the first artery; passing through the main palatal opening into the nasal cavity, it gives off two branches - the posterior nasal lateral and septal arteries, which provide blood supply in the posterior parts of the nasal cavity, both lateral and medial walls. The ocular artery originates from the internal carotid artery, from which branches of the anterior and posterior ethmoid arteries branch off. The anterior ethmoidal arteries pass into the nose through the ethmoidal plate, the posterior ones through the posterior ethmoidal opening. They provide nutrition to the ethmoid labyrinth area and the anterior nasal cavity.
The outflow of blood is carried out through the anterior facial and ocular veins. Features of the outflow of blood often determine the development of orbital and intracranial rhinogenic complications. In the nasal cavity, especially pronounced venous plexuses are found in the anterior sections of the nasal septum.

Lymphatic vessels form two networks - superficial and deep. The olfactory and respiratory regions, despite their relative independence, have anastomoses. Lymphatic drainage occurs in the same lymph nodes: from the anterior regions of the nose to the submandibular, from the posterior to the deep cervical.

Sensitive innervation of the nasal cavity provide the first and second branches of the trigeminal nerve.

Anterior section the nasal cavity is innervated by the first branch of the trigeminal nerve (anterior ethmoid nerve - a branch of the nasal ciliary nerve). The nasal ciliary nerve from the nasal cavity penetrates through the nasal opening into the cranial cavity, and from there through the ethmoid plate into the nasal cavity, where it branches in the region of the nasal septum and the anterior sections of the lateral nasal wall. The outer nasal branch between the nasal bone and the lateral cartilage extends to the dorsum of the nose, supplying the skin of the outer nose.
Back sections the nasal cavities are innervated by the second branch of the trigeminal nerve, penetrating into the nasal cavity through the posterior ethmoid opening and branching into the mucous membrane of the posterior ethmoid cells and the sphenoid sinus. From the second branch of the trigeminal nerve, the nodal branches and the infraorbital nerve depart. The nodal branches are part of the pterygopalatine node, but most of them pass directly into the nasal cavity and innervate the posterior-superior part of the lateral wall of the nasal cavity in the region of the middle and superior nasal conchas, posterior cells of the ethmoid bone and sinus of the sphenoid bone in the form of rr. nasales.
A large branch runs along the septum of the nose in the direction from the back in front - nasopalatine nerve ... In the anterior parts of the nose, it penetrates through the incisal canal into the mucous membrane of the hard palate, where it anastomoses with the nasal branches of the alveolar and palatine nerves.
Secretory and vascular innervation it is carried out from the upper cervical sympathetic node, the postganglionic fibers of which penetrate into the nasal cavity as part of the second branch of the trigeminal nerve; parasympathetic innervation is carried out through the pterygopalatine node due to the nerve of the pterygoid canal. The latter is formed by the sympathetic nerve extending from the superior cervical sympathetic node, and the parasympathetic nerve originating from the geniculate node of the facial nerve.
Specific olfactory innervation carried out by the olfactory nerve. Sensory bipolar cells of the olfactory nerve (neuron I) are located in the olfactory region of the nasal cavity. The olfactory filaments extending from these cells penetrate into the cranial cavity through the ethmoid plate, where, when connected, they form an olfactory bulb, enclosed in the vagina, formed by the dura mater. The fleshy fibers of the sensitive cells of the olfactory bulb form the olfactory tract (2 neurons). Further, the olfactory pathways go to the olfactory triangle and end at the cortical centers.

External nose

The blood supply to the external nose is carried out as follows:
arterial blood comes from the system of the external and internal carotid arteries;
venous outflow occurs through the facial vein into the orbital vein, then into the cavernous sinus located in the cranial cavity and further into the internal jugular vein. This structure of the venous system is of great clinical importance, since it can contribute to the development of orbital and intracranial complications.
Lymphatic drainage from the tissues of the external nose is carried out mainly in the submandibular lymph nodes.
Innervation provided by the branches of the facial nerve, the first and second branches of the trigeminal nerve.
The blood supply to the external nose is provided by the ophthalmic artery, the dorsal nasal and facial arteries. Venous outflow is carried out through the facial, angular and partially ocular veins, which in some cases contributes to the spread of infection in inflammatory diseases of the external nose to the sinuses of the dura mater. Lymphatic drainage from the external nose occurs in the submandibular and upper parotid lymph nodes. The motor innervation of the external nose is provided by the facial nerve, the sensory one by the trigeminal (I and II branches).
The nasal cavity is lined with a mucous membrane that covers all the bony sections of the walls, and therefore the contours of the bony section are preserved. The exception is the vestibule of the nasal cavity, which is covered with skin and has hairs. In this area, the epithelium remains stratified, flat, as in the area of ​​the external nose. The mucous membrane of the nasal cavity is covered with multi-row cylindrical ciliated epithelium.

Paranasal sinuses

The paranasal sinuses are air cavities that are located around the nasal cavity and communicate with it through the outflow openings or ducts.
There are four pairs of sinuses:
maxillary,
frontal,
lattice maze and
wedge-shaped (basic).
The clinic distinguishes between the anterior sinuses (maxillary, frontal and anterior and middle ethmoid) and posterior (posterior ethmoid cells and sphenoid). Such a subdivision is convenient from the point of view of diagnosis, since the anterior sinuses open into the middle nasal passage, and the posterior ones - into the upper nasal passage.

Maxillary sinus, (she is a maxillary) located in the body of the maxillary bone, is a pyramid of irregular shape, measuring from 15 to 20 cm3.
Front or front wall The sinus has a depression called a canine fossa. A sinus opening is usually done in this area.
Medial wall is the lateral wall of the nasal cavity and contains a natural excretory opening in the region of the middle nasal passage. It is located almost under the roof of the sinus, which makes it difficult for the contents to drain and contributes to the development of stagnant inflammatory processes.
Top wall the sinus simultaneously represents the lower wall of the orbit. It is quite thin, often has bone openings, which contributes to the development of intraorbital complications.
Bottom wall formed by the alveolar process of the upper jaw and usually occupies the space from the second premolar to the second molar. The low position of the sinus floor contributes to the close position of the roots of the teeth to the sinus cavity. In some cases, the tops of the roots of the teeth will stand in the lumen of the sinus and are only covered with a mucous membrane, which can contribute to the development of odontogenic infection of the sinus, the ingress of filling material into the sinus cavity, or the formation of a persistent perforation during tooth extraction.
The posterior wall of the sinus is thick, bordered by the cells of the ethmoid labyrinth and the sphenoid sinus.

Frontal sinus is located in the thickness of the frontal bone and has four walls:
inferior orbital- the thinnest,
front- the thickest up to 5-8 mm (frontal bone)
back, separating the sinus from the anterior cranial fossa, and
internal- septum (septum between the frontal sinuses)
The frontal sinus communicates with the nasal cavity through a thin tortuous canal that opens into the anterior part of the middle nasal passage. The size of the sinus ranges from 3 to 5 cm3, and in 10-15% of cases it may be absent.

Lattice maze located between the orbit and the nasal cavity and consists of 5-20 air cells, each of which has its own outlet openings into the nasal cavity. There are three groups of cells: anterior and middle, opening in the middle nasal passage, and posterior, opening in the upper nasal passage.

Sphenoid, or main, sinus located in the body of the sphenoid bone, divided by a septum into two halves, which have an independent exit to the area of ​​the upper nasal passage. The cavernous sinus, the carotid artery, the intersection of the optic nerves, and the pituitary gland are located near the sphenoid sinus. As a result, the inflammatory process of the sphenoid sinus is a serious danger.

Has 6 walls:

Lower- makes up the vault of the nasopharynx and the vault of the nasal cavity

Upper- the lower surface of the sella turcica (pituitary gland), divided by a septum, there is an orifice

Front- wall of the sinus

Back- goes into the posterior basilar part of the occipital bone

Medial- sinus septum

Lateral- bordered by the internal carotid artery and the cavernous sinus (neurovascular bundle)

Blood supply paranasal sinuses occurs due to the branches of the external and internal carotid artery. The veins of the maxillary sinus form numerous anastomoses with the veins of the orbit, nose, sinuses of the dura mater.

Lymphatic vessels closely related to the vessels of the nasal cavity, the vessels of the teeth, the retropharyngeal and deep cervical lymph nodes.
Innervation carried out by the first and second branches of the trigeminal nerve.

Features of the structure of the paranasal sinuses in childhood
Newborns have only two sinuses: the maxillary sinus and the ethmoid labyrinth.
Maxillary sinus It is a fold of mucous membrane about 1 cm long at the inner corner of the orbit, laterally, under the lower wall of the orbit, there are two rows of primordia of primary and permanent teeth. By the end of the first year of life, the sinus takes on a rounded shape. By the age of 6-7 years, the teeth gradually take their position, and the sinus becomes multifaceted. In early childhood, the canine is closest to the sinus; at 6 years old, there are two premolars and a molar. By the age of 12, the volume of the sinus increases and the topography approaches that of an adult.
Lattice maze cells in newborns, they are in their infancy and fully develop by the age of 14-16.
Frontal and sphenoid sinuses in newborns are absent and begin to form from 3-4 years of age. The frontal sinuses develop from the anterior cells of the ethmoid labyrinth and by the age of 6 they have a volume of about 1 cm3. Sphenoid sinuses are formed from cells of the ethmoid labyrinth located in the body of the sphenoid bone. The final development of the sinuses ends by the age of 25-30.

Research methods:

Methods of transillumination of sinuses with white and red light

Anatomy of the nasopharynx

Nasopharynx- the upper part of the pharynx, the front border of which are the choans and the edge of the opener. Behind the nasopharynx there are 1 and 2 cervical vertebrae. The lower border of the nasopharynx is a mental continuation of the plane of the hard palate posteriorly. The mucous membrane of this part of the pharynx, like the mucous membrane of the nasal cavity, is covered with stratified squamous ciliated epithelium and contains a large number of mucous glands.
On the lateral wall of the nasopharynx are the mouths of the auditory tubes, around them there is an accumulation of lymphoid tissue - paired tubal tonsils. In the fornix of the nasopharynx is the third unpaired pharyngeal tonsil - adenoids, consisting of 5-9 cushion-like accumulations of lymphoid tissue up to 25 mm long. The greatest immunological activity of the pharyngeal tonsil is observed up to 5 years, and therefore adenotomy in young children is not desirable. In the presence of a deficiency of the immune system, an increase in adenoids is noted, which leads to the closure of the choanal lumen and difficulty in nasal breathing. The pharyngeal tonsil reaches its maximum size by the age of 12, after 15 years its atrophy begins, by the age of 20-25 only small areas remain.

Research methods:

1. Posterior rhinoscopy.

2. Digital examination of the nasopharynx

3. X-ray

4. Endoscopy.

Foreign bodies of the nose

Foreign body of the nose - a foreign object accidentally trapped in the nasal cavity: a bead, a berry seed, a seed, a small part of a toy, a mosquito or other insect, a piece of wood, plastic, food, cotton wool or paper. A nasal foreign body may be asymptomatic. But more often it is manifested by pain, one-sided nasal congestion and discharge from the affected half of the nose.