. Nose

1. Respiratory system – an overview 2. Embryonic development of the respiratory system 3. Respiratory passages – structure principles 4. Nose: V external nose V 5. SPLANCHNOLOGY Respiratory system

° Respiratory system, systema respiratorium V gas exchange – negative pressure breathing ‹ conducting portion – respiratory tract ‹ respiratory portion – lungs V voice formation (phonation) – larynx V olfaction (sense of smell) – nasal cavity

Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY The air passages ° Conducting portion – respiratory tract: V Upper respiratory tract ‹ nasal cavity ‹ V Lower respiratory tract ‹ larynx ‹ trachea ‹ bronchi – external and internal ‹ distributing bronchioles ° Respiratory portion – lungs V respiratory bronchioles V alveolar ducts V alveolar sacs V alveoli ° Conditioning of the air: V warming V moistening V removal of particulate materials Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Embryonic development

° Embryogenesis of the upper respiratory tract – origin: V ectoderm of the foregut ‹ epithelium and nasal glands, nasopharynx V endoderm of the foregut ‹ epithelium and glands of oropharynx and hypopharynx V mesenchyme ‹ bony and cartilaginous frameworks o nasal prominences ° Nose: V frontonasal prominence Ù root V two medial nasal prominences Ù nasal dorsum and apex V two lateral nasal prominences Ù sidewalls and alae nasi V nasal (olfactory) placode Ù

Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Embryonic development

° Embryogenesis of the lower respiratory tract – 3rd week of pregnancy: V respiratory diverticulum (lung bud) V blind-ended sac ‹ larynx and trachea ‹ lung buds ° Larynx: V epithelium – endoderm of the foregut V cartilages and muscles – splanchnic mesoderm

Prof. Dr. Nikolai Lazarov 5 SPLANCHNOLOGY Embryonic development

° Embryogenesis of the lungs: V lung buds Ù bronchial buds – Hox genes ‹ bronchi and bronchioles – 4th mo. ‹ alveolar ducts and sacs – 6th mo. V endodermal epithelium V mesenchymal elements V maturation of lungs:

Prof. Dr. Nikolai Lazarov 6 SPLANCHNOLOGY Nose ° Nose – nasus (Gr. rhis, rhinos ): V both respiratory and olfactory organ V role in “forming” the timbre of the voice ° Anatomical parts: V external nose, nasus externus V nasal cavity, cavitas nasi

Prof. Dr. Nikolai Lazarov 7 SPLANCHNOLOGY External nose ° External nose, nasus externus: V side at the middle and upper parts of the face V generally pyramidal in shape V human trait – different types: ‹ straight, humpy and saddle nose ° Anatomical parts: V base, basis nasi V lateral side ‹ wings, alae nasi V dorsum, dorsum nasi ‹ root, radix nasi ‹ free tip, apex nasi V nostrils, nares V columella

Prof. Dr. Nikolai Lazarov 8 SPLANCHNOLOGY External nose framework

° Bony framework – : V nasal bones, ossa nasalia V frontal processes of maxilla ° Cartilaginous framework, cartilagines nasi: V unpaired ‹ septal cartilage, cartilago nasi septi V paired: ‹ lateral nasal cartilage, cartilago nasi lateralis ‹ major alar cartilage, cartilago alaris major ‹ minor alar cartilages , cartilagines alares minores ‹ cartilagines nasales accessoriae Prof. Dr. Nikolai Lazarov 9 SPLANCHNOLOGY External nose sidewall

° Nasal musculature – rudimentary muscles: V the procerus, m. procerus V the nasalis, m. nasalis V m. depressor septi nasi V m. apicis nasi – variable V m. compressor nares V m. levator labii superioris alaequae nasi ° Connective tissue ° Skin: V fine hairs V sweat glands V numerous large sebaceous glands

Prof. Dr. Nikolai Lazarov 10 SPLANCHNOLOGY External nose – clinical relevance

V crooked nose, rhinoscoliosis V saddle nose, rhinolordosis V humpy nose, rhinokyphosis V rhinophyma V trauma and fracture V squamous cell carcinoma V nasal anomalies

Prof. Dr. Nikolai Lazarov 11 SPLANCHNOLOGY Nasal cavity ° Nasal cavity, cavum (cavitas) nasi: V vestibule, vestibulum nasi V nasal cavity proper, cavum nasi proprium ° , septum nasi: V bony part, pars ossea ‹ vomer ‹ lamina perpendicularis ossis ethmoidalis V pars cartilaginea ‹ cartilago septi nasi ‹ cartilagines alares majores ‹ organum vomeronasale (Jacobsoni) – pheromones ‹ Kiesselbach’ s area V membranous part, pars membranacea ‹ nasal septum deviation, deviatio septi nasi Prof. Dr. Nikolai Lazarov 12 SPLANCHNOLOGY Vestibule of the nasal cavity

° Nasal cavity, cavum (cavitas) nasi: V entrance – nostrils, nares ‹ shape – racial trait V exit – posterior nasal apertures, choanae ° Nasal vestibule, vestibulum nasi: V limen nasi V V regio cutanea ‹ stiff hairs, vibrissae ‹ sweat and sebaceous glands V transition area ‹ stratified squamous Ù pseudostratified epithelium ‹ seromucous glands ‹ absent sweat and sebaceous glands Prof. Dr. Nikolai Lazarov 13 SPLANCHNOLOGY Nasal cavity proper ° Nasal cavity proper, cavitas nasalis ossea: V bone skeleton – walls ‹floor, inferior – hard palate ‹roof, superior wall: o nasal bone o ethmoid bone o sphenoid bone ‹medial wall – nasal septum ‹lateral wall: o maxilla o lacrimal bone o ethmoid labyrinth o palatine bone o sphenoid bone o conchae nasales, superior, media et inferior Prof. Dr. Nikolai Lazarov 14 SPLANCHNOLOGY Nasal cavity proper ° Nasal mucous membrane: V medial wall ‹respiratory segment, regio respiratoria ‹olfactory segment, regio olfactoria V lateral wall ‹nasal conchae ‹nasal meatuses: o meatus nasi superior o meatus nasi medius o meatus nasi inferior o meastus nasi communis o meatus nasopharyngeus ‹openings of the paranasal sinuses: o recessus sphenoethmoidalis o hiatus semilunaris, infundubulum, plica lacrimalis Prof. Dr. Nikolai Lazarov 15 SPLANCHNOLOGY Nasal cavity proper ° Nasal mucous membrane: V medial wall ‹respiratory segment, regio respiratoria ‹olfactory segment, regio olfactoria V lateral wall ‹nasal conchae ‹nasal meatuses: o meatus nasi superior o meatus nasi medius o meatus nasi inferior o meastus nasi communis o meatus nasopharyngeus ‹openings of the paranasal sinuses: o recessus sphenoethmoidalis o hiatus semilunaris, infundubulum, plica lacrimalis Prof. Dr. Nikolai Lazarov 16 SPLANCHNOLOGY Nasal cavity proper ° Microscopic anatomy: V olfactory segment – 5-10 mm2; yellowish-brown ‹, tunica mucosa o olfactory epithelium – • receptor (olfactory) cells • supporting cells (sustentacular) • basal cells – stem cells • brush cells o lamina propria • olfactory (Bowman ’s ) glands ‹absent submucosa, tela submucosa Prof. Dr. Nikolai Lazarov 17 SPLANCHNOLOGY Nasal cavity proper ° Microscopic anatomy: V respiratory segment, regio respiratoria – 1-3 mm ‹ lamina epithelialis – ciliated, pseudostratified columnar epithelium – five cell types: o ciliated cells o goblet cells o brush cells o small granule cells o basal cells ‹ lamina propria o nasal glands – seromucous, tubular o venous plexuses, stratum cavernosum Ù plexus cavernosi concharum Ù epistaxis o Kiesselbach’s area, locus Kiesselbachi o broad lymphatic network – lymphatic nodules Prof. Dr. Nikolai Lazarov 18 SPLANCHNOLOGY Blood supply of the nose

° External nose: V facial artery V ophthalmic artery ° Nasal cavity: V respiratory segment ‹ sphenopalatine artery (external carotid artery) V olfactory segment ‹ anterior and posterior ethmoidal arteries (internal carotid artery) ° Venous drainage: V facial and ophthalmic veins ° Lymphatic drainage: V deep neck lymph nodes (internal jugular vein) V retropharyngeal lymph nodes Prof. Dr. Nikolai Lazarov 19 SPLANCHNOLOGY Innervation of the nose ° Sensory innervation – trigeminal nerve: V ophthalmic nerve ‹nasal nerve V maxillary nerve ‹infraorbital nerve, infratrochlear nerve (root), anterior ethmoidal nerve ‹posterior nasal nerves ° Autonomic innervation: V sympathetic ‹carotid plexus V parasympathetic ‹pterygopalatine ganglion

Prof. Dr. Nikolai Lazarov 20 SPLANCHNOLOGY Innervation of the nose ° Sensory innervation – trigeminal nerve: V ophthalmic nerve ‹nasal nerve V maxillary nerve ‹infraorbital nerve, infratrochlear nerve (root), anterior ethmoidal nerve ‹posterior nasal nerves ° Autonomic innervation: V sympathetic ‹carotid plexus V parasympathetic ‹pterygopalatine ganglion

Prof. Dr. Nikolai Lazarov 21 SPLANCHNOLOGY Paranasal sinuses, sinus paranasales V sinus maxillaris (antrum Highmori) V sinus frontalis V sinus ethmoidalis V sinus sphenoidalis

Prof. Dr. Nikolai Lazarov 22 SPLANCHNOLOGY Paranasal sinuses, sinus paranasales V sinus maxillaris – developed in newborns V sinus frontalis – during the 2 nd year of life V sinus ethmoidalis – 3-4 years after birth V sinus sphenoidalis V pneumatization – around 20 years

Prof. Dr. Nikolai Lazarov 23 SPLANCHNOLOGY , sinus maxillaris ° maxillary sinus (antrum of Highmore): V the largest air sinuses V pyramidal cavity in the maxillary body ‹hiatus maxillaris Ù hiatus semilunaris ‹drainage Ù meatus nasi medius

Prof. Dr. Nikolai Lazarov 24 SPLANCHNOLOGY Maxillary sinus, sinus maxillaris ° maxillary sinus (antrum of Highmore): V the largest air sinuses V pyramidal cavity in the maxillary body ‹hiatus maxillaris Ù hiatus semilunaris ‹drainage Ù meatus nasi medius

Prof. Dr. Nikolai Lazarov 25 SPLANCHNOLOGY , sinus frontalis ° frontal sinus, sinus frontalis: V two sinuses in the frontal bone ‹septum sinuum frontalium ‹ductus nasofrontalis – 12-16 mm ‹drainage Ù infundibulum of the meatus nasi medius

Prof. Dr. Nikolai Lazarov 26 SPLANCHNOLOGY Ethmoidal sinus, sinus ethmoidalis ° Cellulae ethmoidales – 10 (5-16): V cellulae ethmoidales anteriores ‹2-3 in number ‹drainage Ù meatus nasi medius V cellulae ethmoidales medii, incl. bulla ethmoidalis ‹3-4 in number

‹drainage Ù meatus nasi medius V cellulae ethmoidales posteriores ‹4-5 in number

‹drainage Ù meatus nasi superior (meatus nasi supremus)

Prof. Dr. Nikolai Lazarov 27 SPLANCHNOLOGY Sphenoidal sinus, sinus sphenoidalis ° Sinus sphenoidales: V two sinuses within the sphenoid bone body ‹septum sinuum sphenoidalium ‹apertura sphenoidalis ‹drainage Ù

Prof. Dr. Nikolai Lazarov 28 SPLANCHNOLOGY Clinical significance V sinus infection – sinusitis V paranasal sinus tumors, cysts V sinus drainage V spread to adjacent structures

Prof. Dr. Nikolai Lazarov 29 SPLANCHNOLOGY

Thank you ... Prof. Dr. Nikolai Lazarov 30