Glands of the vestibule of the nose. Clinical anatomy of the nose. The structure of the outer part
10-01-2013, 20:57
Description
External nose consists of a cartilaginous (mobile) part and a bone skeleton formed in the upper section by the nasal processes (processes nasales) of the frontal bone and the nasal bones, to which the frontal processes of the maxillary bone adjoin from below and from the side.The cartilaginous part is composed of a number of cartilages (paired triangular and alar cartilages, as well as sesamoid, varying in both number and size).
Triangular lateral cartilage(cartilago triangularis) the medial side is parallel to the back of the nose; the lower part merges with the cartilaginous part of the nasal septum. The back of the triangular cartilage reaches the lower edge of the nasal bone, and its lower side borders on the upper edge of the alar cartilage.
Alar cartilages(cartilagines alares) of both sides, touching along the midline, form the tip of the nose and take part in the formation of the solid base of the wing of the nose, limiting the nasal openings - the nostrils (nares) of each side.
Cartilages are connected to each other by fibrous tissue.
The muscles of the external nose are located in the region of the nasal wings and serve to expand the entrance to the nose (mm. levatores alae nasi) and narrow the nasal openings (mm. compressores nasi et depressores alae nasi).
Blood supply to the external nose carried out through the branches of the external and internal maxillary arteries, namely a. dorsalis nasi (from a. ophthalmica - the system of the internal carotid artery), anastomosing with a. angularis, a branch of a. maxillaris externa (external carotid artery system), as well as from a. septi mobilis nasi (from a. labialis).
Blood from the veins of the external nose flows to the anterior facial vein. The venous system of the external nose is closely related to the venous system of the nasal mucosa.
The lymphatic system is connected to the submandibular and anterior parotid glands.
Motor innervation of the external nose carried out by branches of the facial nerve, and sensory fibers come from the ethmoid nerve (from n. ophthalmicus I branch of the trigeminal nerve) and lower orbital (from n. maxillaris - II branch of the trigeminal nerve) nerve to the cartilaginous part of the external nose and from the upper and lower orbital nerves to the bony skeleton of the nose.
The nasal cavity is located between the orbits, the oral cavity and the anterior cranial fossa (Fig. 1).
Rice. one. The skeleton of the nasal cavity; anterior sections. Front view (according to V.P. Vorobyov).
In front, it communicates through the anterior nasal openings with the outer surface of the face, and behind - through the choanae with the upper pharynx (nasopharynx). The nasal septum divides the nasal cavity into two non-communicating halves (right and left), each of which has an external opening and a choana (Fig. 2).
Rice. 2. The bony skeleton of the nasal cavity from behind (frontal cut through the anterior sections of the zygomatic arches).
The vestibule of the nasal cavity(vestibulum nasi). The skin covering the external nose tucks inward and retains its properties throughout the entire vestibule; it is covered with a significant number of hairs (vibrissae), especially in older men. Hairs are, to a certain extent, a filter that traps large dust particles, but in some cases they can become a source of development of boils, since staphylococci nest in the hair bulbs.
The entrance to the bony part of the nose (apertura piriformis) is pear-shaped, the edges of which are formed by the frontal processes of the upper jaw and the lower edges of both nasal bones.
The nasal cavity proper, being a continuation of the canal of the vestibule of the nose, bounded by a bony skeleton and covered by a mucous membrane. In addition to the nasopharynx, it communicates with the accessory cavities of the nose and through the foramen sphenopalatinum - with the pterygopalatine fossa, as well as with the lacrimal canal and through it with the conjunctival sac.
The channel of each half of the nasal cavity is limited by four walls: internal (common for both halves), external, upper (roof) and lower (bottom).
The inner, or medial, wall is the nasal septum. It consists of a perpendicular plate hanging downwards (lamina perpendicularis ossis ethmoidalis; Fig. 1, e, Fig. 2), supplemented downward and backward with a vomer (vomer; Fig. 3, b),
Rice. 3. Bony skeleton of the nasal cavity, posterior sections. Frontal cut through the temporal processes of the zygomatic bones (according to V.P. Vorobyov). a - choanae; b - coulter; in - opener wings; g - horizontal plate of the palatine bone; e - vertical plate of the palatine bone; e - crista turbinalis; g - maxillary sinus; h - mastoid process; and - zygomatic process of the temporal bone (sawed off); to - foramen sphenopalatinum; l - cells of the lattice labyrinth; m - opening of the main sinus; to - opening of the optic nerve.
and anteriorly - by a quadrangular cartilage, which, at the border of the nasal cavity and the vestibule, passes into the skin part of the septum. The last two sections make up the movable part of the nasal septum, as opposed to its fixed bony section (the posterior part of the septum). The outer wall of the nasal cavity, common with the inner wall of the maxillary sinus, is the most complex anatomically. Acquaintance with the topographic anatomy of the lateral wall of the nasal cavity is necessary not only for the rhinologist, but also for the ophthalmologist, since the lacrimal canal passes here.
outer wall(fig. 4 and 5)
Rice. four. The outer wall of the skeleton of the nasal cavity (according to V.P. Vorobyov). a - frontal sinus; b - nasal bone; c - spina frontalis; g - lacrimal bone; d - inferior nasal concha; e - canalis incisivus; g - alveolar process; h - crista galli; and - palatine process of the maxillary bone; to - lower nasal passage; l-middle nasal passage; m - upper nasal passage; n - middle nasal concha; o - superior nasal concha; p - main cavity; p - foramen sphenopalatinura; c - opening of the main sinus.
Rice. 5. The outer wall of the skeleton of the nasal cavity (after removal of the upper, middle and part of the lower nasal concha) (according to V.P. Vorobyov). a - frontal sinus; b - the probe from the frontal cavity protrudes into the lumen of the semilunar fissure; c - semicanalis obliquus (hiatus semilunaris); g - proc. uncinatus ossis ethmoidalis; e - bulla ethmoidalis; e - os lacrimale; g - lower nasal concha; h - probe in the lacrimal canal; and - canalis incisivus; k - palatine process of the maxillary bone; l - maxillary sinus; m - body of the main bone; to - Turkish saddle; o - opening of the optic nerve; p - main sinus; p - opening of the rear cells of the lattice labyrinth; c - sieve, or perforated, plate; m - opening of the anterior cells of the ethmoid labyrinth; y - middle nasal concha (cut off); f - superior nasal concha (cut off); x - opening of the main cavity.
formed by the nasal bone, the nasal (medial) surface of the body of the maxillary bone with its frontal process, the lacrimal bone, the ethmoid bone (with its upper and middle nasal conchas, bulla ethmoidalis et processus uncinatus), the vertical plate of the palatine bone and the pterygoid process of the sphenoid bone, which takes part in the formation of the choana. In addition to the superior and middle turbinates (Fig. 4, o and n), which belong to the ethmoid bone, on the outer wall of the nose there is an inferior turbinate (Fig. 4, e), which is an independent bone (os turbinale). It is attached with its upper edge in front to the linear protrusion (crista turbinalis; Fig. 3, e) on the frontal process of the upper jaw, and behind - to the crest of the palatine bone. Under the arch of the lower shell, the outlet of the lacrimal canal opens (Fig. 5, h).
When one of the anterior cells of the ethmoid labyrinth enters the anterior end of the middle shell, this shell takes the form of an inflated bubble (concha bullosa).
According to the three shells, three nasal passages are distinguished:
- inferior (the space between the inferior nasal concha and the floor of the nasal cavity),
- middle (between the middle and lower turbinates)
- and upper (above the middle shell) (Fig. 4, j, k, l).
The area bounded on the medial side by the nasal septum, and on the outer side by the shells, is called the common nasal passage (meatus nasi communis). It is customary to divide it into two sections: upper (regio olfactoria) and lower (regio respiratoria).
In clinical and diagnostic terms, the most important part of the outer wall of the nasal cavity is middle nasal passage(Fig. 4, l), into which the excretory openings of the maxillary and frontal cavities, as well as the anterior and partly middle cells of the ethmoid labyrinth, open.
On a macerated skull, this area corresponds to the hiatus maxillaris, which is significantly narrowed, since it is covered with bone formations (the uncinate process - proc. uncinatus of the ethmoid bone, processes of the inferior nasal concha). Places devoid of bone are covered with fontanelles (fountains), i.e., duplication of fused layers of the mucous membrane of the nasal and maxillary cavities. Usually there are two fontanelles, of which the posterior one is limited by the ethmoid process, the posterior end of the uncinate process and the perpendicular plate of the palatine bone, and the anterior one is located between the uncinate process, the inferior shell and its ethmoid process.
On a fresh preparation, after removal of the middle turbinate or part of it, a crescent-shaped or crescent-shaped slit (hiatus semilunaris; Fig. 5c) is visible, first described by N.I. Pirogov and called by him semicanalis obliquus.
It is limited in front and below by the above-mentioned uncinate process of the ethmoid bone (Fig. 5, d) with bone protrusions extending from it downward and backward, and behind and above by a bulge (bone bladder) of one of the cells of the ethmoid labyrinth (bulla ethmoidalis; Fig. 5). , e). Small gaps between the individual protrusions of the uncinate process lead to the maxillary sinus, and on a fresh preparation they are covered with a duplication of the mucous membrane. Only the posterior part of the semilunar fissure remains free from the mucous membrane and is a permanent opening of the maxillary sinus (ostium maxillare). In the posterior part of the semilunar fissure there is an extension that narrows towards the maxillary cavity in the form of a funnel (infundibulum), at the bottom of which is the outlet of the maxillary sinus (ostium maxillare).
Along with a permanent hole, it is not uncommon to see accessory opening of the maxillary sinus(ostium maxillare accessorium), also opening into the middle nasal passage.
The outlet of the frontal cavity (ductus naso-frontalis; Fig. 5b) opens into the anterior-upper part of the semilunar fissure.
The anterior and part of the posterior cells of the ethmoid labyrinth usually open on the anterior and posterior wall of the semilunar fissure, as well as in the angle between the bulla ethmoidalis and the middle turbinate. Sometimes one of the anterior cells of the ethmoid labyrinth opens near the outlet of the frontal sinus.
We will dwell on the question of the options for the location of the excretory ducts of the accessory cavities in the middle nasal passage when we talk about the anatomy of the sinuses.
At empyema of the anterior sinuses, namely the maxillary and frontal sinuses, as well as the anterior and part of the middle cells of the ethmoid labyrinth, pus drains through the above excretory ducts and accumulates in the deepening of the semilunar fissure. Using rhinoscopy, it is possible in such cases to detect pus in the middle nasal passage.
The posterior and part of the middle cells of the ethmoid labyrinth, as well as the main cavity, open with their excretory openings into the upper nasal passage and into the recess located between the surface of the body of the sphenoid bone and the superior nasal concha (recessus spheno-ethmoidalis). The presence of pus detected during posterior rhinoscopy always indicates a purulent process in the posterior adnexal cavities of the nose.
The upper wall of the nasal cavity is mainly formed by sieve, or perforated, plate(lamina cribrosa), supplemented in front by the frontal and nasal bones, frontal processes of the upper jaw, and behind - by the anterior wall of the main cavity. The sieve, or perforated, plate (Fig. 5, c) is permeated with a large number of holes where the fila olfactoria pass, the fibers of the olfactory nerve penetrate the olfactory bulb (bulbus olfactorius) of the corresponding half of the nose, which lies on the cranial surface of the sieve plate, lateral to the cockscomb. Through the openings of the sieve plate from the nose, the anterior ethmoidal artery and the veins and nerve of the same name also penetrate into the cranial cavity.
Inferior wall of the nasal cavity formed by the palatine processes of the upper jaw (Fig. 2), supplemented posteriorly by horizontal plates of the palatine bone (Fig. 3d), and concave in the frontal and sagittal planes.
The mucous membrane covering the respiratory region of the nose, from the vestibule to the olfactory region, is covered with stratified cylindrical ciliated epithelium. The mucous membrane of the olfactory region, which extends to the surface of the upper shell, the upper part of the middle shell and the part of the nasal septum corresponding to these areas, is lined with a special olfactory epithelium, which consists of cells of two genera: olfactory and supporting. Olfactory cells are peripheral nerve receptors of the olfactory analyzer. The central processes of the olfactory cells, extending from the bottom of the flask, form olfactory fibers (fila olfactoria) in the holes of the sieve plate, through which they penetrate, heading to the olfactory nerve.
The arteries of the nasal cavity depart from the common and external carotid arteries.
Arterial nutrition provided a. sphenopalatina from a. maxillaris interna - VIII branch of the external carotid artery, which enters the nasal cavity from the fossa pterygopalatina through the foramen sphenopalatinum and splits here into aa. nasales posteriores with branches (a. nasalis posterior lateralis et a. nasalis posterior septi nasi) and on a. nasopalatina. Through these branches, the lower, middle and upper nasal conchas, their corresponding nasal passages, as well as part of the nasal septum are supplied with arterial blood.
The upper part of the outer wall of the nose and partially the septum receive blood from the anterior and posterior ethmoid arteries, which are branches of a. ophthalmica.
The veins of the nasal cavity repeat the course of the arteries of the same name. A large number of venous plexuses connect the veins of the nasal cavity with the veins of the orbit, skull, face and pharynx.
In the pathology of inflammatory diseases of the orbit, the connection of the anterior and posterior ethmoid veins with the veins of the orbit is of great importance, and through the ophthalmic veins there is a connection with the cavernous sinus. One of the branches of the anterior ethmoid vein, penetrating through the sieve plate into the cranial cavity, connects the nasal cavity, and with it the orbit, with the venous plexus of the pia mater.
The lymphatic system of the nasal cavity consists of superficial and deep layers of vessels that are connected with the subdural and subarachnoid space of the meninges.
Sensory innervation of the nasal cavity carried out by the II branch of the trigeminal nerve, as well as by the ganglion sphenopalatinum.
From the I branch of the trigeminal nerve (n. ophthalmicus and its branches n. nasociliaris) nn are sent to the nasal cavity. ethmoidales anterior et posterior, as well as rr. nasales mediales et laterales.
From the II branch of the trigeminal nerve (n. maxillaris) depart to the nasal cavity of the branch n. infraorbitalis - rr. nasales externi et interni.
From the olfactory epithelium of the mucous membrane of the nasal cavity, the nerve fibers (fila olfactoria) of each side go through the holes in the sieve plate to the olfactory bulb and further as part of the tractus olfactorius et trigonum olfactorium, forming a common trunk, first reach the subcortical centers of smell in the gray matter, and then the brain bark (gyrum hippocampus et gyrus subcallosus).
The connection between the innervation of the nasal cavity and the eye is provided through n. nasociliaris et ganglion nasociliare.
Sympathetic innervation stands in connection with the upper cervical sympathetic ganglion. Sympathetic fibers originating from the plexus caroticus are sent to the gasser node, and from there as part of n. ophthalmicus and n. maxillaris (I and II branches of the trigeminal nerve) penetrate the nasal cavity, paranasal sinuses and orbit. The bulk of the fibers are in the composition of n. maxillaris through the pterygopalatine node (ganglion spheno-palatinum), in which they are not interrupted, and then branch into the nasal cavity and paranasal sinuses. A smaller part of the fibers (anterior and posterior lattice nerves - branches of n. ophthalmicus) enters the nose through the corresponding openings on the inner wall of the orbit.
Parasympathetic fibers, starting in the corresponding centers of the medulla oblongata, are part of the facial nerve and along n. petrosus major reach the pterygopalatine node, where they are interrupted, and then in the form of postganglionic fibers reach the nasal cavity and orbit.
From the above data it follows that there is a close nervous connection between the nasal cavity, its paranasal sinuses and the orbit, which is carried out due to trigeminal sympathetic and parasympathetic innervation through ganglion cervicalis superior, ganglion Gasseri, ganglion, ciliaris (in the orbit) and ganglion sphenopalatinum (in nose).
Nosebleeds can occur unexpectedly, some patients have prodromal phenomena - headache, tinnitus, itching, tickling in the nose. Depending on the amount of blood lost, there are minor, moderate and severe (severe) nosebleeds.
Minor bleeding usually comes from the Kisselbach area; blood in a volume of several milliliters is released in drops for a short time. Such bleeding often stops on its own or after pressing the wing of the nose to the septum.
Moderate epistaxis is characterized by more abundant blood loss, but not exceeding 300 ml in an adult. At the same time, changes in hemodynamics are usually within the physiological norm.
With massive nosebleeds, the volume of blood lost exceeds 300 ml, sometimes reaching 1 liter or more. Such bleeding poses an immediate threat to the life of the patient.
Most often, epistaxis with large blood loss occurs with severe facial injuries, when the branches of the sphenopalatine or ethmoid arteries are damaged, which depart from the external and internal carotid arteries, respectively. One of the features of post-traumatic bleeding is their tendency to recur after a few days and even weeks. A large loss of blood during such bleeding causes a drop in blood pressure, increased heart rate, weakness, mental disorders, panic, which is explained by cerebral hypoxia. Clinical landmarks of the body's reaction to blood loss (indirectly - the volume of blood loss) are the patient's complaints, the nature of the skin of the face, blood pressure, pulse rate, and blood test indicators. With a slight and moderate blood loss (up to 300 ml), all indicators remain, as a rule, normal. A single blood loss of about 500 ml may be accompanied by slight deviations in an adult (dangerous in a child) - blanching of the skin of the face, increased heart rate (80-90 beats / min), lowering blood pressure (110/70 mm Hg), in In blood tests, the hematocrit, which quickly and accurately responds to blood loss, may decrease harmlessly (30-35 units), hemoglobin values remain normal for 1-2 days, then they may slightly decrease or remain unchanged. Repeated moderate or even minor bleeding for a long time (weeks) causes depletion of the hematopoietic system and deviations from the norm of the main indicators appear. Massive severe simultaneous bleeding with a blood loss of more than 1 liter can lead to the death of the patient, since compensatory mechanisms do not have time to restore the violation of vital functions and, first of all, intravascular pressure. The use of certain therapeutic methods depends on the severity of the patient's condition and the predicted picture of the development of the disease.
Cavum nasi, is a space that lies in the sagittal direction from the pyriform aperture to the choanae and is divided into two halves by a septum. The nasal cavity is bounded by five walls: superior, inferior, lateral and medial.
Top wall formed by the frontal bone, the inner surface of the nasal bones, the lamina cribrosa of the ethmoid bone and the body of the sphenoid bone.
bottom wall formed by the bony palate, palatinum osseum, which includes the palatine process of the upper jaw and the horizontal plate of the palatine bone.
Lateral wall formed by the body of the maxilla, the nasal bone, the frontal process of the maxilla, the lacrimal bone, the labyrinth of the ethmoid bone, the inferior nasal concha, the perpendicular plate of the palatine bone and the medial plate of the pterygoid process.
medial wall, or nasal septum, septum nasi osseum, divides the nasal cavity into two halves. It is formed by a perpendicular plate of the ethmoid bone and a plowshare, from above - by the nasal spine of the frontal bone, spina nasalis, from behind - by the sphenoid crest, crista sphenoidalis, sphenoid bone, from below - by the nasal crest, crista nasales, upper jaw and palatine bone. The nasal cavity opens in front with a pear-shaped aperture, apertura piriformis, and behind with choanae. Choanae, choanae - paired internal openings of the nasal cavity that connect it to the nasal part of the pharynx.
On the lateral wall of the nasal cavity there are three nasal conchas: upper, middle and lower, concha nasalis superior, media et inferior. The upper and middle turbinates belong to the labyrinth of the ethmoid bone, the lower one is an independent bone. The listed shells limit three nasal passages: upper, middle and lower, meatus nasalis superior, medius et inferior.
superior nasal passage, meatus nasalis superior, lies between the upper and middle nasal conchas. The posterior cells of the ethmoid bone open into it. At the posterior end of the superior turbinate there is a cuneiform opening, foramen sphenopalatinum, leading to the fossa pterygopalatina, and above the superior turbinate there is a wedge-shaped depression, recessus spheno-ethmoidalis, in the region of which the sphenoid sinus, sinus sphenoidalis, opens.
middle nasal passage, meatus nasalis medius, located between the middle and lower nasal conchas. Within its limits, after the removal of the middle shell, a semilunar opening, hiatus semilunaris, opens. The posterior part of the semilunar foramen expands, at the bottom of which there is a hole, hiatus maxillaris, leading to the maxillary sinus, sinus maxillaris. In the anterior-upper part of the nasal cavity, the semilunar opening expands and forms a cribriform funnel, infundibulum ethmoidale, into which the frontal sinus, sinus frontalis, opens. In addition, the anterior and some middle ethmoidal cells open into the middle nasal passage and semilunar opening.
inferior nasal passage, meatus nasalis inferior, located between the bony palate and the inferior nasal concha. It opens the nasolacrimal canal, canalis nasolacrimal. In clinical (otolaryngological) practice, the maxillary sinus is punctured through the lower nasal passage for diagnostic and therapeutic purposes.
The slit-like space between the posterior turbinates and the bony nasal septum is called the common nasal passage, meatus nasi communis. The section of the nasal cavity, located behind the nasal conchas and the bony nasal septum, forms the nasopharyngeal passage, meatus nasopharyngeus, which opens into the posterior nasal openings - the choanae.
buttresses- these are bone thickenings in separate parts of the skull, combined with each other by transverse shifts, through which, during chewing, the pressure force is transmitted to the cranial vault. Buttresses balance the force of pressure that occurs during chewing, pushing and jumping. Between these thickenings are thin bone formations called weak spots. It is here that fractures most often occur during physical exertion, which does not coincide with the physiological acts of chewing, swallowing and speech. In clinical practice, fractures are more often observed in the region of the neck of the lower jaw, angle and upper jaw, as well as the zygomatic bone and its arch. The presence of holes, fissures and weaknesses in the bones of the skull determine the direction of these fractures, which is important to consider in maxillofacial surgery. In the upper jaw, the following buttresses are distinguished: fronto-nasal, collar-zygomatic, palatine and pterygopalatine; at the bottom - cellular and ascending.
The nose is the initial section of the upper respiratory tract and is divided into the external nose and the nasal cavity with paranasal sinuses.
The external nose consists of bony, cartilaginous and soft parts and has the shape of an irregular trihedral pyramid. The root of the nose is distinguished - the upper section connecting it with the forehead, the back - the middle part of the nose, going down from the root, which ends with the tip of the nose. The lateral convex and movable surfaces of the nose are called the wings of the nose; their lower free edges form nostrils, or external openings.
The nose can be divided into 3 sections: 1) external nose; 2) nasal cavity; 3) paranasal sinuses.
The external nose is called an elevation resembling an irregular trihedral pyramid in shape, protruding above the level of the face and located along its midline. The surface of this pyramid is made up of two lateral slopes, which descend towards the cheeks and converge along the midline, forming here a rounded rib - the back of the nose; the latter is obliquely directed anteriorly and downwards. On the third, lower surface of the pyramid are two nasal openings - nostrils. The upper end of the back of the nose, which rests against the forehead, is called the root of the nose, or nose bridge. The lower end of the back of the nose, where it meets the lower surface, is called the tip of the nose. The lower, movable section of each lateral surface of the nose is called the ala of the nose.
The skeleton of the external nose consists of bones, cartilage and soft tissues. The composition of the external nose includes paired nasal bones, frontal processes of the maxillary bones and paired cartilages: the lateral cartilage of the nose, the large cartilage of the alar of the nose and the small cartilages located in the posterior part of the alar of the nose.
The skin on the bony part of the nose is mobile, on the cartilaginous part it is inactive. The skin contains many sebaceous and sweat glands with wide excretory openings, which are especially large on the wings of the nose, where the mouths of their excretory ducts are visible to the naked eye. Through the edge of the nasal opening, the skin passes to the inner surface of the nasal cavity. The strip that separates both nostrils and belongs to the nasal septum is called the movable septum. The skin in this place, especially in the elderly, is covered with hair, which delays the penetration of dust and other harmful particles into the nasal cavity.
The nasal septum divides the nasal cavity into two halves and consists of bone and cartilage parts. Its bony part is formed by the perpendicular plate of the ethmoid bone and the vomer. The quadrangular cartilage of the nasal septum enters the angle between these bone formations. To the anterior edge of the quadrangular cartilage adjoins the cartilage of the greater wing of the nose, which is wrapped inwards. The anterior skin-cartilaginous section of the nasal septum, unlike the bone section, is mobile.
The muscles of the external nose in humans are rudimentary and have almost no practical significance. Of the muscle bundles that are of some importance, the following can be noted: 1) the muscle that lifts the wing of the nose - starts from the frontal process of the upper jaw and is attached to the posterior edge of the wing of the nose, partly passes into the skin of the upper lip; 2) narrowing the nasal openings and pulling down the wings of the nose; 3) a muscle that pulls the nasal septum down.
The vessels of the external nose are branches of the external maxillary and ophthalmic arteries and are directed towards the tip of the nose, which is rich in blood supply. The veins of the external nose drain into the anterior facial vein. The innervation of the skin of the external nose is carried out by the first and second branches of the trigeminal nerve, and the muscles - by the branches of the facial nerve.
The nasal cavity is located in the center of the facial skeleton and borders on top of the anterior cranial fossa, on the sides - on the eye sockets, and on the bottom - on the oral cavity. In front, it opens with nostrils located on the lower surface of the external nose, which have a variety of shapes. Posteriorly, the nasal cavity communicates with. the upper part of the nasopharynx through two adjacent oval-shaped posterior nasal openings, called choanae.
The nasal cavity communicates with the nasopharynx, with the pterygopalatine fossa, and with the paranasal sinuses. Through the Eustachian tube, the nasal cavity also communicates with the tympanic cavity, which determines the dependence of some ear diseases on the state of the nasal cavity. The close connection of the nasal cavity with the paranasal sinuses also causes the fact that diseases of the nasal cavity most often to one degree or another pass to the paranasal sinuses and through them can affect the cranial cavity and orbit with their contents. The topographic proximity of the cavity of the spit to the orbits and the anterior cranial fossa is a factor contributing to their combined damage, especially in trauma.
The nasal septum divides the nasal cavity into two not always symmetrical halves. Each half of the nasal cavity has inner, outer, upper and lower walls. The nasal septum serves as the inner wall (Fig. 18, 19). The outer, or side, wall is the most complex. There are three protrusions on it, the so-called nasal conchas: the largest is the lower, middle and upper. The inferior nasal concha is an independent bone; the middle and upper shells are processes of the ethmoid labyrinth.
Rice. 18. Anatomy of the nasal cavity: lateral wall of the nose.
1 - frontal sinus; 2 - nasal bone; 3 - lateral cartilage of the nose; 4 - middle sink; 5 - middle nasal passage; 6 - lower sink; 7 - hard palate; 8 - lower nasal passage; 9 - soft palate; 10 - pipe roller; 11 - Eustachian tube; 12 - Rosenmuller's fossa; 13 - main sinus; 14 - upper nasal passage; 15 - upper sink; 16 - cockscomb.
Rice. 19. Medial wall of the nose.
1 - frontal sinus; 2 - nasal bone; 3 - perpendicular plate of the ethmoid bone; 4 - cartilage of the nasal septum; 5 - sieve plate; 6 - Turkish saddle; 7 - main bone; 8 - coulter.
Under each turbinate there is a nasal passage. Thus, between the lower concha and the bottom of the nasal cavity is the lower nasal passage, between the middle and lower shells and the side wall of the nose - the middle nasal passage, and above the middle shell - the upper nasal passage. In the anterior third of the lower nasal passage, approximately 14 mm from the anterior edge of the shell, is the opening of the lacrimal canal. In the middle nasal passage, they open with narrow openings: the maxillary (maxillary) sinus, the frontal sinus and the cells of the ethmoid labyrinth. Under the upper shell, in the area of the upper nasal passage, the posterior cells of the ethmoid labyrinth and the main (sphenoidal) sinus open.
The nasal cavity is lined with a mucous membrane that continues directly into the paranasal sinuses. Two areas are distinguished in the mucous membrane of the nasal cavity: respiratory and olfactory. The olfactory region includes the mucous membrane of the upper concha, parts of the middle conch and the corresponding section of the nasal septum. The rest of the mucous membrane of the nasal cavity belongs to the respiratory region.
The mucous membrane of the olfactory region contains olfactory, basal and supporting cells. There are special glands that produce a serous secretion, which contribute to the perception of olfactory irritation. The mucous membrane of the respiratory region is tightly soldered to the periosteum or perichondrium. The submucosal layer is absent. In some places, the mucous membrane thickens due to cavernous (cavernous) tissue. This occurs most frequently in the region of the inferior turbinate, the free edge of the middle turbinate, and also the elevation on the nasal septum corresponding to the anterior end of the middle turbinate. Under the influence of a variety of physical, chemical or even psychogenic moments, the cavernous tissue causes an instant swelling of the nasal mucosa. By slowing down the speed of blood flow and creating conditions for stagnation, the cavernous tissue favors the secretion and release of heat, and also regulates the amount of air entering the respiratory tract. The cavernous tissue of the inferior turbinate is connected with the venous network of the mucous membrane of the lower part of the lacrimal canal. Swelling of the lower concha can therefore cause closure of the lacrimal canal and lacrimation.
The blood supply to the nasal cavity is carried out by branches of the internal and external carotid arteries. The ophthalmic artery departs from the internal carotid artery, entering the orbit and giving off the anterior and posterior ethmoid arteries there. From the external carotid artery departs the internal maxillary artery and the artery of the nasal cavity - the main palatine. The veins of the nasal cavity follow the arteries. The veins of the nasal cavity are also connected to the veins of the cranial cavity (hard and soft
meninges), and some flow directly into the sagittal sinus.
The main blood vessels of the nose pass in its posterior sections and gradually decrease in diameter towards the anterior sections of the nasal cavity. This is why bleeding from the back of the nose is usually more severe. In the initial part, right at the entrance, the nasal cavity is lined with skin, the latter folds inward and is provided with hairs and sebaceous glands. The venous network forms plexuses that connect the veins of the nasal cavity with neighboring areas. This is important in connection with the possibility of infection spreading from the veins of the nasal cavity to the cranial cavity, orbit, and to more distant areas of the body. Particularly important are venous anastomoses with the cavernous (cavernous) sinus located at the base of the skull in the region of the middle cranial fossa.
In the mucous membrane of the anteroinferior part of the nasal septum, there is the so-called Kisselbach place, which is distinguished by a rich arterial and venous network. The Kisselbach site is the most frequently traumatized site and is also the most common location for recurrent nosebleeds. Some authors (B. S. Preobrazhensky) call this place "the bleeding zone of the nasal septum." It is believed that bleeding here is more frequent because in this area there is a cavernous tissue with underdeveloped muscles, and the mucous membrane is more tightly attached and less extensible than in other places (Kisselbach). According to other data, the reason for the slight vulnerability of the vessels is the insignificant thickness of the mucous membrane in this area of the nasal septum.
The innervation of the nasal mucosa is carried out by sensitive branches of the trigeminal nerve, as well as branches emanating from the pterygopalatine node. From the latter, sympathetic and parasympathetic innervation of the nasal mucosa is also carried out.
The lymphatic vessels of the nasal cavity are connected with the cranial cavity. The outflow of lymph occurs partly to the deep cervical nodes and partly to the pharyngeal lymph nodes.
The paranasal sinuses include (Fig. 20) the maxillary, frontal, sphenoid sinuses and ethmoid cells.
Rice. 20. Paranasal sinuses.
a - front view; b - side view; 1 - maxillary (maxillary) sinus; 2 - frontal sinus; 3 - lattice labyrinth; 4 - main (sphenoidal) sinus.
The maxillary sinus is known as the maxillary sinus and is named after the anatomist who described it. This sinus is located in the body of the maxillary bone and is the most voluminous.
The sinus has the shape of an irregular quadrangular pyramid and has 4 walls. The anterior (facial) wall of the sinus is covered by the cheek and is palpable. The upper (orbital) wall is thinner than all the others. The anterior part of the upper wall of the sinus takes part in the formation of the upper opening of the lacrimal canal. The infraorbital nerve passes through this wall, which emerges from the bone in the upper part of the anterior wall of the sinus and branches in the soft tissues of the cheek.
The inner (nasal) wall of the maxillary sinus is the most important. It corresponds to the lower and middle nasal passages. This wall is pretty thin.
The lower wall (bottom) of the maxillary sinus is located in the region of the alveolar process of the upper jaw and usually corresponds to the alveoli of the posterior upper teeth.
The maxillary sinus communicates with the nasal cavity with one, and often two or more openings that lie in the middle nasal passage.
The frontal sinus is shaped like a trihedral pyramid. Its walls are as follows: front - anterior, posterior - border with the cranial cavity, lower - orbital, internal - forms a partition between the sinuses. Up the frontal sinus can rise to the scalp, outwards extends to the outer corner of the eyes, the fronto-nasal canal opens in the anterior part of the middle nasal passage. The frontal sinus may be absent. It is often asymmetrical, being larger on one side. In a newborn, it already exists in the form of a small bay, which increases every year, but their underdevelopment or incomplete absence (aplasia) of the frontal sinus occurs.
The main (sphenoid, sphenoidal) sinus is located in the body of the sphenoid bone. Its shape resembles an irregular cube. Its value varies greatly. It borders on the middle and anterior cranial fossae, with its bony walls adjacent to the cerebral appendage (pituitary gland) and other important formations (nerves, blood vessels). The opening leading to the nose is located on its front wall. The main sinus is asymmetric: in most cases, the septum divides it into 2 unequal cavities.
The lattice labyrinth has a bizarre structure. The cells of the ethmoid labyrinth are wedged between the frontal and sphenoid sinuses. Outside, the lattice labyrinth borders on the orbit, from which it is separated by the so-called paper plate; from the inside - with the upper and middle nasal passages; above - with the cavity of the skull. The size of the cells is very different: from a small pea to 1 cm 3 or more, the shape is also varied.
The cells are divided into anterior and posterior, the first of which open in the middle nasal passage. The posterior cells open in the superior nasal passage.
The ethmoidal labyrinth is bordered by the orbit, the cranial cavity, the lacrimal sac, the optic nerve, and other ophthalmic nerves.
1.2. Clinical anatomy of the nasal cavity
The nasal cavity (cavum nasi) is located between the mouth and anterior cranial fossa, and from the sides - between paired upper jaws and paired ethmoid bones. The nasal septum divides it sagittally into two halves, opening anteriorly with the nostrils and backwards, into the nasopharynx, with the choanae. Each half of the nose is surrounded by four paranasal sinuses: maxillary, ethmoidal labyrinth, frontal and sphenoid, which communicate on their side with the nasal cavity (Fig. 1.2). The nasal cavity has four walls: lower, upper, medial and lateral; posteriorly, the nasal cavity communicates with the nasopharynx through the choanae, remains open in front and communicates with the outside air through openings (nostrils).
Inferior wall (bottom of the nasal cavity) formed by two palatine processes of the upper jaw and, in a small area posteriorly, by two horizontal plates of the palatine bone (hard palate). Along an akin line, these bones are connected by a suture. Violations of this connection lead to various defects (non-closure of the hard palate, cleft lip). In front and in the middle in the bottom of the nasal cavity there is a nasopalatine canal (canalis incisivus), through which the nerve and artery of the same name pass into the oral cavity, anastomosing in the canal with the great palatine artery. This circumstance must be taken into account when performing submucosal resection of the nasal septum and other operations in this area in order to avoid significant bleeding. In newborns, the bottom of the nasal cavity is in contact with the tooth germs, which are located in the body of the upper jaw.
Upper wall (roof) the nasal cavity in front is formed by the nasal bones, in the middle sections - by the cribriform plate (lamina cribrosa) and the cells of the ethmoid bone (the largest part of the roof), the posterior sections are formed by the anterior wall of the sphenoid sinus. Threads of the olfactory nerve pass through the holes of the cribriform plate; the bulb of this nerve lies on the cranial surface of the cribriform plate. It must be borne in mind that in a newborn, lamina cribrosa is a fibrous formation that ossifies only by 3 years.
medial wall, or nasal septum(septum nasi), consists of the anterior cartilaginous and posterior bone sections (Fig. 1.3). The bone section is formed by a perpendicular plate (lamina perpendicularis) of the ethmoid bone and a vomer (vomer), the cartilaginous section is formed by a quadrangular cartilage, the upper edge of which forms the anterior part of the back of the nose. In the vestibule of the nose anteriorly and downward from the anterior edge of the quadrangular cartilage, there is a skin-webbed movable part of the nasal septum (septum mobile) visible from the outside. In a newborn, the perpendicular plate of the ethmoid bone is represented by a membranous formation, the ossification of which ends only by 6 years. The nasal septum is usually not exactly in the median plane. Significant curvature of it in the anterior section, more common in men, can cause breathing problems through the nose. It should be noted that in a newborn, the height of the vomer is less than the width of the choana, so it appears as a transverse slit; only by the age of 14, the height of the vomer becomes greater than the width of the choana and it takes the form of an oval, elongated upwards.
Structure lateral (outer) wall of the nasal cavity more complex (Fig. 1.4). In its formation take part in the front and middle parts medial wall and frontal process of maxilla, lacrimal and nasal bones, medial surface ethmoid bone, in the back, forming the edges of the choana, - the perpendicular process of the palatine bone and the pterygopalatine processes of the sphenoid bone. On the outer (lateral) wall are located three turbinates(conchae nasales): lower (concha inferior), middle (concha media) and upper (concha superior). The lower shell is an independent bone, the line of its attachment forms an arc convex upwards, which should be taken into account when puncturing the maxillary sinus and conchotomy. The middle and superior shells are processes of the ethmoid bone. Often the anterior end of the middle shell is swollen in the form of a bubble (conhae bullosa) - this is an air cell of the ethmoid labyrinth. Anterior to the middle shell there is a vertical bony protrusion (agger nasi), which can be expressed to a greater or lesser extent. All turbinates, attached with one lateral edge to the lateral wall of the nose in the form of oblong flattened formations, with the other edge hang down and medially in such a way that under them, respectively, the lower, middle and upper nasal passages are formed, whose height is 2-3 mm. The small space between the superior concha and roof of the nose, called the sphenoethmoid
Rice. 12. Sagittal section of the nose.
1 - upper knife stroke 2 - sphenoid sinus, 3 - superior nasal concha, 4 - pharyngeal mouth of the auditory rough, 5 - middle nasal passage 6 - additional fistula of the maxillary sinus 7 - hard chebo: 8 - inferior nasal concha; 9 - lower, axial passage 10 - vestibule of the nose; 11 - middle turbinate; 12 - frontal sinus and a bellied probe inserted into its lumen through the fronto-nasal canal
Rice. 13. nasal septum
Rice. 1.4. Lateral wall of the nasal cavity
1 - spruceous shell of the nasal cavity, 2 - perpecial plate of the ethmoid bone: 3 - triangular lateral cartilage. 4 - quadrilateral cartilage of the nasal septum 5 - small cartilage of the wing of the nose, 6 - medial pedicle of the superior cartilage of the wing of the nose. 1 - nasal crest 8 - sphenoid process of the cartilage of the nasal septum, 9 - vomer a - with a preserved structure of the relief 1 - sphenoid sinus 2 - up to the last cell of the sphenoid sinus; 3 - superior turbinate 4 vertices of the nasal passage, 5 - middle. concha; 6 - gular mouth of the onion tube; 7 - nasopharynx: 8 - palatine uvula; 9 - tongue i0 - hard palate, 11 - inferior nasal passage 12 - inferior nasal concha; 13 - additional suspicious fistula of the maxillary sinus.4 - uncinate process ; li - semilunar fissure 16 - ethmoid bulla; 17 - pocket of the ethmoid bulla; 18 - frontal sinus; (9 - cells of the ethmoid labyrinthusually referred to as the upper nasal passage Between the nasal septum and the turbinates there is a free space in the form of a gap (3-4 mm in size), which runs from the bottom to the roof of the nose - the common nasal passage
In a newborn, the lower concha descends to the bottom of the nose, there is a relative narrowness of all nasal passages, which leads to the rapid onset of difficulty in nasal breathing in young children, even with a slight swelling of the mucous membrane due to its catarrhal state
On the lateral wall of the lower nasal passage at a distance of 1 cm in children and 1.5 cm in adults from the anterior end of the shell is the outlet opening of the nasopharyngeal canal This hole is formed after birth, in case of delay in its opening, the outflow of tear fluid is disturbed, which leads to cystic expansion of the canal and narrowing of the nasal passages. with puncture of the maxillary
Rice. 1.4. Continuation.
b - with opened okojioi "ocobhin, sinuses: 20 - lacrimal sac; 21 - pockets of the maxillary hysukha: 22 - nasolacrimal canal; 23 - back to the aunt of the ethmoid labyrinth 24 - anterior cells of the ethmoid labyrinth 25 - obno-nasal canal.
sinuses) The posterior ends of the lower conchas come close to the pharyngeal mouths of the auditory (Eustachian) tubes on the side walls of the pharynx, as a result of which, with hypertrophy of the conchas, the function of the auditory tubes can be disturbed and their disease develops.
middle nasal passage located between the lower and middle shells, on its lateral wall there is a crescent-shaped (lunate) fissure (hiatus semilunaris), the posterior section of which is located below the anterior one (first described by N. I. Pirogov). This gap is opened in the posterior part - the maxillary sinus through the opening (ostium maxii-lare), in the anterior superior section - the opening of the canal of the frontal sinus, which does not form a straight line, which must be kept in mind when probing the frontal sinus. The crescent-shaped gap in the posterior part is limited by protrusion ethmoidal labyrinth (bulla ethmoidals), and in the anterior - hook-shaped process (processus uncinatus), which extends anteriorly from the anterior edge of the middle turbinate. The anterior and middle cells of the ethmoid bone also open into the middle nasal passage.
superior nasal passage extends from the middle concha to the roof of the nose and includes the sphenoethmoid space. At the level of the posterior end of the superior concha, the sphenoid sinus opens into the superior nasal passage through an opening (ostium sphenoidale). The posterior cells of the ethmoid labyrinth also communicate with the superior nasal passage.
The mucous membrane of the nasal cavity covers all its walls in a continuous layer and continues into the paranasal sinuses, pharynx and middle ear; she is does not have a submucosal layer, which is generally absent in the respiratory tract, with the exception of the subvocal region of the larynx. The nasal cavity can be divided into two sections: anterior - nasal vestibule(vestibulum nasi) and actually nasal cavity(cavum nasi). The latter, in turn, is divided into two areas: respiratory and olfactory.
The respiratory region of the nasal cavity (regio respiratoria) occupies the space from the bottom of the nose up to the level of the lower edge of the middle shell. In this area, the mucous membrane is covered with multi-row cylindrical ciliated epithelium.
Under the epithelium is the actual tissue of the mucous membrane (tunica propria), consisting of connective tissue collagen and elastic fibers. Here there are a large number goblet cells that secrete mucus, and tubular-alveolar branched glands that produce a serous or serous-mucous secret, which through the excretory ducts reaches the surface of the mucous membrane. Somewhat below these cells on the basement membrane are basal cells that do not undergo desquamation. They are the basis for the regeneration of the epithelium after its physiological and pathological desquamation (Fig. 1.5).
The mucous membrane throughout its entire length is tightly soldered ^, by the perichondrium or periosteum, which makes up with it whole, therefore, during the operation, the shell is separated together with these formations. In the region of the predominantly medial and lower sections of the inferior shell, the free edge of the middle shell and their posterior ends, the mucous membrane is thickened due to the presence of cavernous tissue, consisting of dilated venous vessels, the walls of which are richly supplied with smooth muscles and connective tissue fibers. Areas of cavernous tissue can sometimes occur on the nasal septum, especially in its posterior section. Filling and emptying of the cavernous tissue with blood occurs reflexively under the influence of various physical, chemical and psychogenic stimuli. Mucous membrane containing cavernous tissue
Rice. 1.5. The structure of the mucous membrane of the nasal cavity and paranasal sinuses.
1 - direction of the mucocyl stream; 2 - mucous membrane ieta 3 - periosteum ■ nita 4 - bone, 5 - vein, 6 - artery: 7 - arteriovenous shunt; 8 - venous sinus. 9 - postmucosal capillaries. 10 - goblet notch II - hair cell; 12 - liquid component of mucus: 13 - viscous (gel-like) component of mucus
can instantly swell (thereby increasing the surface and warming the air to a large extent), causing a narrowing of the nasal passages, or shrink, exerting a regulatory effect on the respiratory function. In children, cavernous venous formations reach full development by the age of 6. At a younger age, in the mucous membrane of the nasal septum, rudiments of Jacobson's olfactory organ are sometimes found, 2 cm from the anterior edge of the septum and 1.5 cm from the bottom of the nose. Cysts and inflammation can develop here.
The olfactory region of the nasal cavity (gegio olfactona) is located in its upper sections, from the vault to the lower edge of the middle turbinate. In this area, the mucous membrane covers olfactory epithelium, the total area of which in one half of the nose is about 24 cm ^. Among the olfactory epithelium in the form of islets is the ciliated epithelium, which performs a cleansing function here. The olfactory epithelium is represented by olfactory spindle-shaped, basal and supporting cells. The central fibers of spindle-shaped (specific) cells pass directly into the nerve fiber (fila olfactoria); the tops of these cells have protrusions into the nasal cavity - olfactory hairs. Thus, the spindle-shaped olfactory nerve cell is both a receptor and a conductor. The surface of the olfactory epithelium is covered with secretion of specific tubular-alveolar olfactory (Bowman) glands, which is a universal solvent of organic substances.
The blood supply to the nasal cavity (Fig. 1.6, a) is provided by the terminal branch of the internal carotid artery (a.ophthalmica), which in the orbit gives off the ethmoid arteries (aa.ethmoidales anterior et posterior); these arteries feed the anterior superior sections of the walls of the nasal cavity and the ethmoid labyrinth. The largest artery in the nasal cavitya.sphe-nopalatina(branch of the internal maxillary artery from the system of the external carotid artery), it leaves the pterygopalatine fossa through an opening formed by the processes of the vertical plate of the palatine bone and the body of the main bone (foramen sphenopalatinum) (Fig. 1.6, b), gives the nasal branches to the side wall of the nasal cavity, septum and all paranasal sinuses. This artery projects on the lateral wall of the nose near the posterior ends of the middle and inferior turbinates, which must be kept in mind when performing operations in this area. Features of vascularization of the nasal septum is the formation of a dense vascular network in the mucous membrane in the region of its anterior third (locus Kisselbachii), here the mucous membrane is often thinned (Fig. 1.6, c). From this place more than from other areas, nosebleeds occur, so it was called the "bleeding zone of the nose." Venous vessels accompany arteries. A feature of the venous outflow from the nasal cavity is its connection with the venous plexuses (plexus pterigoideus, sinus cavernosus), through which the nasal veins communicate with the veins of the skull, orbit and pharynx, as a result of which there is the possibility of infection spreading along these pathways and the occurrence of rhinogenic intracranial and orbital complications, sepsis, etc.
Lymph outflow from the anterior sections of the nose is carried out to the submandibular lymph nodes, from the middle and posterior sections to the deep cervical ones. It is important to note the connection of the lymphatic system of the olfactory region of the nose with the intershell spaces, carried out along the perineural pathways of the olfactory nerve fibers. This explains the possibility of meningitis after surgery on the ethmoid labyrinth.
Rice. 1.6. Blood supply to the cavity and nasal septum, the main hemorrhagic zones of the nasal septum
a - lateral wall of the leg posture: 1 - posterolateral nasal arteries; 2 - persneolateral nasal artery 3 - palatal artery 1 - greater palate nag arterig 5 - ascending palatine artery. 6 - small palatine artery; 7 - mainly palatine artery; b - medial wall of the nasal cavity; 8 - anterior ethmoid artery; 10 - mucous membrane of the nasal septum; 11 - upper jaw 12 - tongue 13 - lower jaw; 14 - pubic aptery of the tongue, 15 - lingual artery; 16 - posterior septal artery |: nasal ducts 17 - perforated (sieve) i lasta of the ethmoid bone 18 -; posterior ethmoidal artery in - blood supply to the septum of the nasal cavity 19 - Kisselbach zone 20 - dense network of anastomoses of the arteries of the nasal septum and the internal system main palatine artery.
In the nasal cavity, olfactory, sensory and secretory innervation is distinguished ) The parahippocampal gyrus (gyrus hippocampi), or the seahorse gyrus, is the primary center of smell, the hippo-cortex 
Fig 1.7. Innervation of the nasal cavity
1 - nerve of the pterygoid canal. 2 - infraorbital nE 3 - main-1 palatine nerve; 4 - posterolateral nasal quarters 5 - main palatine node 6 - postero-facial nasal quarters 7 - chadny palatine neov; 8 - middle palatine nerve; 9 - anterior palatine nerves: 10 - nasopalatine HepR 11 - nasal mucosa: 12 - oral mucosa; 13 - maxillofacial muscle; 14 - chin-lingual bowl; I5 - geniohyoid muscle; 16 - cranial hyoid nerve "17 - muscle straining the palatine backlash; 18 - internal pterygoid muscle; 19 - lingual nerve: 20 - internal pterygoid nerve; 21 - black cervical ganglion; nerr 24 - uishy knot 1 25 - drum string; 26 - jugular node vagus iero nerve, 27 - 111 pair of cranial nerves (i reddverno-cochlear nerve): 28 - facial nerve: 9 - large superficial pebble nerve. 30 - mandibular nerd: 31 - semilunar node; 32 - maxillary nerve; 33 - trigeminal nerve (large and small portions)
campa (Ammon's horn) and the anterior leforative substance are the highest cortical center of smell
Sensitive innervation of the nasal cavity is carried out by the first (n ophtalmicus) and second (n.maxillaris) branches of the trigeminal nerve (Fig. 1.7) vault of the nasal cavity. The second branch is involved in the innervation of the nose directly and through the anastomosis with the pterygopalatine node, from which the posterior nasal nerves depart mainly to the nasal septum. The inferior orbital nerve departs from the second branch to the mucous membrane of the bottom of the nasal cavity and the maxillary sinus. The branches of the trigeminal nerve anastomose with each other, which explains the irradiation of pain from the nose and paranasal sinuses to the area of the teeth, eyes, dura mater (pain in the forehead, back of the head), etc. The sympathetic and parasympathetic innervation of the nose and paranasal sinuses is represented by the nerve of the pterygopalatine canal (Vidian nerve), which originates from the plexus on the internal carotid artery (superior cervical sympathetic ganglion) and the geniculate ganglion of the facial nerve (parasympathetic portion).
| " |