They are involved in the formation of the lateral wall of the nasal cavity. The nasal cavity, the structure of its walls
Top wall the nasal cavity is formed by the nasal bones, the nasal part of the frontal bone, the ethmoid plate of the ethmoid bone and the lower surface of the body sphenoid bone.
Bottom wall the nasal cavity consists of the palatine processes of the maxillary bones and the horizontal plates of the palatine bones. Along the midline, these bones form the nasal crest, to which the bony septum of the nose joins, which is the medial wall for each of the halves of the nasal cavity.
Lateral wall the nasal cavity has a complex structure. It is formed by the nasal surface of the body and the frontal process of the upper jaw, the nasal bone, the lacrimal bone, the ethmoid labyrinth of the ethmoid bone, the perpendicular plate of the palatine bone, the medial plate of the pterygoid process of the sphenoid bone (in the posterior part). On the lateral wall, three turbinates protrude, located one above the other. The upper and middle are parts of the ethmoid labyrinth, and the lower turbinate is an independent bone.
The turbinates divide the lateral portion of the nasal cavity into three nasal passages: upper, middle and lower.
Upper nasal passage , medtus nasalis superior,bounded from above and medially by the superior turbinate, and from below by the middle turbinate. This nasal passage is poorly developed, located in the back of the nasal cavity. The posterior ethmoid cells open into it. Above the posterior part of the superior nasal concha there is a wedge-shaped lattice depression, recesus sphenoethmoidalis,into which the aperture of the sphenoid sinus opens, apertura sinus sphenoidalis.Through this aperture, the sinus communicates with the nasal cavity.
Middle nasal passage , medtus nasalis medius,located between the middle and lower turbinates. It is much longer, higher and wider than the top. In the middle nasal passage, the anterior and middle cells of the ethmoid bone open, the aperture of the frontal sinus through the ethmoid funnel, infundibutum ethmoidale,and a lunar cleft, hiatus semilundris,leading to the maxillary sinus. Located behind the middle nasal concha, the wedge-palatine opening, foramen sphenopalatinum, connects the nasal cavity with the pterygo-palatine fossa.
Lower nasal passage , meat us nasalis inferior,the longest and widest, bounded from above by the inferior turbinate, and from below - by the nasal surfaces of the palatine process upper jaw and the horizontal plate of the palatine bone. The nasolacrimal canal opens into the anterior part of the lower nasal passage, canalls nasolacrimalis,starting in the eye socket.
The space in the form of a narrow sagittal slit, bounded by the septum of the nasal cavity on the medial side and the turbinates, constitutes the common nasal passage.
№ 13 Characteristics of the inner surface of the base of the skull, holes and their purpose.
Inner base of the skull,basis cranii interna,has a concave uneven surface that reflects the complex relief of the lower surface of the brain. It is divided into three cranial fossae: anterior, middle and posterior.
Anterior cranial fossa, fossa cranii anterior,formed by the orbital parts of the frontal bones, on which the cerebral eminences and finger-like depressions are well expressed. In the center, the fossa is deepened and made with an ethmoid plate of the ethmoid bone, through the holes of which the olfactory nerves pass (I pair). A cock's comb rises in the middle of the lattice plate; in front of it are a blind foramen and a frontal ridge.
Middle cranial fossa, fossa cranii media,much deeper than the front, its walls are formed by the body and large wings of the sphenoid bone, the front surface of the pyramids, the scaly part of the temporal bones. In the middle cranial fossa, central part and side.
On the lateral surface of the body of the sphenoid bone there is a well-defined carotid groove, and near the apex of the pyramid, an irregularly shaped ragged hole is visible. Here, between the lesser wing, the greater wing and the body of the sphenoid bone, is the upper orbital fissure, fissura orblalis superior,through which the oculomotor nerve (III pair), block (IV pair), abducens (VI pair) and ocular (first branch of the V pair) nerves pass into the orbit. Behind the superior orbital fissure there is a round hole that serves for the passage of the maxillary nerve (the second branch of the V pair), then the oval hole for the mandibular nerve (the third branch of the V pair).
At the posterior edge of the large wing lies a spinous opening for the middle meningeal artery... On the front surface of the pyramid temporal bone, on a relatively small area, there is a trigeminal depression, a cleft of the canal of a large petrosal nerve, a sulcus of a large petrosal nerve, a cleft of a canal of a small petrosal
nerve, groove of the lesser stony nerve, roof of the tympanic cavity and arcuate eminence.
Posterior cranial fossa, fossa cranii posterior,the deepest. The occipital bone, the posterior surfaces of the pyramids and the inner surface of the mastoid processes of the right and left temporal bones take part in its formation. Complement the fossa not most of the body of the sphenoid bone (in front) and the posterior inferior corners of the parietal bones - from the sides. In the center of the fossa there is a large occipital foramen, in front of it is a slope, clivus,formed by the bodies of the sphenoid and occipital bones that have grown together in an adult.
An internal auditory opening (right and left) opens into the posterior cranial fossa on each side, leading to the internal auditory canal, in the depth of which the facial canal for the facial nerve originates (VII pair). The vestibular cochlear nerve (VIII pair) emerges from the internal auditory opening.
It should be noted two more paired large formations: the jugular foramen through which the glossopharyngeal (IX pair), vagus (X pair) and accessory (XI pair) nerves pass, and the hypoglossal canal for the nerve of the same name (XII pair). In addition to the nerves, through the jugular opening, the internal jugular vein, into which the sigmoid sinus continues, lying in the groove of the same name. The border between the vault and the inner base of the skull in the region of the posterior cranial fossa is the groove of the transverse sinus, which passes from each side into the groove of the sigmoid sinus.
№ 14 Outer surface of the skull base. Holes and their purpose.
The outer base of the skull,basis cranii externa,closed in front with facial bones. The posterior section of the skull base, free for inspection, is formed by the outer surfaces of the occipital, temporal and sphenoid bones. Here you can see numerous openings through which arteries, veins, and nerves pass in a living person. Almost in the center of the indicated area there is a large occipital foramen, and on its sides - the occipital condyles. Behind each condyle there is a condyle fossa with a non-constant opening - the condylar canal. The base of each condyle is pierced by a sublingual canal. The posterior part of the skull base ends with an external occipital protuberance with an upper nuchal line extending to the right and left from it. Anterior to the foramen magnum lies the basilar part of the occipital bone with a well-defined pharyngeal tubercle. The basilar part passes into the body of the sphenoid bone. On the sides of the occipital bone, on each side, the lower surface of the temporal bone pyramid is visible, on which the following most important formations are located: the external opening of the carotid canal, the musculocutaneous canal, the jugular fossa and the jugular notch, which forms the jugular foramen, styloid process with the jugular notch of the occipital bone , the mastoid process, and between them the styloid opening. The tympanic part of the temporal bone, which surrounds the external auditory opening, adjoins the pyramid of the temporal bone from the lateral side. Behind, the tympanic part is separated from the mastoid process by means of the tympanic-mastoid fissure. On the posteromedial side of the mastoid process is the mastoid notch and the groove of the occipital artery.
On the horizontally located area of \u200b\u200bthe scaly part of the temporal bone there is a mandibular fossa, which serves to articulate with the condylar process of the lower jaw. In front of this fossa is the articular tubercle. The posterior part of the large wing of the sphenoid bone enters the gap between the stony and scaly parts of the temporal bone on the whole skull; here the spinous and oval holes are clearly visible. The pyramid of the temporal bone is separated from the occipital bone by the petrosoccipital fissure, fissura petrooccipitalis,and from the large wing of the sphenoid bone - a sphenoid-stony gap, fissura sphenopetrosa.In addition, on the lower surface of the outer base of the skull, a hole with uneven edges is visible - a ragged hole, foramen lacerum,bounded laterally and behind by the apex of the pyramid, which is wedged between the body of the occipital and the greater wing of the sphenoid bones.
Anatomy and topography of the temporal and infratemporal fossa.
On the upper lateral surfaces the parietal tubercles protrude from the cranial vault. Below each parietal tubercle is the arcuate superior temporal line (the place of attachment of the temporal fascia), which extends from the base of the zygomatic process of the frontal bone to the junction of the parietal bone with the occipital. Below this line, the lower temporal line is more clearly expressed - the place where the temporal muscle begins. Anterolateral department the cranial vault, bounded from above by the lower temporal line, from below - by the infratemporal crest of the large wing of the sphenoid bone, is called the temporal fossa, fossa temporalis.The infratemporal ridge separates the temporal fossa from the infratemporal fossa, fossa infratemporalis.On the lateral side, the temporal fossa is limited by the zygomatic arch, arcus zygomdticus,and in front - the temporal surface of the zygomatic bone.
# 15 Anatomical and biomechanical classification of bone joints: Continuous bone joints.
The nasal cavity has paranasal sinuses, which communicate with various nasal passages (Fig. 50). So, in the upper nasal passage, the body cavity of the main bone and the posterior cells of the ethmoid bone open, in the middle nasal passage - the frontal and maxillary sinuses, the anterior and middle cells of the ethmoid bone. The lacrimal canal flows into the lower nasal passage.
Figure: fifty.
A - the outer wall of the nasal cavity with holes in the paranasal sinuses: 1 - the frontal sinus; 3 - opening of the frontal sinus; 3 - aperture of the anterior ethmoid cells; 4 - opening of the maxillary sinus; 5 - holes of the posterior cells of the ethmoid bone; 6 - the main sinus and its opening; 7 - pharyngeal opening of the auditory tube; 8 - opening of the nasolacrimal duct. B - nasal septum: 1 - crista galli; 2 - lamina cribrosa; 3 - lamina perpendicularis ossis ethmoidalis; 4 - opener; 5 - hard palate; 5 - cartilago septi nasi.
Maxillary sinus (sinus maxillaris Highmori) is located in the body of the upper jaw. It begins to be created from the 10th week of embryonic life and develops up to 12-13 years. In an adult, the volume of the cavity ranges from 4.2-30 cm 3, it depends on the thickness of its walls and, less, on its position. The shape of the sinus is irregular, it has four main walls. The anterior (in 1/3 of cases) or antero-external (in 2/3 of cases) wall is represented by a thin plate corresponding to the fossa canina. There is n on this wall. infraorbitalis together with the blood vessels of the same name.
The upper wall of the sinus is also the lower wall of the orbit. In the thickness of the wall there is canalis infraorbitalis, containing the mentioned neurovascular bundle. At the site of the latter, the bone may be thinned or have a gap. In the presence of a gap, the nerve and blood vessels are separated from the sinus only by the mucous membrane, which leads to inflammation of the inferior orbital nerve with sinusitis. Usually, the top wall of the sinus is flush with the top of the middle nasal passage. N.N. Rezanov points to a rare variant when this wall of the sinus is low and the middle nasal passage is adjacent to the inner surface of the orbit. This is due to the possibility of penetration into the orbit of the needle during puncture maxillary sinus through the nasal cavity. Often, the dome of the sinus extends into the thickness of the inner wall of the orbit, pushes the ethmoid sinuses up and back.
The lower wall of the maxillary sinus is represented by the alveolar process of the jaw, corresponding to the roots of the 2nd small and anterior large molars. The zone of the position of the roots of the teeth can protrude into the cavity in the form of an elevation. The bone plate separating the cavity from the root is often thinned, sometimes has a gap. These conditions favor the spread of infection from the affected roots of the teeth to the maxillary sinus, explain the cases of penetration of the tooth into the sinus at the time of its extirpation. The bottom of the sinus can be 1–2 mm above the bottom of the nasal cavity, at the level of this bottom or below it as a result of the development of the alveolar bay. The maxillary cavity rarely extends under the bottom of the nasal cavity, forming a small depression (buchta palatina) (Fig. 51).
Figure: 51. Paranasal sinuses, maxillary sinus.
A - sagittal cut: B - frontal cut; В - construction options - high and low position of the lower wall: 1 - canalis infraorbitalis; 2 - fissura orbitalis Inferior; 3 - fossa pterygopalatina; 4 - maxillary sinus; 5- ethmoid cells; 6 - eye socket; 7 - processus alveolaris; 8 - lower nasal concha; 9 - nasal cavity; 10 - buchta prelacrimalis; 11 - canalis infraorbitalis (deprived of the lower wall); 12 - buchta palatina; 13 - buchta alveolaris; G - frontal sinus on a sagittal cut; D - options for the structure of the frontal sinus.
The inner wall of the maxillary sinus is adjacent to the middle and lower nasal passages. The wall of the lower nasal passage is solid, but thin. Here it is relatively easy to puncture the maxillary sinus. The wall of the middle nasal passage has a webbed structure and an opening communicating the sinus with the nasal cavity over a considerable extent. Hole length 3-19 mm, width 3-6 mm.
The posterior wall of the maxillary sinus is represented by the maxillary tubercle in contact with the pterygopalatine fossa, where n. infraorbitalis, ganglion sphenopalatinum, a. maxillaris with its branches. Through this wall you can approach the pterygopalatine fossa.
Frontal sinuses (sinus frontalis) are located in the thickness of the frontal bone, corresponding to the superciliary arches. They look like triangular pyramids with a downward base. Sinuses develop from 5-6 to 18-20 years. In adults, their volume reaches 8 cm 3. Upward, the sinus extends somewhat beyond the brow ridges, outward - to the outer third of the upper edge of the orbit or to the supraorbital notch and descends down into the nasal part of the bone. The anterior wall of the sinus is represented by the superciliary tubercle, the posterior wall is relatively thin and separates the sinus from the anterior cranial fossa, the lower wall forms part of the upper wall of the orbit and at the midline of the body - part of the nasal cavity, the inner wall is the septum separating the right and left sinuses. The top and side walls are absent, since its front and back walls converge at an acute angle. The cavity is absent in about 7% of cases. The partition separating the cavities from each other does not occupy a middle position in 51.2% (M.V. Miloslavsky). The cavity is opened through a canal (canalis nasofrontalis) up to 5 mm in length into the middle nasal passage, in front of the opening of the maxillary sinus. In the frontal sinus, canalis nasofrontalis forms at the bottom of its funnel. This promotes the drainage of mucus from the sinus. Tillo points out that the frontal sinus can sometimes open into the maxillary sinus.
Ethmoid sinuses (sinus ethmoidalis) are represented by cells corresponding to the level of the upper and middle turbinates, make up upper part lateral wall of the nasal cavity. These cells communicate with each other. On the outside, the cavities are delimited from the orbit by a very thin bone plate (lamina papyrocea). If this wall is damaged, air from the cells of the cavity can penetrate into the tissue of the periorbital space. The resulting emphysema produces a protrusion eyeball - exophthalmos. From above, the cells of the sinus are delimited by a thin bony septum from the anterior cranial fossa. The anterior group of cells opens into the middle nasal passage, the posterior group of cells opens into the upper nasal passage.
Main sinus (sinus sphenoidalis) is located in the body of the main bone. It develops between the ages of 2 and 20. The sinus is divided into right and left by a septum along the midline. The sinus opens into the upper nasal passage. The hole lies 7 cm from the nostril in a line following through the middle of the middle turbinate. The position of the sinus made it possible to recommend that surgeons approach the pituitary gland through the nasal cavity and nasopharynx. The main sinus may be absent.
Lacrimal canal (canalis nasolacrimalis) is located in the zone of the lateral border of the nasal region (Fig. 52). It opens into the lower nasal passage. The canal opening is located under the anterior edge of the inferior turbinate on the outer wall of the nasal passage. It is 2.5-4 cm from the posterior edge of the nostril. The length of the lacrimal canal is 2.25-3.25 cm (N.I. Pirogov). The channel runs in the thickness of the outer wall of the nasal cavity. In the lower segment, it is limited by bone tissue only on the outside, on the other sides it is covered with the mucous membrane of the nasal cavity.
Figure: 52. Topography of the lacrimal passages.
1 - fornix sacci lacrimalis; 2 - ductus lacrimalis superior; 3 - papilla et punctum lacrimale superior; 5 - caruncula lacrimalis; 6 - ductus et ampula lacrimalis Inferior; 7 - saccus lacrimalis; 8 - m. orbicularis oculi; 9 - m. obliquus oculi inferior; 10 - sinus maxillaris; 11 - ductus nasolacrimalis.
A - cross section: 1 - lig. palpebrale medialis; 2 - pars lacrimalis m. orbicularis oculi; 3 - septum orbitale; 4 - f. lacrimalis; 5 - saccus lacrimalis; 6 - periosteum
The anatomy of the nose and paranasal sinuses is of great clinical importance, since not only the brain is located in the immediate vicinity of them, but also many great vessels, which contribute to the rapid spread of pathogenic processes.
It is important to understand exactly how the structures of the nose communicate with each other and with the surrounding space in order to understand the mechanism of development of inflammatory and infectious processes and to prevent them qualitatively.
The nose, as an anatomical formation, includes several structures:
- external nose;
- nasal cavity;
- paranasal sinuses.
External nose
This anatomical structure is an irregular pyramid with three faces. The outer nose is very individual in appearance and has a wide variety of shapes and sizes in nature.
The backrest delimits the nose from the upper side, it ends between the eyebrows. The top of the nasal pyramid is the tip. The lateral surfaces are called wings and are clearly separated from the rest of the face by nasolabial folds. Thanks to the wings and the nasal septum, clinical structures such as the nasal passages or nostrils are formed.
The structure of the external nose
The outer nose includes three parts
Bone skeleton
Its formation occurs due to the participation of the frontal and two nasal bones. The nasal bones on both sides are bounded by processes extending from the upper jaw. Bottom part of the nasal bones participates in the formation of the pear-shaped opening, which is necessary for the attachment of the external nose.
Cartilaginous part
Lateral cartilage is required for the formation of the lateral nasal walls. If you go from top to bottom, then the adjoining of the lateral cartilages to the large cartilages is noted. The variability of small cartilages is very high, since they are located near the nasolabial fold and can differ from person to person in quantity and shape.
The septum of the nose is formed by the quadrangular cartilage. The clinical significance of cartilage is not only in concealing the inner part of the nose, that is, in organizing a cosmetic effect, but also in the fact that due to changes in the quadrangular cartilage, a diagnosis of curvature of the nasal septum may appear.
Soft tissues of the nose
The person does not have a strong need for the muscles surrounding the nose to function. Basically, muscles of this type perform mimic functions, helping the process of identifying smells or expressing an emotional state.
The skin adheres strongly to the surrounding tissues, and also contains many different functional elements: glands that secrete fat, sweat, hair follicles.
Hair blocking the entrance to the nasal cavities performs a hygienic function, being additional filters for air. Due to hair growth, the formation of the nasal threshold occurs.
After the threshold of the nose, there is a formation called the intermediate belt. It is tightly connected with the perchondral part of the nasal septum, and when deepening into nasal cavity transforms into a mucous membrane.
To correct a deviated nasal septum, an incision is made exactly in the place where the intermediate girdle is tightly connected to the perchondral part.
Circulation
The facial and orbital arteries provide blood flow in the nose. Veins follow the course of arterial vessels and are represented by external and nasal veins. The veins in the nasolabial region merge in anastomosis with the veins that provide blood flow in the cranial cavity. This is due to the angular veins.
Because of this anastomosis, easy penetration of infection from the nasal region into the cranial cavity is possible.
The flow of lymph is provided through the nasal lymphatic vessels, which flow into the facial, and those, in turn, into the submandibular.
The anterior ethmoid and infraorbital nerves provide the nose with sensation, while the facial nerve is responsible for the movement of the muscles.
The nasal cavity is limited to three formations. It:
- anterior third of the cranial base;
- eye sockets;
- oral cavity.
The nostrils and nasal passages in front are the limitation of the nasal cavity, and posteriorly it passes into the upper part of the pharynx. The places of passage are called khoans. The nasal cavity is divided by a nasal septum into two approximately identical components. Most often, the nasal septum can deviate slightly to either side, but these changes do not matter.
The structure of the nasal cavity
Each of the two components has 4 walls.
Inner wall
It is created through the participation of the nasal septum and is divided into two sections. The ethmoid bone, or rather its plate, forms the posterior-superior section, and the vomer, the posterior-inferior section.
Outer wall
One of the most complex formations. Consists of the nasal bone, the medial surface of the bone of the upper jaw and its frontal process, the lacrimal bone adjacent to the back, as well as the ethmoid bone. The main space of the posterior part of this wall is formed due to the participation of the bone of the palate and the main bone (mainly the inner plate belonging to the pterygoid process).
The bony part of the outer wall serves as a place for the attachment of three turbinates. The bottom, vault and shells are involved in the formation of a space called the common nasal passage. Thanks to the turbinates, three nasal passages are also formed - the upper, middle and lower.
The nasopharyngeal passage is the end of the nasal cavity.
Upper and middle concha
Shells of the nose
Formed due to the participation of the ethmoid bone. The outgrowths of this bone also form the vesicle shell.
The clinical significance of this shell is due to the fact that its large size can interfere with the normal process of breathing through the nose. Naturally, breathing is difficult from the side where the vesicle is too large. Its infection must also be taken into account in the development of inflammation in the cells of the ethmoid bone.
Bottom sink
It is an independent bone that is anchored on the crest of the maxilla and the bone of the palate.
The lower nasal passage has in its anterior third the orifice of a canal intended for the outflow of tear fluid.
Nasal conchas are covered soft tissueswhich are very sensitive not only to the atmosphere, but also to inflammation.
The middle passage of the nose has passages to most of the paranasal sinuses. An exception is the main sinus. There is also a semilunar slit, the function of which is to provide communication between the middle course and the maxillary sinus.
Top wall
The perforated plate of the ethmoid bone provides the formation of the nasal vault. The holes in the plate give passage to the cavity for the olfactory nerves.
Bottom wall
Blood supply to the nose
The bottom is formed due to the participation of the processes of the maxillary bone and the horizontal process of the bone of the palate.
The nasal cavity is supplied with blood by the main palatine artery. This same artery gives several branches for the blood supply to the wall located behind. The anterior ethmoid artery supplies blood to the lateral nasal wall. The veins of the nasal cavity merge with the facial and ocular veins. The eye branch has branches leading to the brain, which is important in the development of infections.
The deep and superficial network of lymphatic vessels ensures the outflow of lymph from the cavity. The vessels here communicate well with the spaces of the brain, which is important for accounting for infectious diseases and the spread of inflammation.
The mucous membrane is innervated by the second and third branches of the trigeminal nerve.
Paranasal sinuses
The clinical significance and functional properties of the paranasal sinuses are enormous. They work in close contact with the nasal cavity. If the sinuses are exposed to an infectious disease or inflammation, this leads to complications on important organslocated in close proximity to them.
The sinuses are literally dotted with a variety of holes and passages, the presence of which contributes to the rapid development of pathogenic factors and the aggravation of the situation in diseases.
Paranasal sinuses
Each sinus can cause infection to spread into the cranial cavity, eye damage, and other complications.
Maxillary sinus
Has a pair, located deep in the bone of the upper jaw. Sizes vary greatly, but the average is 10-12 cm.
The wall within the sinus is the lateral wall of the nasal cavity. The sinus has an entrance to the cavity located in the last part of the lunate fossa. This wall is endowed with a relatively small thickness, and therefore it is often pierced in order to clarify the diagnosis or conduct therapy.
The wall of the upper part of the sinus has the smallest thickness. The posterior sections of this wall may not have a bone base at all, making do with cartilaginous tissue and many clefts bone tissue... The thickness of this wall is penetrated by the canal of the inferior orbital nerve. The infraorbital foramen opens this canal.
The channel does not always exist, but this does not play any role, since if it is absent, then the nerve passes through the sinus mucosa. The clinical significance of such a structure is that the risk of developing complications inside the skull or inside the orbit increases if a pathogenic factor affects this sinus.
From below, the wall represents the holes of the most posterior teeth. Most often, the roots of the tooth are separated from the sinus by only a small layer of soft tissue, which is common reason inflammation, if you do not monitor the condition of the teeth.
Frontal sinus
It has a pair, located deep in the forehead bone, in the center between the scales and the plates of the part of the orbit. The sinuses can be demarcated with a thin bone plate, and not always equally. Displacement of the plate to one side is possible. Holes may exist in the plate, providing communication between the two sinuses.
The sizes of these sinuses are variable - they may be absent altogether, or they can be hugely distributed throughout the frontal scales and the base of the skull.
The wall in front is the exit site for the nerve of the eye. The exit is provided by the presence of a cut above the eye socket. The notch cuts the entire upper part of the eye orbit. In this place, it is customary to open the sinus and trepanopuncture.
Frontal sinuses
The bottom wall is the smallest in thickness, which is why the infection can quickly spread from the sinus to the eye orbit.
The wall of the brain ensures the separation of the brain itself, namely the lobes of the forehead from the sinuses. It is also the site of infection.
A canal running in the frontal-nasal region provides interaction between the frontal sinus and the nasal cavity. The anterior cells of the ethmoid labyrinth, which have close contact with this sinus, often intercept inflammation or infection through it. Also, through this connection, tumor processes spread in both directions.
Lattice maze
It is cells separated by thin partitions. The average number of them is 6-8, but it can be more or less. The cells are located in the ethmoid bone, which is symmetrical and unpaired.
The clinical significance of the ethmoidal labyrinth is due to its close proximity to important organs. Also, the labyrinth can be adjacent to the deep parts that form the skeleton of the face. The cells located at the back of the labyrinth are in close contact with the channel in which the optic nerve runs. Clinical diversity appears to be an option when the cells serve as a direct pathway for the canal.
Diseases affecting the labyrinth are accompanied by a variety of pains that differ in localization and intensity. This is due to the peculiarities of the innervation of the labyrinth, which is provided by the branch of the orbital nerve, which is called the nasal nerve. The ethmoid plate also provides a path for the nerves needed for the sense of smell to function. That is why, if there is swelling or inflammation in this area, olfactory disturbances are possible.
Lattice maze
Main sinus
The sphenoid bone with its body provides the location of this sinus just behind the ethmoid labyrinth. The choanae and the vault of the nasopharynx will be located on top.
In this sinus there is a septum that has a sagittal (vertical, dividing the object into the right and left parts) location. She, most often, divides the sinus into two unequal lobes and does not allow them to communicate with each other.
The front wall is a pair of structures: ethmoid and nasal. The first falls on the area of \u200b\u200bthe labyrinth cells located posteriorly. The wall is characterized by a very small thickness and due to the smooth transition it almost merges with the wall from below. In both parts of the sinus there are small rounded passages that make it possible for the sphenoid sinus to communicate with the nasopharynx.
The back wall has a frontal position. The larger the size of the sinus, the thinner this septum, which increases the likelihood of injury during surgical interventions in this area.
The wall from above is the bottom region of the sella turcica, which is the location of the pituitary gland and the nerve cross that provides vision. Often, if the inflammatory process affects the main sinus, it spreads to the optic nerve junction.
The wall below is the vault of the nasopharynx.
The walls on the sides of the sinus are closely adjacent to the bundles of nerves and blood vessels that are located on the side of the sella turcica.
In general, infection of the main sinus can be called one of the most dangerous. The sinus is closely adjacent to many structures of the brain, for example, with the pituitary gland, subarachnoid and arachnoid membranes, which simplifies the spread of the process to the brain and can be fatal.
Pterygopalatine fossa
Located behind the tubercle of the mandibular bone. A large number of nerve fibers pass through it, therefore the significance of this fossa in the clinical sense is difficult to exaggerate. A large number of symptoms in neurology are associated with inflammation of the nerves passing through this fossa.
It turns out that the nose and the formations that are closely related to it are a completely complex anatomical structure. Treatment of diseases affecting the nasal system requires maximum care and caution from the doctor due to the proximity of the brain. The main task of the patient is not to start the disease, bringing it to a dangerous border, and promptly seek help from a doctor.
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The nasal cavity (cavum nasi) is a canal that runs sagittally through the facial skeleton.
It is located between the anterior cranial fossa, oral cavity, paired maxillary and ethmoid bones.
Outwardly, the nasal cavity opens with the nostrils (anterior nasal openings), and backward with the choans (posterior nasal openings).
Throughout it is divided in the middle by a nasal septum (septum nasi), consisting of bony and cartilaginous parts (Fig. 32).
Figure: 32. Nasal septum: 1 - nasal bone; 2 - the cartilaginous part of the nasal septum; 3 - alveolar process; 4 - perpendicular plate of the ethmoid bone; 5 - opener; 6 - palatine bone; 7 - frontal sinus; 8 - sphenoid sinus
The first is represented by a perpendicular plate of the ethmoid bone (lamina perpendicularis as ethmoidalis) and a vomer (vomer), the second is a quadrangular cartilage (cartilago guadrangularis septi nasi). In newborns, the perpendicular plate of the ethmoid bone is represented by a membranous formation and ossifies until the 6th year of life. In places where it connects to the cartilage and vomer, there is a growth zone. The uneven growth of the nasal septum is due to the presence of tissues of different structures in it, which leads to the development of deformities that can disrupt nasal breathing... A perfectly flat nasal septum is very rare.
The upper wall of the nasal cavity is formed in front of the nasal and frontal bones, in the middle sections - the sieve plate (lamina cribrosd) of the ethmoid bone and behind - the anterior wall of the main sinus. The sieve plate is thin, there may be dehiscences in it, which predetermines the possibility of infection spreading into the cranial cavity. Through its numerous small holes (25-30 on both sides of the cockscomb) are fibers of the olfactory nerve (fila olfactoria).
The lower wall of the nasal cavity in front is formed by the palatine processes of the upper jaw (processus palatimis maxillae), and behind by the horizontal plate of the palatine bone (lamina horizontalis ossis palatini). In the front part of the bottom of the nasal cavity near the nasal septum there is an incisal canal (canalis incisivus), through which the nerve and artery of the same name pass, anastomosing in the canal with the large palatine artery.
The lateral wall of the nasal cavity is formed in front by the nasal bone and the frontal process of the upper jaw, to which the lacrimal bone is adjacent, then by the medial surface of the upper jaw body, ethmoid bone, the vertical plate of the palatine and the medial plate of the pterygoid process of the main bone. On the lateral wall there are three conchae nasales: lower, middle and upper (Fig. 33).
Figure: 33. Lateral wall of the nasal cavity: 1 - frontal sinus; 2 - upper nasal concha; 3 - sphenoid sinus; 4 — upper nasal passage; 5 - middle turbinate; 6 - middle nasal passage; 7 - lower turbinate; 8 - lower nasal passage
The inferior turbinate is an independent bone, while the other turbinates are processes extending from the medial wall of the ethmoid labyrinth. Under each nasal concha there is a corresponding nasal passage - lower, middle and upper (meatus nasi inferior, medius, superior). The space between the turbinates and the septum is the common nasal passage (meatus nasi communis).
The anterior third of the lower nasal passage contains the opening of the nasolacrimal canal. On the lateral wall of the middle nasal passage there is a crescent-shaped slit (hiatus semilunaris), leading to a depression - a funnel (infundibulum). The edges of the slit are bounded behind and above by a lattice bladder (bulla ethmoidalis), in front and below by a hook-shaped process (processus uncinatus).
The opening of the frontal sinus (ductus nasofrontalis) opens into the funnel in front and above, and the opening of the maxillary sinus (ostium maxillarе) near its posterior end. Sometimes this sinus has an additional opening (ostium accessorium), which also opens into the middle nasal passage. Here, in the space between the ethmoid bladder and the place of attachment of the middle turbinate, the anterior and middle cells of the ethmoid labyrinth open. In the shortest upper nasal passage, the opening of the sphenoid sinus and posterior ethmoid cells opens.
The entire nasal cavity is covered with a mucous membrane, which passes through the corresponding holes into the mucous membrane of the paranasal sinuses, therefore, the inflammatory processes developing in the nasal cavity can pass to the sinuses.
The mucous membrane of the nasal cavity is divided into two sections: respiratory (regio respiratoria) and olfactory (regio olfactoria). The respiratory area occupies the space from the bottom of the nasal cavity to the middle of the middle turbinate. The mucous membrane in this area is covered with a multi-row columnar ciliated epithelium with a large number of goblet cells secreting mucus. The oscillation of the cilia of the ciliated epithelium is directed towards the choanas.
Below the epithelium is a thin subepithelial membrane, and below it is the mucosal tissue itself. Mainly in the middle section of its own tissue, there is a large number of tubular-alveolar branched glands with serous or serous-mucous secretion and excretory ducts that open on the surface of the mucous membrane. In some places, the mucous membrane of the respiratory zone is very thick: in the region of the anterior and posterior ends of the lower and middle turbinates, on the nasal septum at the level of the anterior end of the middle turbinate, near the inner edge of the choanas. The vascular network is represented here by varicose veins (cavernous tissue), as a result of which the mucous membrane in this area can easily swell.
The olfactory zone is located in the upper sections of the nasal mucosa - from the lower edge of the middle turbinate to the fornix of the nasal cavity, including the adjacent section of the nasal septum. The mucous membrane here is covered with a specific epithelium, consisting of supporting, basal and olfactory neurosensory cells. The surface of the olfactory epithelium is covered with a secretion of simple and branched tubular (Bowman's) glands, which dissolves aromatic substances.
The supporting cells contain a granular yellowish pigment, which gives the corresponding color to the mucous membrane of this area. The olfactory cells are flask-shaped. They are the 1st neuron of the olfactory tract. The peripheral process of the olfactory cells (dendrite) ends in a clavate thickening.
The central processes of the olfactory cells (axons) form the olfactory filaments (fila olfactoria), which, through the sieve plate, enter the anterior cranial fossa and end in the olfactory bulb (bulbus olfactorius), which contains the 2nd neuron. Axons of the 2nd neuron form the olfactory tract (tractus olfactorius). The third neuron is contained in the olfactory triangle (trigonum olfactorium), the perforated substance (substantia perforate). From the 3rd neuron, impulses go to the olfactory cortical center of its own and the opposite side, located in the temporal lobe in the area of \u200b\u200bthe seahorse gyrus (gyrus hippocampi).
The blood supply to the nasal cavity is provided by the terminal branch of the internal carotid artery (a.ophthalmica), which in the orbit is divided into ethmoidal arteries (a.a. ethmoidalis anterior etposterior), and a large branch from the system of the external carotid artery (a.sphenopalatina), which is included into the nose near the posterior edge of the middle nasal concha through the opening of the same name and gives branches to the side wall of the nasal cavity and the nasal septum.
A feature of the vascularization of the nasal septum is the formation of a dense vascular network in the mucous membrane of its antero-inferior part - the bleeding zone of the nasal septum (the so-called Kisselbach site), where the network of superficially located vessels, capillaries and precapillaries is located. Most nosebleeds come from this area.
The veins of the nasal cavity are accompanied by their corresponding arteries. Feature venous outflow from the nasal cavity is the formation of plexuses connecting these veins with the veins of the skull, orbit, pharynx, face, which makes it possible for the infection to spread through these pathways with the development of complications. With the help of the orbital veins, with which the veins of the nasal cavity are anastomosed through the anterior and posterior ethmoid veins, communication is carried out with the sinuses of the dura mater of the brain (cavernous, sagittal), the venous plexus of the pia mater of the brain.
From the nasal cavity and nasal part of the pharynx, blood also flows into the venous plexus of the pterygopalatine fossa, from where the infection can spread into the middle cranial fossa through the oval and round holes and the inferior orbital fissure.
The outflow of lymph from the anterior parts of the nasal cavity is carried out mainly into the submandibular nodes, from the middle and posterior parts to the deep cervical. The lymphatic vessels of both halves of the nose anastomose to each other along the back free edge of the nasal septum and in front - through its cartilaginous part. The connection of the lymphatic network of the olfactory membrane with the intershell spaces along the perineural pathways of the olfactory nerves, along which infection can spread (after surgery on the ethmoid labyrinth, nasal septum), with the development of intracranial complications (meningitis, etc.) is also important.
Specific innervation of the nose is carried out with the help of the olfactory nerve (n. Olfactorius). Sensory innervation of the nasal cavity is carried out by the first (n. Ophthalmicus) and the second (n. Maxillaris) branches of the trigeminal nerve.
The anterior and posterior ethmoid nerves depart from the first branch, penetrating into the nasal cavity together with the vessels of the same name and innervating the lateral sections and vaults of the nasal cavity. From the second branch of the trigeminal nerve, the pterygo-palatine and infraorbital nerves depart.
The pterygopalatine nerve is part of the fibers in the pterygopalatine node, and most of its fibers pass further, bypassing the node. From the pterygopalatine node, the nasal branches extend, which enter the nasal cavity through the pterygoid opening. These branches are distributed in the posterior-superior part of the lateral wall of the nasal cavity, in the upper nasal passage, in the upper and middle turbinates, ethmoid cells, and the main sinus. A number of branches innervate the inferior turbinate, the maxillary sinus, the mucous membrane of the hard palate.
The infraorbital nerve gives up the superior alveolar nerves to the mucous membrane of the bottom of the nasal cavity and the maxillary sinus. The branches of the trigeminal nerve are anastomosed among themselves, which explains the irradiation of pain from the nose and paranasal sinuses to the area of \u200b\u200bthe teeth, eyes, hard meninges (headache), etc. The sympathetic and parasympathetic innervation of the nose and paranasal sinuses is represented by the nerve of the pterygoid canal, or the vidian nerve (n.ccmalispterygoidei), which originates from the plexus on the internal carotid artery (upper cervical sympathetic node) and from the geniculate node of the facial nerve ( parasympathetic portion). The collector of the sympathetic innervation of the nose is the upper cervical sympathetic node, and the parasympathetic - the pterygoid node.
DI. Zabolotny, Yu.V. Mitin, S.B. Bezhapochny, Yu.V. Deeva
Nasal cavity (cavum nasi)the septum divides into two identical halves, called the right and left halves of the nose. From the front, the nasal cavity communicates with the environment through the nostrils, and from the back through the choanae fromthe upper part of the pharynx - the nasopharynx.
Each half of the nasal cavity has four walls: medial, lateral, upper and lower. The nasal cavity begins with a vestibule, which, unlike its other parts, is lined with skin, which has a significant amount of hair, serving, to a certain extent, as a filter that retains large dust particles when breathing through the nose.
On the lateral wall of the nose (Fig. 4), three protrusions are clearly visible, located one above the other. These are the conchae nasales: lower, middle and upper (conchae nasalis inferior, media et superior). The base of the lower, largest turbinate is an independent bone, while the middle and upper turbinates are parts of the ethmoid bone.
A slit-like space is defined under each nasal concha - the nasal passage. Accordingly, there are lower, middle and upper nasal passages (meatus nasi inferior, medius et superior). The space between the free surface of the turbinates and the nasal septum forms a common nasal passage.
Figure: 4. Lateral wall of the nasal cavity.
1.Medium shell. 2. Joint of the maxillary sinus; 3. Frontal sinus; 4.Frontal sinus joint; 5. Lacrimal canal; 7. Lower nasal passage; 8. Middle nasal passage; 9.Upper turbinate; 10.Middle turbinate; 11.Inferior turbinate; 12. The mouth of the auditory tube; 13.Upper nasal passage; 14. Sphenoid sinus; 15.Justice of the sphenoid sinus; 16. Sieve plate; 17.Ophalous zone.
In addition to bone tissue in the submucosal layer of the turbinates, there is an accumulation of varicose venous plexuses (a kind of cavernous tissue), in which arterioles of small diameter flow into venules of a larger diameter. This makes it possible for the nasal conchas to increase in volume and narrow the lumen of the common nasal passage under the influence of certain stimuli, which contributes to a longer contact of the inhaled air with the mucous membrane filled with blood.
In the lower nasal passage under the anterior ends of the concha into the nasal cavity, the lacrimal canal opens, through which the tear flows. In the middle nasal passage, most of the paranasal sinuses open (maxillary, frontal, anterior and middle cells of the ethmoid labyrinth), therefore, sometimes the middle nasal passage is called the "mirror of the paranasal sinuses", since a purulent, catarrhal pathological process is manifested by characteristic secretions in the middle nasal passage ( fig. 5). On
the lateral wall of the middle nasal passage is a semilunar slit (hiatus semilunaris), which in the posterior part has an expansion in the form of a funnel (infundibulum ethmoidale). Into the lattice funnel anteriorly and upward
Fig. 5. Communication of the paranasal sinuses with the nasal cavity.
1.Inferior turbinate; 2. The opening of the lacrimal canal; 3. Lower nasal passage; 4. Middle turbinate. 5.Frontal sinus; 6. Joint of the frontal sinus; 7. Lattice bubble; 8.The joint of the maxillary sinus; 9.Upper turbinate; 10.Upper nasal passage; 11.Justice of the sphenoid sinus; 12. Sphenoid sinus; 13. Pharyngeal tonsil; 14. The pharyngeal opening of the auditory tube.
the excretory canal of the frontal sinus opens, and posteriorly and downward - the natural anastomosis of the maxillary sinus. In the middle nasal passage, the anterior cells of the ethmoid labyrinth open. The natural anastomosis of the maxillary sinus is covered by the uncinate process (processus uncinatus), so the anastomosis cannot be seen during rhinoscopy. IN last years in connection with the introduction endoscopic methods rhinosurgery needs to know such details anatomical structure the nasal cavity, as an "ostiomeatal complex", is a system of anatomical structures in the region of the middle nasal passage (Fig. 6). It includes
. 
Fig. 6. Coronal section through the ostiomeatal complex.
1. Anastomosis of the frontal sinus; 2.Paper plate; 3.Middle turbinate; 4. Lattice bubble; 5. Middle nasal passage; 6. Funnel; 7. Hook-shaped process. 8.Joint of the maxillary sinus.
hook-shaped process, cells of the nasal roller (agger nasi), posteriorly - a large ethmoid vesicle (bulla ethmoidales) and the lateral surface of the middle nasal concha.
Medial wall the nasal cavity is represented by the nasal septum (septum nasi), consisting of two bone elements - the perpendicular plate of the ethmoid bone and the vomer, as well as the cartilaginous plate (quadrangular cartilage) and the part located in the vestibule of the nose, consisting of skin duplication - the movable part of the nasal septum (Fig. . 7).
The vomer is an independent bone in the shape of an irregular quadrangle. At the bottom, the opener adjoins the nasal crest of the palatine processes of the upper jaw and palatine bone. Its rear edge forms
Figure: 7. Septum of the nose.
1.Medial pedicle of the greater wing cartilage; 2. Quadrangular cartilage; 3. Nasal bone; 4. Frontal sinus; 5. Perpendicular plate of the ethmoid bone; 6. Sphenoid sinus. 7. Opener.
the septum between the right and left choans. The upper edge of the quadrangular cartilage forms the lower dorsum of the nose. This should be taken into account during surgery for the curvature of the nasal septum - too high resection of the cartilage can lead to retraction of the nasal dorsum. IN childhood, as a rule, up to 5 years old, the nasal septum is not curved, and later, due to the uneven growth of the bone and cartilaginous parts of the nasal septum, its deviation, expressed in varying degrees, occurs. In adults, more often in men, the curvature of the nasal septum is observed in 95% of cases.
Top wall the nasal cavity in the anterior sections is formed by the nasal bones, in the middle section - by the ethmoid plate of the ethmoid bone (lamina cribrosa). This is the narrowest part of the roof of the nasal cavity, only a few millimeters. This wall is very thin and if careless surgical interventions in the nasal cavity, damage to this thin plate can occur with the occurrence of nasal liquorrhea. With an associated infection, inflammation of the meninges (meningitis) is possible. The upper wall is permeated with a large number of small holes (about 25-30), passing into the nasal cavity fibers of the olfactory nerve, the anterior ethmoid nerve and the vein accompanying the ethmoid artery - the source of possible heavy nosebleeds.
Bottom wall the nasal cavity delimits the nasal cavity from the oral cavity, it is formed by the palatine process of the upper jaw and the horizontal plate of the palatine bone. The width of the bottom of the nasal cavity in an adult is 12-15mm, in a newborn - 7mm. Posteriorly, the nasal cavity communicates through the choanae with the nasal part of the pharynx. In a newborn, choanas are triangular or rounded, 6x6 mm in size, and by the age of 10 they double.
In children early age the nasal passages are narrowed by the turbinates. The inferior turbinate fits snugly to the bottom of the nasal cavity. Therefore, in young children, even a slight inflammation of the nasal mucosa leads to a complete shutdown of nasal breathing, a disorder of the sucking act.
The mucous membrane of the nasal cavity lines two conditionally divided zones - olfactory and respiratory. Throughout its entire length, the mucous membrane of the respiratory zone is firmly connected with the underlying bone and cartilage formations. Its thickness is about 1mm. The submucosal layer is absent. The mucous membrane of the nasal cavity contains ciliated epithelial cells, as well as a large number of goblet and basal cells. On the surface of each cell, there are 250 to 300 cilia, which perform from 160 to 250 vibrations per minute. These cilia oscillate in the direction of the posterior parts of the nasal cavity, towards the choanas (Fig. 8).
Fig. 8. Mucociliary transport scheme.
1.3 Mucus; 2.Cilia (cilia); 4.Microvilli.
When inflammatory processes ciliated epithelial cells can metaplase into goblet cells and, like them, secrete nasal mucus. Basal cells contribute to the regeneration of the nasal mucosa. Normally, the nasal mucosa secretes about 500 ml of fluid during the day, which is necessary for the normal functioning of the nasal cavity. In inflammatory processes, the excretory capacity of the nasal mucosa increases many times. Under the cover of the mucous membrane of the nasal concha is a tissue consisting of a plexus of small and large blood vessels - a whole ball of dilated veins, resembling cavernous tissue. The walls of the veins are richly supplied with smooth muscles, which are innervated by the fibers of the trigeminal nerve and, under the influence of stimulation of its receptors, can contribute to filling or emptying the cavernous tissue, mainly of the inferior turbinates. Normally, usually both halves of the nose breathe unevenly during the day - either one or the other half of the nose breathes better, as if giving the other half a rest (Fig. 9).
Fig. 9. Nasal cycle on CT scan of the paranasal sinuses.
In the anterior part of the nasal septum, a special zone can be distinguished, with an area of \u200b\u200babout 1 cm 2, where the accumulation of arterial and especially venous vessels is large. This bleeding area of \u200b\u200bthe nasal septum is called the "Kiesselbach place" (locus Kiesselbachi), it is from this area that nosebleeds most often occur (Fig. 10).
Figure: 10. Bleeding area of \u200b\u200bthe nasal septum.
1. Anterior and posterior ethmoid arteries. 2. Wedge-palatine artery; 3. Palatine artery; 4. Lip artery; 5.Kisselbach's place.
The olfactory region captures the upper parts of the middle shell, the entire upper shell and the upper part of the nasal septum located opposite it. Axons (non-fleshy nerve fibers) of olfactory cells in the form of 15-20 thin nerve filaments pass through the holes of the ethmoid plate into the cranial cavity and enter the olfactory bulb. Dendrites of the second neuron approach the nerve cells of the olfactory triangle and reach subcortical centers... Further from these formations, the fibers of the third neuron begin, reaching the pyramidal neurons of the cerebral cortex - the central part of the olfactory analyzer.
Blood supply to the nasal cavity carried out from the maxillary artery, one of the terminal branches of the external carotid artery. The wedge-palatine (a. Sphenopalatina) departs from it, entering the nasal cavity through the hole of the same name approximately at the level of the posterior end of the middle shell. It gives branches for the lateral wall of the nose and the nasal septum, through the incisal canal it anastomoses with the great palatine artery and the artery of the upper lip. In addition, the anterior and posterior ethmoidal arteries (a. Ethmoidalis anterior et posterior) penetrate into the nasal cavity, extending from the ophthalmic artery, which is a branch of the internal carotid artery (Fig. 11).
Thus, the blood supply to the nasal cavity is carried out from the system of the internal and external carotid arteries and therefore not always the ligation of the external carotid artery leads to a stop of persistent nosebleeds.
The veins of the nasal cavity are located more superficially relative to the arteries and form several plexuses in the mucous membrane of the turbinates, the nasal septum, one of which - the Kisselbach site - was described earlier. In the posterior parts of the nasal septum, there is also an accumulation of venous vessels of a larger diameter. The outflow of venous blood from the nasal cavity is in several directions. From the posterior parts of the nasal cavity, venous blood enters the pterygoid plexus (plexus pterigoideus), which in turn is associated with the cavernous sinus (sinus cavernosus), located in the middle cranial fossa. This can lead to the spread of the infectious process from the nasal cavity and nasal part of the pharynx into the cranial cavity.
From the anterior parts of the nasal cavity, venous blood flows into the veins of the upper lip, angular veins, which also through the superior orbital vein
Fig. 11. Blood supply to the nasal cavity.
1. Anterior ethmoid artery; 2. Posterior ethmoid artery; 3. Meningeal artery; 4. Wedge-palatine artery; 5.Maxillary artery. 6.Internal carotid artery.; 7.External carotid artery; 8. Common carotid artery; 9.Maxillary artery embolization site.
penetrate into the cavernous sinus. That is why, with a boil located at the entrance to the nose, where there is hair, it is also possible for the infection to spread into the cranial cavity. Of great importance is the connection of the anterior and posterior veins of the ethmoid labyrinth with the veins of the orbit, which can cause the transition of the inflammatory process from the ethmoid labyrinth to the contents of the orbit. In addition, one of the branches of the anterior veins of the ethmoid labyrinth, passing through the ethmoid plate, penetrates into the anterior cranial fossa, anastomosing with the veins of the pia mater. Due to the dense venous network with numerous anastomoses in the border areas, severe complications may develop, such as thrombophlebitis of the maxillofacial region, orbital vein thrombosis, cavernous sinus thrombosis, and the development of sepsis.
Lymphatic vesselsthey divert lymph to the posterior parts of the nasal cavity, penetrate into the nasal part of the pharynx, bypassing the pharyngeal openings of the auditory tubes from above and below, penetrate into the pharyngeal lymph nodes located between the prevertebral fascia and the fascia of the neck in loose tissue. Some of the lymph vessels from the nasal cavity are sent to the deep cervical nodes. Suppuration lymph nodes with inflammatory processes in the nasal cavity, paranasal sinuses, and also in the middle ear, it can lead to the development of retropharyngeal abscesses in childhood. Metastases in malignant neoplasms of the nasal cavity and ethmoid labyrinth also have a specific localization associated with the features of lymph outflow: an increase in lymph nodes along the internal jugular vein.
Innervation - in addition to the olfactory nerve (n.olphactorius), described earlier, the nasal mucosa is supplied with sensitive fibers I and II branches of the trigeminal nerve (n. Trigeminis). The peripheral branches of these nerves, innervating the region of the orbit and teeth, anastomose among themselves. Therefore, there may be a radiating pain reaction from some zones innervated by the trigeminal nerve to others, for example from the nasal cavity to the teeth and vice versa.