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Anatomy of the nose
In clinical and anatomical terms, the nose is divided into external and internal departments.
The external nose, nasus externus, is an important anatomical component of the face, largely determining its individual characteristics. The external shape of the nose is compared with a trihedral pyramid. In the outer nose, there are: 1) the root located between both eye sockets, 2) the tip (tip) of the nose, 3) the back of the nose, 4) the sides and wings of the nose, 5) the nostrils bounded by the wings of the nose, and 6) the nasal septum (Tonkov V.N., 1953). The outer nose consists of bone and cartilage (Fig. 2.1.1). The bony part is formed by paired nasal bones, os nasales, which, connecting along the midline, form the back of the nose. The back of the nose, dorsum nasi, the narrow convex part of the outer nose, extends from the root of the nose to its apex. The root of the nose, radix nasi, is located in the area of attachment of the nasal bones to the nasal part of the frontal bone. There is also a notch - the bridge of the nose, expressed in different people to one degree or another. Frontal processes of the upper jaw adjacent to the nasal bones, proc. frontales, which make up the lateral surfaces of the bony part of the external nose. Nasal bones, frontal processes, as well as the so-called nasal notches, incisurae nasales, upper jaws and anterior nasal spine, spina nasalis ant., participate in the formation of a pear-shaped opening, apertura piriformis, nose. Cartilage formations adjoin the edges of this opening, which complement the lateral surface of the nose, also called the slope. The cartilaginous part of the external nose includes: the upper rib of the quadrangular cartilage of the nasal septum, which is a continuation of the dorsum of the nose, paired lateral and large cartilage of the wing, as well as additional (sesamoid) cartilage. Lateral cartilage, having a triangular shape, make up the skeleton of the cartilaginous part of the external nose. With their medial edges, they pass into the cartilage of the septum of the nose. Actually, these cartilages are not independent formations, but represent two processes of the quadrangular cartilage of the nasal septum (Tonkov V.N., 1953). Clinicians-rhinologists adhere to the same opinion (Krylov BC, Bereznev A.V., 1969).
The large cartilage of the wing, along with the cartilage of the same name on the opposite side, forms the apex of the nose, apex nasi, and its nostrils, nares. Between the medial legs of large cartilage, separating the nostrils from one another, the front edge of the quadrangular cartilage is wedged. In some cases, diastasis between the medial socks of the large cartilage at the tip of the nose can be quite noticeable, which affects its appearance. The lateral leg of the large cartilage is wider and longer than the medial one and, having a convex shape, determines the appearance of the nose wing. The spaces between the lateral, large and sesamoid cartilages are filled with fibrous tissue, which forms the edge of the nostrils. Bone and cartilage of the outer nose are covered with skin. The inner surface of the vestibule of the nose is also lined with skin. The vestibule of the nose, vestibulum nasi, is formed by the inner surface of the wings of the nose and the anterior section of the cartilaginous part of the septum. In the skin covering it there are hairs, vibrissae, sebaceous glands. The vestibule of the nose is separated from the nasal cavity by a small protrusion - the threshold of the nasal cavity limen nasi, formed by the upper edge of the lateral leg of the large cartilage of the wing of the nose.
The cartilaginous part of the external nose is mobile. By reducing the group of facial muscles that make up the muscles of the circumference of the mouth, and the individual muscles of the nose, innervated by the facial nerve, it is possible to raise and lower the tip of the nose, expand and narrow the nostrils.
The inner nose, or nasal cavity, cavum nasi, is more complex than the outer nose. It is a space that extends in the sagittal direction from the pear-shaped aperture in front to the choanae at the back, divided by a partition into two halves. Through numerous holes and channels for the passage of blood vessels and nerves, the nasal cavity is connected to the anterior cranial fossa, orbits, pterygopalatine fossae and the oral cavity.
There are four walls of the nasal cavity: upper, lower, internal (medial) and lateral (lateral).
The nasal bones and nasal parts of the frontal bone form the upper wall of the nasal cavity in the anterior section, and the anterior wall of the sphenoid sinus in the posterior section. The middle part of the upper wall (the longest) is formed by a trellised plate. The trellis plate is almost always located below the upper edge of the trellis labyrinths and can easily be damaged by surgical interventions.
The lower wall - the bottom of the nasal cavity - is formed by the palatine process of the upper jaw and the horizontal plate of the palatine bone. At the front end of the bottom of the nasal cavity there is an opening in the incisal canal through which the nasolabial nerve passes, n. nasopalatinus, from the nasal cavity to the oral cavity. The horizontal plate of the palatine bone limits the choanas from below.
The inner (medial) wall of the nasal cavity is the nasal septum (Fig. 2.1.2). The nasal septum divides the common cavity into two, usually unequal, halves.
It consists of bone and cartilage. The bone section is formed by the perpendicular plate of the ethmoid bone, the crest (rostrum) of the sphenoid bone, the vomer, the nasal crest of the upper jaw and palatine bone. Most of the cartilaginous part of the nasal septum is formed by the cartilage of the septum, cartilago septi, a quadrangular plate of irregular shape. The most narrowed part of the cartilage, wedged between the perpendicular plate of the ethmoid bone and the vomer, is called the posterior (sphenoid) process, processus posterior (sphenoidalis). At the very beginning of the nasal septum (in anticipation), the medial legs of the large cartilage of the nose wing also participate in its formation.
The lateral wall of the nasal cavity in its structure is the most complex. It consists of the nasal bone, the nasal surface of the upper jaw body with its frontal process, the lacrimal and ethmoid bones, the perpendicular plate of the palatine bone and the medial plate of the pterygoid process of the sphenoid bone. On this wall there are three nasal concha dividing the upper, middle and lower nasal passages (Fig. 2.1.3). The lateral wall of the nasal cavity is separated from the nasopharynx by plica naso-pharyngea, otherwise called the choanal arch.
The space between the nasal septum and the nasal concha is called the common nasal passage.
The upper and middle nasal concha, concha nasalis superior et medialis, are elements of the ethmoid bone. Above and posterior to the superior nasal concha, there may be the highest nasal concha, concha nasalis suprema. The latter occurs with great frequency in newborns and undergoes reverse development in adults (Zuckerkandl F., 1882; Walker F.I., 1959).
In front of the middle nasal concha there is a small vertically located protrusion - agger nasi (threshold, shaft, nose elevation). Sometimes this ledge is barely noticeable, but it can be significant. In practice, it is important as a guideline for endonasal surgery.
The lower nasal concha, concha nasalis inferior, seu os turbinale, is an independent bone. It is attached in front to the upper jaw, and behind - to the palatine bone.
The upper and middle nasal turbinates limit the upper nasal passage, meatus nasi superior, into which the posterior cells of the ethmoid labyrinth open. A sphenoid-ethmoid recess (recessus spheno-ethmoidalis) adjoins the posterior part of the superior nasal passage, where the sphenoid sinus opens.
The space between the lower nasal concha and the lower wall of the nasal cavity is the lower nasal passage, meatus nasi inferior. This is the longest and most extensive of all nasal passages. Near its front end is the lower opening of the nasolacrimal canal.
Between the middle and lower nasal concha, the most clinically important and most complex middle nasal passage, meatus nasi media, is located.
On a macerated skull, this area corresponds to hiatus maxillaris. greatly narrowed due to a number of bone formations related to the ethmoid bone and lower nasal concha.
Areas of hiatus maxillaris, not covered by bone formations, form fontanelles (fountains), which are duplicature of fused layers of the mucous membrane of the nasal cavity and maxillary sinus. Usually there are two fountains - the front and the back, separated by the ethmoid process of the lower nasal concha.
Within the middle nasal passage is a half-moon shaped fissure, hiatus semilunaris, first described by N.I. Pirogov and called the oblique half-channel, semicanalis obliquus. The front and bottom slit is limited by the hook-shaped process, processus uncinatus, the ethmoid bone, which is the rudimentary residue of one of the nasal concha, well developed in mammals. This process connects to the ethmoid process, processus ethmoidalis of the inferior nasal concha. The back and top of the gap is limited by a convex formation - one of the cells of the ethmoid bone - the ethmoid bladder, bulla ethmoidalis, also representing a rudimentary shell. In the posterior-lower part of the lunar fissure there is an extension, tapering in the form of a funnel, at the bottom of which there is an outlet of the maxillary sinus, ostium maxillare.
Along with a permanent opening, an additional sinus opening, ostium maxillare accessorium, is often found.
The anterior orifice of the lunar cleft opens the outlet of the frontal sinus, ostium naso-frontale. In the middle nasal passage, the anterior cells of the ethmoid labyrinth also open. Sometimes, one of the anterior cells of the ethmoid labyrinth opens near the exit opening of the frontal sinus, which is of no small clinical importance. So, the inflammatory process and swelling of the mucous membrane in this part of the ethmoid labyrinth can contribute to dysfunction of the frontal nasal canal with all the consequences arising from this phenomenon.
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Anatomy of the nose
- Clinical anatomy of the external nose
The nose (nasus) consists of the external nose and nasal cavity. The external nasus (nasus externus) is represented by a bone-cartilaginous skeleton in the form of a pyramid (Fig. 1.1), covered with skin. It distinguishes the tip, root (bridge of the nose), back, slopes and wings. Fig. 1.1. Outer nose. a - front view: 1 - nasal bone; 2 - frontal process of the upper jaw; 3 - triangular lateral
- Clinical anatomy of the nasal cavity
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- CLINICAL ANATOMY OF THE NOSE AND NANOSAXIS
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