Approach to the Upper Airway in the Field
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Fossa of Rosenmüller Rosenmüller
Quick Review: Fossa of pharyngeal recess or the fossa of Rosenmüller Rosenmüller. The nasopharynx is a fibromuscular sling suspended from the skull base. The human nasopharynx is mainly derived from the primitive pharynx. It represents the nasal portion of the pharynx behind the nasal cavity and above the free border of the soft palate. The nasopharynx communicates with the nasal cavities through posterior nasal apertures. The choanal orifices along with the posterior edge of the Saggital section of the postnasal space (L E Loh et al 1991) nasal septum form the anterior boundary of the nasopharynx. The The superior constrictor muscle does superior surface of the soft palate not reach the base of skull hence a constitutes its floor and lateral gap (sinus of Morgagni) is velopharyngeal isthum provides created. Fossa of Rosenmüller is a communication between nasopharynx herniation of the nasopharyngeal and oropharynx. The body of mucosa through this deficiency sphenoid, basiocciput and first and between skull base and superior most second cervical vertebrae combine to fibers of the superior constrictor form roof of the nasopharynx. muscle. Through this gap bridged only by the pharyngobasilar fascia, the The part of nasopharynx proximal to eustachian tube enters the the tubal orifice is innervated by the nasopharynx with its two muscles, one maxillary division of the trigeminal (V) on each side. Along the inferior border nerve, and that posterior to the tubal of the two muscles the Fossa of orifice by the glossopharyngeal (IX) Rosenmüller is separated from the nerve. parapharyngeal space by mucosa and pharyngobasilar fascia. Functional studies with contrast and cinefluorography reveal structural The borders of the Fossa of differences between the two Rosenmüller are: components. -
Anatomy, Histology, and Embryology
ANATOMY, HISTOLOGY, 1 AND EMBRYOLOGY An understanding of the anatomic divisions composed of the vomer. This bone extends from of the head and neck, as well as their associ- the region of the sphenoid sinus posteriorly and ated normal histologic features, is of consider- superiorly, to the anterior edge of the hard pal- able importance when approaching head and ate. Superior to the vomer, the septum is formed neck pathology. The large number of disease by the perpendicular plate of the ethmoid processes that involve the head and neck area bone. The most anterior portion of the septum is a reflection of the many specialized tissues is septal cartilage, which articulates with both that are present and at risk for specific diseases. the vomer and the ethmoidal plate. Many neoplasms show a sharp predilection for The supporting structure of the lateral border this specific anatomic location, almost never of the nasal cavity is complex. Portions of the occurring elsewhere. An understanding of the nasal, ethmoid, and sphenoid bones contrib- location of normal olfactory mucosa allows ute to its formation. The lateral nasal wall is visualization of the sites of olfactory neuro- distinguished from the smooth surface of the blastoma; the boundaries of the nasopharynx nasal septum by its “scroll-shaped” superior, and its distinction from the nasal cavity mark middle, and inferior turbinates. The small su- the interface of endodermally and ectodermally perior turbinate and larger middle turbinate are derived tissues, a critical watershed in neoplasm distribution. Angiofibromas and so-called lym- phoepitheliomas, for example, almost exclu- sively arise on the nasopharyngeal side of this line, whereas schneiderian papillomas, lobular capillary hemangiomas, and sinonasal intesti- nal-type adenocarcinomas almost entirely arise anterior to the line, in the nasal cavity. -
Radiological Profiles of Nasopharyngeal Anatomy As Seen
International Journal of Otorhinolaryngology and Head and Neck Surgery Rajamani SK et al. Int J Otorhinolaryngol Head Neck Surg. 2019 Nov;5(6):1489-1495 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20194604 Original Research Article Radiological profiles of nasopharyngeal anatomy as seen in computed tomography scans of normal patients undergoing brain scans for other neurological problems in Konkani population Santhosh Kumar Rajamani1, Nayanna Karodpati2*, Dilesh A. Mogre1, Rashmi Prashant2 1Department of ENT, B.K.L Walawalkar Rural Medical College, Chiplun, Ratnagiri, Maharashtra, India 2Department of ENT, D Y Patil Medical College, Pune, Maharashtra, India Received: 28 August 2019 Revised: 05 October 2019 Accepted: 07 October 2019 *Correspondence: Dr. Nayanna Karodpati, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Nasopharyngeal carcinoma arises from interactions between underlying genetic and racial predilection and variety environmental factors. It is locally aggressive and presents with occult cervical nodal metastasis. A thorough understanding of radiological regional anatomy of the nasopharynx in Indians particularly Konkani population is important for early detection of nasopharyngeal carcinoma. Methods: Routine computed tomography of brain, head and neck for other neurological problems like stroke clearly delineates the loco-regional anatomy of the nasopharynx. Computed tomography (CT) images stored in the computer system were studied to delineate the normal loco-regional anatomy of nasopharynx with special reference to anatomical structure of fossa of Rosenmueller and to find out the normal dimensions of nasopharynx in Konkani population. -
Nose, Nasal Cavity & Paranasal Sinuses & Pharynx
Nose, Nasal cavity, Paranasal Sinuses & Pharynx Objectives . At the end of the lecture, the students should be able to: . Describe the boundaries of the nasal cavity. Describe the nasal conchae and meati. Demonstrate the openings in each meatus. Describe the paranasal sinuses and their functions . Describe the pharynx and its parts Nose . The external root (anterior ) nares or nostrils, lead to the tip nasal cavity. ala septum external nares Formed above by: 1 Bony skeleton 2 . Formed 3 below by plates of hyaline cartilage. Nasal Cavity . Extends from the external (anterior) nares to the posterior nares (choanae). Divided into right & left halves by the nasal septum. Each half has a: . Roof . Lateral wall . Medial wall (septum) . Floor Roof . Narrow & formed (from 3 2 4 behind forward) by the: 1 1. Body of sphenoid. 2. Cribriform plate of ethmoid bone. 3. Frontal bone. 4. Nasal bone & cartilage Floor • Separates it from the oral cavity. • Formed by the hard (bony) palate. Medial Wall (Nasal Septum) . Osteocartilaginous partition. Formed by: 1. Perpendicular plate of ethmoid 1 bone. 3 2. Vomer. 2 3. Septal cartilage. Lateral Wall . Shows three horizontal bony projections, the superior, middle & inferior conchae . The cavity below each concha is called a meatus and are named as superior, middle & inferior corresponding to the conchae. The small space above the superior concha is the sphenoethmoidal recess. The conchae increase the surface area of the nasal cavity. The recess & meati receive the openings of the: .Paranasal sinuses. .Nasolacrimal duct. Nasal mucosa – Olfactory : – It is delicate and contains olfactory nerve cells. It is present in the upper part of nasal cavity: . -
Anatomy of the Nasal Cavity and Pharynx Respiratory Block - Lecture 2
Anatomy of the nasal cavity and pharynx Respiratory Block - Lecture 2 Color index: Important In male’s slides only In female’s slides only Extra information, explanation Doctors notes Editing File Objectives: ● Describe the boundaries of the nasal cavity. ● Describe the nasal conchae and meati. ● Demonstrate the openings in each meatus. ● Describe the paranasal sinuses and their functions ● Describe the pharynx and its parts Nose & Nasal cavity Nose: The external (anterior) nares or nostrils, lead to the nasal cavity. 1 - Formed above by: Nasal Cavity: Bony skeleton. - Extends from the external - Formed below by: (anterior) nares to the posterior plates of hyaline cartilage. 2 nares (choanae). - Divided into right & left halves by the nasal septum. - Each half has a: 1- Roof 2- Lateral wall 3- Medial wall (septum) 4- Floor Floor Roof - Separates it from the oral cavity. Narrow & formed ( from behind forward) by the: - Formed by the hard (bony) palate. 1- Body of sphenoid. Formed by: 2- Cribriform plate of ethmoid bone. - Nasal (upper)surface of the hard (bony) palate: 3- Frontal bone. - Palatine process of maxilla, anteriorly. 4- Nasal bone & cartilage. - Horizontal plate of the palatine bone, posteriorly. 2 1 Lateral Wall Medial Wall (Nasal Septum) 4 3 - Shows three horizontal bony projections, the superior, middle & inferior conchae - Osteocartilaginous partition. - The cavity below each concha is called a meatus and are named as superior, middle & inferior corresponding to the - Formed by: conchae. 1- Perpendicular plate of ethmoid bone. - The small space above the superior concha is the 2- Vomer. sphenoethmoidal recess. 3- Septal cartilage. - The conchae increase the surface area of the nasal cavity. -
Nose, Nasal Cavity, Paranasal Sinuses & Pharynx
Nose, Nasal cavity, Paranasal Sinuses & Pharynx Respiratory block-Anatomy-Lecture 2 Editing file Color guide : Only in boys slides in Green Only in girls slides in Purple Objectives important in Red Doctor note in Blue Extra information in Grey At the end of the lecture, the students should be able to: ● Describe the boundaries of the nasal cavity. ● Describe the nasal conchae and meati. ● Demonstrate the openings in each meatus. ● Describe the paranasal sinuses and their functions. ● Describe the pharynx and its parts. Nose & Nasal cavity 3 Nose Nasal cavity nares/nostrils The external (anterior ) nares - Extends from the external (anterior) nares to the posterior nares or nostrils, lead to the nasal (choanae). cavity. - Divided into right & left halves by the nasal septum. - Formed above by: Bony skeleton. - Each half has a: ▪ Roof - Formed below by: ▪ Lateral wall plates of hyaline cartilage. ▪ Medial wall (septum) ▪ Floor Nasal cavity 4 Roof Floor Lateral Medial sphenoethmoidal recess Nasal cavity Superior conchae Superior meatus Inferior conchae Body of Middle conchae sphenoid Inferior meatus Middle meatus Narrow & formed - Separates it from Shows three horizontal bony projections, the Medial Wall (from behind the oral cavity. superior, middle & inferior conchae. (Nasal Septum) forward) by the: Osteocartilaginous - Formed by the hard - The cavity below each concha is called a meatus partition. 1. Body of sphenoid. (bony) palate. (named corresponding to the conchae). 2. Cribriform plate of Formed by: ethmoid bone. - The small space above the superior concha is 1. Perpendicular 3. Frontal bone. the sphenoethmoidal recess. plate of ethmoid 4. Nasal bone & bone. cartilage. - The conchae increase the surface area of the 2. -
Lab 7: Lab Images
Lab 7: Lab Images • The learning objectives regarding this lab are testable on summative exam 2 and practical exam 2. • Note: On practical exam 2, you can be asked to identify any structure from the structure list on any of the images (photographs, figures, Complete Anatomy images) in this PowerPoint file. Nasal Cavity Nasal Cavity Proper Nasal Cavity * Roof = Floor = Medial wall = * Lateral Wall = Nasal Cavity Frontal Sinus Sphenoid Sinus Nasal Cavity Innervation CN I V1 V2 Sinus Drainage Site Innervation Frontal Middle meatus (semilunar hiatus) Ophthalmic n. (CN V1) Anterior ethmoidal cells Middle meatus (semilunar hiatus) Ophthalmic n. (CN V1) Middle ethmoidal cells Middle meatus from bulla Ophthalmic n. (CN V1) Posterior ethmoidal cells Superior meatus Ophthalmic n. (CN V1) Sphenoidal Sphenoethmoidal recess Ophthalmic n. (CN V1) Maxillary Middle meatus (semilunar hiatus) Maxillary n. (CN V2) All Turbinates have been removed in this dissection photo. Probe passing between Probe passing sphenoethmoidal recess between frontal and sphenoid sinus sinus and middle meatus Semilunar hiatus Ethmoid bulla with Sphenoid opening of middle ethmoid cells Sinus Probe passing between maxillary sinus and middle meatus Probe in nasolacrimal duct Paranasal Sinuses Sinus Drainage Site Innervation Frontal Middle meatus (semilunar hiatus) Ophthalmic n. (CN V1) Anterior ethmoidal cells Middle meatus (semilunar hiatus) Ophthalmic n. (CN V1) Middle ethmoidal cells Middle meatus from bulla Ophthalmic n. (CN V1) Posterior ethmoidal cells Superior meatus Ophthalmic n. (CN V1) Sphenoidal Sphenoethmoidal recess Ophthalmic n. (CN V1) Maxillary Middle meatus (semilunar hiatus) Maxillary n. (CN V2) Paranasal Sinuses https://3d4medic.al/nTJSrmfo Nasal Cavity Highlighted in Green Parnasal Sinus Imaging Different types of radiographic imaging show the paranasal sinuses (below: X-ray, left; CT, right). -
C12 C13 (1000219, 1000220) 2 Deutschlatin C12 OSSA
…going one step further C12 C13 (1000219, 1000220) 2 DeutschLatin C12 OSSA A Os parietale d Ostium pharyngeum tubae auditivum B Os frontale e Recessus pharyngeus a Sinus frontalis f Tonsilla pharyngealis C Os nasale g M. orbicularis oris D Os ethmoidale h Dentes incisivi E Os sphenoidale i Uvula palatina b Sinus sphenoidalis k Tonsilla palatina F Os occipitale l Lingua G Maxilla m M. geniohyoideus H Os palatinum n M. mylohyoideus I Mandibula o Pharynx K Os hyoideum p M. genioglossus L Atlas M Axis 23 LARYNX I Epiglottis ENCEPHALON II Cartilago thyroidea I Telencephalon III Cartilago cricoidea II Diencephalon IV Lig. thyrohyoideum medianum III Mesencephalon V Lig. cricothyroideum medianum IV Metencehalon VI M. arytenoideus transversus V Myelencephalon VII Plica vestibularis I, II, III Cerebrum VIII Plica vocalis 1 Sinus sagittalis superior IX Ventriculus laryngis 2 Tentorium cerebelli X Trachea ® 3 Cerebellum XI Oesophagus 3a Arbor vitae 4 Corpus callosum 4a Rostrum corporis callosi 4b Genu corporis callosi 5 Septum pellucidum 6 Fornix 7 Commissura anterior 8 Adhesio interthalamica 9 Commissura posterior 10 Thalamus 11 Foramen interventriculare 12 Aqueductus mesencephali 13 Ventriculus quartus 14 Glandula pinealis 15 Chiasma opticum 16 Hypophysis 17 Corpus mammillare 18 Lamina tecti 19 Velum medullare superius 20 Pons 21 Medulla oblongata 22 Medulla spinalis CAVITAS NASI, CAVITAS PHARYNGIS et CAVITAS ORIS a Concha nasalis superior b Concha nasalis media c Concha nasalis inferior 3 C13 EnglishLatin A Os frontale B Os temporale C Os zygomaticum D Maxilla E Os palatinum F Mandibula 1 Dura mater cranialis 2 Cerebrum 3 Corpus adiposum orbitae cum VI mm. -
Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma
J Int Adv Otol 2020; 16(3): 373-7 • DOI: 10.5152/iao.2020.7508 Original Article Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma Muammer Melih Şahin , Deniz Sözmen Cılız , Melih Çayönü , Seçil Kayalı Dinç , Şeyda Akbal , Süleyman Boynueğri , Adil Eryılmaz Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey (MMŞ, MÇ, SKD, ŞA, SB, AE) Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey (DSC) ORCID iDs of the authors: M.M.Ş. 0000-0002-1804-2730; D.S.C. 0000-0003-3640-9273; M.Ç. 0000-0001-5542-1898; S.K.D. 0000-0001-9004-8806; Ş.A. 0000-0003-4554-9278; S.B. 0000-0002-1244-7294; A.E. 0000-0003-3754-6317. Cite this article as: Şahin MM, Sözmen Cılız D, Çayönü M, Kayalı Dinç S, Akbal Ş, Boynueğri S, et al. Magnetic Resonance Imaging of the Eustachian Tube and the Paratubal Structures in Patients with Unilateral Acquired Cholesteatoma. J Int Adv Otol 2020; 16(3): 373-7. OBJECTIVES: This study aimed to compare the Eustachian tube (ET) and the paratubal structures between the two sides in subjects with unilateral acquired cholesteatoma and a healthy contralateral ear to determine if there are anatomical differences. MATERIALS and METHODS: Of the 217 patients with cholesteatoma evaluated, 36 patients with unilateral cholesteatoma were included in the study. All of the patients had a healthy contralateral ear with no history of surgery. Nine different paratubal parameters were measured through contrast-enhanced magnetic resonance imaging (MRI). The measurements of the ear with cholesteatoma were compared with those of the healthy ear. -
Neuroanatomy Objectives
1 ` 2019 Neuroanatomy Objectives Cerebral Cortex Cortical Lobes Frontal Lobe Parietal Lobe Occipital Lobe Temporal Lobe Limbic Lobe (Insula) Major Cortical Fissures and Lobe Division Landmarks Central Sulcus (CS) Lateral Fissure (LF) Preoccipital Notch Parieto-occipital Fissure (POF) Frontal Lobe Central Sulcus Precentral Gyrus (Primary Motor Cortex – M1) Precentral Sulcus Brocca’s Area (Expressive Speech) Prefrontal Cortex (Cognition) Parietal Lobe Postcentral Sulcus Postcentral Gyrus (Primary Sensory Cortex – S1) Central Sulcus Occipital Lobe Calcarine Fissure Primary Visual Cortex (V1) Temporal Lobe Superior Temporal Sulcus Heschl’s Gyrus (Primary Auditory Area –A1) Wernicke’s Area (Comprehensive Speech Area) Limbic Lobe Structures Cingulate Gyrus (Cognition). Cingulate Sulcus Parahippocampal Gyrus (Memory) Uncus – Near Primary Olfactory Cortex (Smell). Summary of Major Functional Centers of the Cerebral Cortex Head and Neck Motor Control – Precentral Gyrus (M1), cranial nerves V, VII, IX, X, XII. 2 Head and Neck Sensory Perception – Post Central Gyrus (S1), head area receives sensory information largely from cranial nerve V. Speech – Broca’s Area (speech production) and Wernicke’s Area (speech comprehension). Hearing – Primary Auditory Cortex (A1) Vision – Primary Visual Cortex (V1) (within the depths of the calcarine fissure) Smell –Limbic Cortex (Near Uncus) Interhemispheric Commissures Corpus Callosum Anterior and Posterior Commissures Brainstem Diencephalon Thalamus (sensory relay to cortex and motor relay to cortex) Hypothalamus (basic physiologic drives and homeostasis) 3rd Ventricle Midbrain Superior Colliculus (visual system relay) Inferior Colliculus (auditory system relay) Cerebral Aqueduct (Aqueduct of Sylvius) Pons and Cerebellum Superior Cerebellar Peduncle - white matter pathway (i.e., nerve fibers) connecting midbrain and cerebellum. Middle Cerebellar Peduncle -white matter pathway connecting pons and cerebellum. -
Pitfalls in the Staging of Cancer of Nasopharyngeal Carcinoma
Pitfalls in the Staging of Cancer of Nasopharyngeal Carcinoma Christine M. Glastonbury, MBBSa,*, Karen L. Salzman, MDb KEYWORDS Staging Nasopharyngeal carcinoma Nasopharynx Epstein-Barr virus KEY POINTS Although nasopharyngeal carcinoma (NPC) is the most common primary malignancy of the naso- pharynx, it is an uncommon malignancy in much of the Western world. Over the last several years, there have been important changes in the terminology used for the histologic classification of NPC and important changes to the American Joint Committee on Cancer TNM staging of NPC. Accurate imaging assessment is critical for diagnose, to stage and plan the radiation treatment, and for ongoing follow-up and surveillance. This article emphasizes important nasopharyngeal anatomy landmarks and the imaging appear- ances and pitfalls of nasopharyngeal carcinoma, its patterns of spread, and posttreatment appear- ances. INTRODUCTION posttreatment appearances. The updated histology and new AJCC TNM staging are presented, Although nasopharyngeal carcinoma (NPC) is the emphasizing key changes that are of relevance to most common primary malignancy of the naso- the radiologist. pharynx, it is an uncommon malignancy in much of the Western world where it has an incidence NASOPHARYNGEAL ANATOMY of less than 10 per 1 000 000. Over the last several years, there have been important changes in the The nasopharynx is the most superior portion of terminology used for the histologic classification the tubular pharynx, located immediately caudal of NPC and important changes to the American to the central skull base. The inferior limit of the Joint Committee on Cancer (AJCC) TNM staging nasopharynx is the soft palate, and it is at this level of NPC. -
Tumors of the Nasopharynx and Adjacent Areas: MR Imaging with Gd-DTPA
187 Tumors of the Nasopharynx and Adjacent Areas: MR Imaging with Gd-DTPA T. Vogl1 The purpose of this study was to describe our experience with Gd-DTPA-enhanced S. Dresel1 MR imaging in the evaluation of the most common nasopharyngeal tumors. Forty-two L. T. Bilaniuk2 patients with tumors of the nasopharynx and adjacent spaces had MR imaging before G. Grevers3 and after IV injection of Gd-DTPA. Images were obtained with a 1.0-T superconducting K. Kang 1 magnet imaging system in transverse, coronal, and sagittal planes with T1- and T2- weighted sequences. MR images were compared with CT scans and tumor histology. J. Lissner1 The studies were categorized by using a grading system with grades ranging from unsatisfactory (grade 0) to optimal (grade 3). Contrast-enhanced MR enables better identification of small anatomic details such as both palatini muscles and the pharyn gobasilar fascia. MR after Gd-DTPA was superior to CT in all cases except for tumors of the maxillary sinuses. MR with Gd-DTPA is recommended for tumors that are small and difficult to detect on the initial nonenhanced MR examination or that show subtle infiltrations. Because of the increased cost and longer examination time, MR with Gd-DTPA does not need to be done when large tumors are well delineated. AJNR 11 :187-194, January/February 1990; AJR 154: March 1990 The complex patterns created by spread of nasopharyngeal tumors with involve ment of soft tissue and bony structures require an imaging method that distin guishes both soft tissue and bone. MR imaging has shown that its superior soft tissue contrast resolution depicts tumor margins in the nasopharyn x and related spaces more accurately than CT does [1-3].