ANATOMY OF PARANASAL SINUS FULL PPT.pptx

Anatomy of Paranasal sinuses

1. ANATOMY OF PARANASAL SINUS MODERATOR : DR SANA PRESENTOR : DR SONALI

2. SUB HEADINGS : INTRODUCTION . FRONTAL SINUS MAXILLARY SINUS . ETHAMOIDAL SINUS . SPHENOID SINUS .

3. INTRODUCTION . PAIRED STRUCTURES LINED BY THE CILIATED PSEUDOSTRATIFIED COLUMNAR RESPIRATORY EPITHELIUM . DIVIDED INTO THE ANTERIOR , POSTERIOR AND SPHENOIDAL COMPARTMENTS . ANTERIOR FUNCTION UNIT : MAXILLARY , ANTERIOR ETHAMOIDAL AND FRONTAL SINUSES : DRAIN INTO THE NOSE THROUGH THE OSETOMEATAL COMPLEX IN THE MIDDLE MEATUS . THE SPHENOID FUNCTION UNIT : SPHENOID SINUS DRAIN THROUGH THE SPHENOIDAL RECESS . SCOTT AND BROWN 8 TH EDITION

4. FRONTAL SINUS :

5. DEVEOPS FROM THE TWO OSSIFICATION CENTES . ONE IN EACH SUPRACILIARY RIDGE : 8 TH INTRAUTRINE WEEK . TWO HALVES SEPERATED BY THE FRONTAL / METOPIC SUTURES. FUSE BY EIGHTH YEAR . EMBRYOLOGICALLY , IT IS REGARDED AS THE ANTERIOR ETHAMOIDAL CELL . FRONTAL BONE IS GRADUALLY PNEUMATISED FROM THE ANTERIOR AND SUPERIOR SEGMENT OF THE ANTERIOR ETHAMOID COMPLEX . INVADES FRONTAL BONE 2-4 YEARS . PROCESS OF PNENUMATIOSATION IS VERY SLOW . WELL DEVELOPED BY 12 YEARS SCOTT AND BROWN 8 TH EDITION

6. FRONTAL BONE . FORMS THE FOREHEAD AND ORBITAL ROOF . FORMS THE ROOF OF THE ETHAMOIDAL SINUSES : PRODUCE INDIVIDUAL IMPRESSION UPON FRONTAL BONE , FOVEA ETHAMOIDALES. BONE IS THICK IN THE REGION , THINER IN THE ORBITAL ROOFS . SCOTT AND BROWN 8 TH EDITION

7. FRONTAL SINUS. SITUVATED ABOVE AND DEEP TO THE SUPRAORBITAL MARGINS . LIES BETWEEN THE INNER AND OUTER TABLES OF THE LOWER PART OF THE FRONTAL BONE . MOST VARIABLE IN SIZE AND SHAPE . L SHAPED , COMPOSED OF THE HORIZONTAL AND VERTICAL COMPARTMENTS . OFTEN ASSYMETRICAL IN NATURE . SCOTT AND BROWN 8 TH EDITION

8. RELATION OF THE FRONTAL SINUS . ANTERIOR WALL : SKIN OVER FOREHEAD . POSTERIOR WALL : MENINGES AND FRONTAL LOBE OF THE BRAIN . FLOOR : ORBIT FRONTAL SINUS IS COMPARTMENTALISED FURTHER BY THE INTRASINUS SEPTA - LOSS OF DEFINITION OF THE SCALLOPED BORDER OR THE INTRASINUS SEPTA ON PLAIN X RAY INDICATED : CHRONIC INFECTION . SCOTT AND BROWN 8 TH EDITION

9. FRONTAL SINUS OSTIUM IS SITUVATED IN THE FLOOR AND OPENS INTO THE FRONTAL RECESS . FRONTO NASAL OUTFLOW TRACT : HOURGLASS CONFIGURATION . 1. UPPER PORTION IS : FRONTAL INFUNDIBULUM. 2. NECK : FRONTAL SINUS OSTIUM. 3. LOWER PORTION : FRONTAL SINUS AREA . SCOTT AND BROWN 8 TH EDITION

10. THE FRONTAL SINUS DRAIN INTO THE FRONTAL RECESS EITHER MEDIALLY OR LATERALLY TO THE UNCINATE PROCESS DEPENDING ON THE MODE OF ATTACHMENT OF THE UNCINATE PROCESS . THE UNCINATE PROCESS ATTACHES TO THE LP IN 33% OF CASES : THEREFORE THE FRONTAL RECESS DRAINAGE IS PATHWAY IS MEDIAL TO THE UNCINATE PROCESS IN 33% CASES . IT MAY ALSO DRAIN INTO SUPRA BULLAR RECESS WHEN IT PRESENT. SCOTT AND BROWN 8 TH EDITION

11. FRONTAL RECESS : ANTERIOR : ANTERIOR WALL OF AGGER NASI AND THE FRONTAL PROCESS OF THE MAXILLA , FRONTAL BEAK . MEDIALLY : THE SUPERIOR ATTACHEMENTS OF THE MIDDLE TURBINATES , LATERAL LAMELLA OF THE CRIBRIFORM PLATE . LATERAL : LAMINA PAPYRACEA. POSTERIOR : UPWARD CONTINUATION OF THE ANTERIOR FACE OF THE BULLA . IF THERE IS SUPRABULLAR RECESS IT WILL OPEN INTO POST WALL OF THE FR. SUPERIOR : FR OPENS VIA FO INTO FS SCOTT AND BROWN 8 TH EDITION

12. ACCESARY CELLS OF THE FRONTAL SINUS

13. CLINICAL SIGNIFICANCE IF THE BULLA LAMELLA IS ABSENT SUPERIORLY , A SUPRA BULLA SPACE WILL COMMUNICAYE DIRECTLY WITH THE FRONTAL RECESS. IN THIS SITUVATION : 1. ANTERIOR ETHAMOIDAL ARTERY IS NOT PROTECTED BY THE BULLA LAMELLA AND MAY BE AT RISK DURING DISSECTION OF THE FRONTAL RECESS. 2. FAILURE TO RECOGNISE THESE CELLS PREOPERATIVELY WILL RESULT IN INCOMPLETE SURGICAL DISSECTION OF THE FRONTAL RECESS. 3. T HESE CELLS CAN BECOME QUITE LARGE AND MISTAKEN FOR EITHER THE SKULL BAS E OR POSTERIOR TABLE OF THE FRONTAL SINUS SCOTT AND BROWN 8 TH EDITION

14. SUPRA ORBITAL ETHAMOIDAL CELLS : ARE THE ANTERIOR ETHAMOIDAL CELLS THAT EXTENDS SUPERIORLY AND LATERALLY OVER ORBITAL ROOF . OR ORBITAL PLATE OF THE FRONTAL BONE IS EXTENSIVELY PNEMATISED. SOEC : CLINICAL SIGNIFICANCE : 1. THE ANTERIOR ETHAMOIDAL ARTER Y IS MORE LIKELY TO BE PRESENT IN A MESENTRY AND HENCE SUSCEPTIBLE TO INJURY. 2. A GREATER PROPORTION OF THE ORBIT AND SKULL BASE ARE EXPOSED WITHIN SURGICAL FIELD . 3.IT IS EASY TO MISTAKE THE OPENINGS OF THE SUPRAORBITAL CELLS AS THAT OF THE FRONTAL SINUS . THE FORMER TENDS TO OPEN MORE POSTERIORLY AND LATERALLY SCOTT AND BROWN 8 TH EDITION

15. FRONTAL INTERSINUS SEPTAL CELLS : ARISES FROM THE FRONTAL SINUS SEPTUM . THESE TENDS TO PUSH THE DRAINAGE PATHWAY LATERALLY AND ULTIMATELY DRAIN INTO FRONTAL RECESS ON THAT SIDE . SCOTT AND BROWN 8 TH EDITION

16. BENT AND KUHS CLASSIFICATIONS;

17. WORMALD FURTHER MODIFIES THIS CLASSIFICATION TO MORE ACCURATELY DESCRIBE TYPE 3 CELLS AS FRONTAL ETHAMOIDAL CELLS THAT FILLS LESS THAN 50% OF THE FRONTAL SINUS AND TYPE 4 CELLS THAT FILLS GREATER T HAN 50 % OF THE FRONTAL SINUS . SCOTT AND BROWN 8 TH EDITION

18. MAXILLARY CELLS : FIRST SINUS TO APPEAR ( 7 TO 10 WEEK ) OF GESTATION. SHALLOW GROOVE EXPANDINGS FROM THE PRIMITIVE ETHAMOIDAL INFUNDIBULUM INTO MASS OF MAXILLA. ABSORPTION AND EXPANSION RESULTS IN A S MALL CAVITY AT BIRTH WHICH MEASURES 7 DEPTH , 3 WIDTH, 4 DEPTH ( MM). IT CONTINUES TO GROW DURNING CHILDHOOD OF 2MM VERTICALLY AND 3 MM ANTEROPOSTERIOR. 12 YEARS : PNEMATISATION REACHES LATERAL ORBIT WALL AT THE INSERTION OF THE ZYGOMATIC PROCESS , INFERIORLY TO THE LEVEL OF THE NASAL FLOOR AND AFTER SECOND DENTITION BELOW THE NASAL FLOOR. AFTER DENTITION SINUS REACHES THE FINAL SIZE IN 17 TO 18 YEARS . SCOTT AND BROWN 8 TH EDITION

19. SYNONYM : ANTRUM OF HIGHMORE . IT IS PNEMATIC SPACE THAT IS LODGES INSIDE THE BOSY OF MAXILLA. PYRAMIDAL IN SHAPE , THE BASE LIES MEDIALLY AND APEX IS DIRECTED TO THE ZYGOMATIC PROCESS. CAPACITY : 15 ML IN ADULTS .

20. BASE ( MEDIAL WALL ) : THE BASE OF THE PYRAMID CORRESPONDS TO THE LATERAL NASAL WALL . ROOF : FLOOR OF THE ORBIT , INFRAORBITAL NERVES AND VESSELS . FLOOR : ALVEOLAR PROCESS OF MAXILLA . ANTERIOR : ANTERIOR WALL OF MAXILLA . CANNINE FOSSA : THE THINNEST PORTION OF THE ANTERIOR WALL IS JUST ABOVE THE CANINE TOOTH . BOUNDARIES : INFERIOR : BOUNDED BY THE ALVEOLAR RIDGE . LATERALLY : BOUNDED BY THE CANINE EMINENCE WHICH IS CAUSED BY THE CANINE TOOTH SCOTT AND BROWN 8 TH EDITION

21. SUPERIOR : INFRAORBITAL FORAMEN . MEDIALLY : PYRIFORM APERTURE . POSTERIOR SURFACE : TEMPORAL SURFACE , THICK _ SEPERATED SINUS FROM THE PTERYGOPALATINE AND INFRATEMPORAL FOSSA SCOTT AND BROWN 8 TH EDITION .

22. MAXILLARY SINUS OSTIUM : LOCATED IN THE SUPERIOR ASPECT OF THE MEDIAL WALL OF THE MAXILLARY SINUS . OPENS IN THE POSTERIOR PART OF THE ETHAMOIDAL INFUNDIBULUM INTO MIDDLE MEATUS . NATURAL OSTIUM :I S ELLIPTICAL , 1-20 MM IN LENGTH. ACCESSORY OSTIUM : IS SEEN IN 30 % OF CASES - ANTERIOR AND POSTERIOR FONTANELLS . SCOTT AND BROWN 8 TH EDITION

23. TWO BONY DEHISCENCE OF THE LATERAL NASAL BONE . THESE ARE USUALLY COVERED BY MUCOSA. IN SOME INDIVIDUALS THE ANTERIOR OR POSTERIOR FONTANELLS MAY BE PATENT WHICH RESULTS IN AN ACCESORY OSTIUM . ( POST > ANT )

24. THE RELATIONSHIPS OF THE MAXILLARY OSTIUM. INFERIORLY IS THE INFERIOR TURBINATES. 1 TO 2 MM SUPERIORLY IS THE LAMINA PAPYRACEA AND THE ORBIT. POSTERIORLY IS THE POSTERIOR FONTANELLE. 0.5 CM ANTERIOR - NLD . SCOTT AND BROWN 8 TH EDITION

25. NORMAL MO . 1. 3D 2. OVOID , TUNNELS LIKE 3. WELL HIDDEN UP. ACESSARY OSTIUM : 1. 2D. 2. CIRCULAR. 3. EASILY SEEN SCOTT AND BROWN 8 TH EDITION

26. ANATOMICAL VARIATIONS . MAXILLARY SINUS HYPOPLASIA : IS PRESENT IN UP TO 10 % CT SCANS . RADIOGRAFICALLY DIAGNOSTICS CRITERIA FOR THE MAXILLARY HYPOPLASIA INCLUDES. 1. ENLARGEMENTS OF THE VERTICAL ORBITS. 2. LATERAL POSITION OF THE INFRAORBITAL NEUROVASCULAR CANAL. 3. ELEVATED C ANINE FOSSA. 4. ENLARGEMENTS OF THE SUPRAORBITAL FISSURE AND 5. ENLARGEMENTS OF THE PTERYGOPALATINE FISSURE SCOTT AND BROWN 8 TH EDITION

27. AN EXTENSIVE PNEUMATIZED MAXILLARY SINUS MAY ENCROACH UPON THE ALVEOLAR PROCESS OF THE MAXILLA - THE ROOTS OF THE TEETH WILL PROJECT INTO MAXILLARY SINUS . PNEUMATISATION MAY ALSO ENCROACH INTO ZYGOMATIC PROCESS OF THE MAXILLA .

28. ETHAMOID SINUS DEVELOPS FROM 3 OSSIFICATION CENTRES IN THE CARTILAGINOUS NASAL CAPSULE. CENTRES APPEAR AROUND 4TH , 5 TH INTRAUTRINE MONTH. 9TH -10 WEEKS OF GESTATION 6 -7 FOLDS APPEAR IN THE LATERAL WALL OF NASAL CAPSULE . SEPERATED FROM EACH OTHER BY THE CORRESPONDING GROOVES. FOLDS FUSE TOGETHER TO FORM CRESTS 1. ANTERIOR ASCENDING 2. POSTERIOR DESCENDING. SCOTT AND BROWN 8 TH EDITION

29. NASOTURBINAL : . ASCENDING PORTION - AGGER NASI DESCENDING PART - UNCINATE PROCESS. ETHMOTURBINAL : ETHAMOIDAL BULLA . MIDDLE , SUPERIOR , AND SUPERIOR TURBINATES. MAXILLOTURBINALS . MOST INFERIOR FOLDS. INFERIOR TURBINATES SCOTT AND BROWN 8 TH EDITION

30. ANTERIOR AND POSTERIOR GROUP IS DIVIDED BY THE GROUND / BASAL LAMELLA. ANTERIOR ETHAMOIDAL CELLS ARE SMALLER AND MORE NUMEROUS ( 2-8 ) THAN POSTERIOR ETHAMOIDAL CELLS ( 1-5 ) ANTERIOR ETHAMOIDS : MIDDLE MEATUS . POSTERIOR ETHAMOIDS : SUPERIOR MEATUS .

31. BOUNDARIES : SUPERIOR : ROOF OF THE ETHAMOIDAL CELLS IS FORMED BY THE FRONTAL BONE . SEPERATES ANTERIOR CRANIAL FOSSA FROM THE NASAL CAVITY. PITS / INDENTATIONS OVERLYING ETHAMOIDAL SPACES ARE CALLED FOVEOLAE ETHAMOIDALES. ARTICULATES WITH LATERAL LAMELLA OF THE CRIBRIFORM PLATE ( THINNEST BONE OF THE SKULL BASE ) SCOTT AND BROWN 8 TH EDITION

32. ANTERIOR : THE LACRIMAL BONE , FRONTAL PROCESS OF MAXILLA . POSTERIOR : ANTERIOR WALL OF THE SPHENOID SINUS . MEDIALLY : MIDDLE AND SUPERIOR MEATI. LATERALLY : THE LAMINA PAPYRACEA.

33. ANTERIOR ETHAMOIDAL CELLS : 1. ANTERIOR : LACRIMAL BONE . 2. POSTERIOR : BASAL LAMELLA. 3. MEDIAL : MIDDLE MEATUS . 4. DRAINAGE : MIDDLE MEATUS . SCOTT AND BROWN 8 TH EDITION

34. POSTERIOR ETHAMOIDAL CELLS . ANTERIOR : BASAL LAMELLA OF THE MIDDLE TURBINATES. POSTERIOR : ANTERIOR WALL OF THE SPHENOIDAL SINUS . MEDIAL : SUPERIOR OR SUPREME TURBINATES ( VERTICAL PORTION ,) DRAINAGE : SUPERIOR OR SUPREME MEATUS .

35. KEROS CLASSIFICATION

36. ETHAMOIDAL BULLA . IS THE LARGEST AND MOST CONSISTENT ANTERIOR ETHAMOIDAL CELLS . 1. IT ATTACHES TO THE L AMINA PAPYRACEA LATERALLY AND HAS VARIABLE ATTACHMENTS TO THE SKULL BASE AND BASAL LAMELLA CREATING A SERIES OF CLEFTS AND SPACES WITHIN MIDDLE MEATUS . 2. IT IS SEPARATED POSTERIORLY FROM THE GROUND LAMELLA BY A RECESS CALLED RETROBULLAR RECESS. OCCASIONALLY THE BULLA DOES NOT EXTEND UPTO THE BASE OF THE SKULL AND IS SEPEARTED FROM IT BY THE SUPRABULLAR RECESS . THE RETROBULLAR AND SUPRABULLAR RECESS TOGETHER FORMS A SEMILUNAR SPACES - SINUS LATERAILS OF GRUNWALD SCOTT AND BROWN 8 TH EDITION

37. T HE SINUS OPENS INTO THE MIDDLE MEATUS BY A SEMILUNAR CLEFTS WHICH IS OPPOSITE IN ORIENTATION TO THE HIATUS SEMILUNARIS - HIATUS SEMILUNARIS SUPERIORIS. THUS THE HIATUS SEMILUNARIS INFERIOR LEADS INTO THE INFUNDIBULUM AND THE HIATUS SEMILUNARIS SUPERIOR LEADS INTO THE SINUS LATERALIS OF GRUNWALD

38. HALLER CELLS : NAMED AFTER ALBRECHT VON HALLER. PRESENT IN 2-45% OF THE POPULATION . THEY ARE GENERALLY NOT THOUGHT TO BE ASSOCIATED WITH INCREASED RATES OF SINUSITIS BUT CAN CAUSE OBSTRUCTION OF MAXILLARY SINUS . ONODICELLS :( SPHENOETHAMOIDAL CELLS ) : POSTERIOR ETHAMOIDAL CELL MAY EXTEND POSTEROLATERALLY OVER THE SPENOID. ONODI CELLS WHEN PRESENT INSINUATES ITSELF BETWEEN THE OPTIC NERVE AND THE SPENOIDAL SINUS . OPTIC NERVE THEREFORE PRODUCES A BULGE IN THE ONODI CELLS INSTEAD OF THE SPHENOID CELLS .

39. AGGER NASI CELLS : PNEUMATISATION OF THE LACRIMAL BONE AND THE ADJACENT FRONTO NASAL PROCESS OF THE MAXILLA . 90 % OF THE PATIENTS . 1-3 IN NUMBER. - MAY PRODUCE A DISTINCT BULGE , ANTERIOR TO THE ANTERIOR ATTACHEMENTS OF THE MIDDLE TURBINATES. A PROMINENT AGGER NASAI CELLS TENDS TO DISPLACE THE ANTERIOR ATTACHEMENTS OF THE MIDDLE TURBINATES POSTERO SUPERIORLY. SCOTT AND BROWN 8 TH EDITION

40. DEVELOPMENT OF THE SPHENOIDAL BONE . PRE SPHENOIDAL PART : TUBERCULUM SELLAE , LESSER WINGS . 6 OSSIFICATION CENTRES. POST SPHENOIDAL CELLS. SELLA TURCICA , DORSUM SELLAE. GREATER WINGS , PTERYGOID PROCESS. 8 OSSIFICATION CENTRES

41. -RECOGNIZABLE AT THIRD INTRAUTERINE MONTH AS EVAGINATION FROM THE SPHENOIDAL RECESS. AT BIRTH , IT IS A SMALL CAVITY ( 2X2X1.5 MM). AT AGE 3 : PNEMATISATION PROGRESS. AT AGE 7 : PNEUMATISATION HAS REACHED THE FLOOR OF THE SELLA . ADULTS : PNEUMATISATION VARIES GREATLY ( ASYMMERTRY)

42. OCCUPIES THE BODY OF THE SPHENOID . DIVIDED BY A SEPTUM WHICH IS IS OFTEN PARAMEDIAN. AVERAGE ADULTS SINUS MEASURES 20 MM IN HEIGHT , 17 MM IN WIDTH. AVERAGE VOLUME : 5 TO 7 ML. PNEUMATISATION CAN EXTEND INTO THE GREATER WING , PTERYGOID PROCESS AND ROSTRUM AND MAY ENCROACH ON THE BASILLAR PART OF THE OCCIPITAL BONE . SCOTT AND BROWN 8 TH EDITION

43. TYPES : CONCHAL : RUDIMENTRY SINUS . 1%. PRESELLAR: PNEUMATISATION AS FAR AS ANTERIOR BONY WALL OF THE PITUITARY FOSSA. 9%. SELLAR : PNEUMATISATION EXTENDS BENEATH THE PITUTARY FOSSA. 90% SCOTT AND BROWN 8 TH EDITION

44. THE SPHENOIDAL SINUSES CAN ALSO PNEUMATISE LATERALLY INTO THE PTERYGOID ROOT RESULTING IN THE PRESENCE OF A LATERAL SPHENOIDAL RECESS. THIS PNEUMATISATION PATTERN RESULTS IN EXPOSURE OF THE NEUROVASCULAR STRUCTURES SURROUNDINGS THE SPHENOID SINUS . THE LATERAL RECESS PNEUMATISATION PATHWAY OCCURS BETWEEN THE SECOND TRIGEMINAL DIVISION AND THE VIDIAN NERVE .

45. THE TWO SINUS AR E SEPERATED BY BONY SEPTUM. IS RARELY IN MIDLINE , OFTEN PARAMEDIAN , AND THERE MAY BE DIVERTICULA , INCOMPLETE SEPTA OR COMPLETE ABSENT ( 1%). MAY BE ATTACHED TO OPTIC NERVE OR CAROTID CANAL.

46. THE OPTIC NERVE AND INTERNAL CAROTID ARTERY PRODUCES VARIABLE PROMINACES IN THE LATERAL AND POSTERIOR WALLS OF THE SINUS , WITH AN INTERVENING CLEFT WHICH CAN BE DEEP. THE BONE OVERLYING THESE STRUCTURES IS EXTREMELY THIN OR DEHISCENT IN A SIGNIFICANT PROPORTION OF THE POPULATIONS . CAROTICO - OPTIC RECESS : RECESS WHICH SEPARATES CAROTID AND OPTIC NERVE . THIS RECESS MAY BE VERY DEEP IF THE ANTERIOR CLINOID PROCESS IS PNEUMATIZED SCOTT AND BROWN 8 TH EDITION

47. DELANO CLASSIFICATION : TYPE 1 : OPTIC NERVE IS ADJACENT TO THE WALL OF THE SPHENOPIDAL SINUS , WITHOUT IMPRESSION ON THE SINUS WALL.(76%) TYPE 2 OPTIC NERVE CAUSES AN INDENTATION ON THE SPHENOIDAL SINUS WALL BUT WITHOUT CONTACTING POST ETHMOIDAL AIR CELLS .(15%) TYPE 3 : OPTIC NERVE COURSES THROUGH THE SPHENOIDAL SINSUS WITH AT LEAST 50 % OF THE NERVE BEING SURROUNDED BY THE AIR .(6%) TYPE 4 : OPTIC NERVE COURSES IMMEDIATELY ADJACENT TO THE POSTERIOR ETHAMOIDAL AND SPHENOIDAL SINSUSES ( 3%)

48. RELATION OF THE SPHENOIDAL SINUS : . ANTERIOR : THIN , POSTERIOR ETHAMOID AIR CELLS . POSTERIOR : THE POSTERIOR WALL IS USUALLY THICK SEPERATES THE SINUS FROM PONS AND BASILLAR ARTERY. LATERALLY : THEY MAY INVADE THE GREATER AND LESSER WINGS , PTERYGOID PROCESS AND LATERAL PTERYGOID PLATE OF THE SPHENOID THE INTERNAL CAROTID ARTERY AND CAVERNOUS SINUS ARE LATERAL SUPERIOR : THEY ARE RELATED TO THE ANTERIOR CRANIAL FOSSA , THE ORBITAL SURFACE OF THE FRONTAL BONE , OLFACTORY TRACT , PITUTARY GLAND , OPTIC CHIASMA. INFERIOR : ROOF OF THE NASAL CAVITY, AND NASOPHARYNX , VIDIAN NERVE RUNS FORWARDS BELOW THE FLOOR. MAXILLARY NERVE :INFEROLATERAL SCOTT AND BROWN 8 TH EDITION

49. MAXILLARY SINUS : BLOOD SUPPLY : 1. BRANCHESFROM THE FACIAL, MAXILLARY , INFRAORBITAL , GREATER PALATINE VENOUS :DRAINAGE IS TO THE ANTERIOR FACIAL VEIN AND PTERYGOID PLEXUS . NERVE SUPPLY : 1. BRANCHES OF THE MAXILLARY NERVE VIA THE INFRAORBITAL , SUPERIOR ALVEOLAR ( ANTERIOR , MIDDILE AND POSTERIOR ) AND GREATER PALATINE NERVE. LYMPHATIC DRAINAGE : SUBMANDIBULAR NODES AND PTERYGOPALATINE FOSSA FRONTAL SINUS : BLOOD SUPPLY : 1. SUPRA ORBITAL AND ANTERO ETHMOIDAL ARTERIES AND CORRESEPONDING VEINS , DIPLOIC VEINS DRAINAGE INTO SAGITAL AND SPHENOPARRITAL SINSUS NERVE SUPPLY :SUPRAORBITAL NERVE . LYMPHATIC: SUBMANDIBULAR NODES

50. SPENOID SINUS : BLOOD SUPPLY : POSTERIOR ETHAMOIDAL ARTERY : SUPPLIES THE ROOF OF THE SPHENOIDAL SINUS . BRANCHES OF THE SPHENOIDPALATINE ARTERY . NERVE : POSTERIOR ETHAMOIDAL NERVES AND ORBITAL BRANCHES OF PTERYGOPALATINE GANGLION. LYMPHATIC : RETROPHARYNGEAL NODES ETHAMOIDAL SINUS : BLOOD SUPPLY : SPHENOPALATINE , ANTERIOR AND POSTERIOR ETHAMOIDAL ARTERY AND CORRESEPONDING VEINS . NERVE SUPPLY : ANTERIOR AND POSTERIOR ETHAMOIDAL NERVES AND ORBITAL BRANCHES OF THE PTERYGOPALATINE GANGLION. LYMPHATIC DRAINAGE : SUBMANDIBULAR NODES ANTERIOR AND RETROPHARNGEAL NODES POSTERIORLY

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