Kristina Fatima Louise P. GarciaGroup 5A1

Develops as a diverticula of the lateral nasal wall

Extends to the maxilla, ethmoid, frontal and sphenoid bones

Reach maximum size at puberty and contribute to the definitive shape of the face

The maxillary sinus is the only sinus The maxillary sinus is the only sinus routinely present at birthroutinely present at birth

Conchae, Meatus and Septum sphenopalatine branch of the internal maxillary artery

Ethmoidal and Frontal Sinuses and Roof of the Nose anterior and posterior ethmoidal branches of the ophthalmic artery

Blood Supply:Blood Supply: Paranasal Paranasal SinusesSinuses

Maxillary Sinus a branch of superior labial artery; infraorbital and alveolar branches of the internal maxillary artery

Sphenoid Sinus pharyngeal branch of the internal maxillary artery

Blood Supply:Blood Supply: Paranasal Paranasal SinusesSinuses

Nerve SupplyNerve Supply

1. infraorbital nerve 2. posterior superior

alveolar nerve 3. pterygopalatine

ganglion (parasympathetic)

4. greater palatine nerve 5. lesser palatine nerve 6. cut nasopalatine

nerve 7. nerve of the

pharyngeal canal

• All of the nerves are sensory branches of V2. • The pterygopalatine ganglion is suspended from

V2 by two sensory roots. Since the ganglion is parasympathetic, there are preganglionic neurons feeding into it from the facial nerve (greater petrosal branch) that synapse at this point then continue onward as postganglionic neurons.

• Their destination is the lacrimal nerve and reach there by rejoining the maxillary nerve through a sensory root, hopping onto the zygomatic nerve (V2), running up the lateral side of the orbit to jump onto the lacrimal nerve (V1) and then to the lacrimal gland to produce tears.

Olfaction Chemical Theory Undulation Theory Sinuses have no obvious physiologic

function. Airway Resistance

Variations in nasal resistance are due primarily to changes in the erectile tissues of the turbinates

Air Conditioning Inspired air is warmed (or cooled) to near

body temperature and its relative humidity is brought to near 100 percent.

Air Purification Hairs or vibrissae Solubility of gases

PhysiologyPhysiology

Mucociliary Function Transport of foreign particles is carried out

via action of cilia moving the mucous blanket with its entrapped particles

Pulmonary Correlations

Speech Modification

PhysiologyPhysiology

Clinical Picture Signs and symptoms

depend upon the sinuses involvedMaxillary = maxillary sinus and the adjacent midface and temple

Ethmoid = over bridge of the nose and medial canthus of the eye

Frontal = over the anterior wall and floor of the frontal sinus with pain radiating to the medial canthus

Sphenoid = non-specific, marked by dull, aching pressure located at the center of the skull and radiating to the occiput

Acute SinusitisAcute Sinusitis

Diagnostics Rhinoscopy or nasal endoscopy Sinus radiograph

Acute SinusitisAcute Sinusitis

Acute SinusitisAcute Sinusitis

CT Scan MRI

Management Conservative: antibiotics, analgesics and

decongestants Surgical: maxillary sinus puncture following

decongestion and topical anesthesia of the nasal mucosa Sharp puncture, Blunt puncture, Beck

puncture

Acute Sinusitis

Chronic inflammatory, allergic, traumatic, neoplastic

Impaired ventilation of the ostiomeatal unit due to stenosis and obstruction Poor drainage > swollen mucosa esp at the

narrow anatomical passages > recurrent bouts of inflammation > persistent, chronic sinusitis

DiagnosisDiagnosis Rhinoscopy, Endoscopy

Turbinate hyperplasia, pneumatized middle turbinate, concha bullosa, change in appearance of ostiomeatal unit, change in the nasal septum

CT Scan TreatmentTreatment

Decongestants, heat therapy, antibiotics, mucolytics

Sinus surgery – definitive treatment Endoscopic sinus surgery

Mucocele – cystlike, mucus containing sac that can form within the paranasal sinus

Pyocele – mucocele containing purulent material (superinfection)

Caused by adhesions or mass lesions that obstruct drainage from the paranasal sinus system Frontal > Ethmoid > Maxillary > Sphenoid

Obstruction > INC pressure on sinus wall > thinning of bone > erosion of mass

Clinical PictureClinical Picture Frontal: isolated, tense swelling over the ant. wall of the

frontal sinus, inferolateral displacement of orbital contents

Maxillary: swelling in the cheek area, upward displacement of orbital contents

Sphenoid: non-specific DiagnosticsDiagnostics

Prior surgical history, clinical appearance CT, MRI

TreatmentTreatment Surgical removal

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