#PLEMARCH2019 ANATOMY [Type text]

MODULE I Sinuses Status at First Reaches adult

birth radiological size
MODULE II evidence
Nasal cavity Maxillary Present 4-5 months 15 years
- Divided by nasal septum into right/left halves; with bony sinus after birth
ridges called conchae which increase the surface area Ethmoid sinus Present 1 year 12 years
o External nars/nostrils Sphenoid - 4 years 15 years- adult
o Nasal vestibule Frontal - 6 years Size increases
o Internal nares until teens
- Medial wall (nasal septum) - vomer, perpendicular plate
of ethmoid, septal cartilage Drainage
- Lateral wall- superior, middle, inferior nasal conchae Sphenoethmoidal recess Sphenoidal sinus
- Roof - cribriform plate of ethmoid, nasal, frontal and Superior meatus Posterior ethmoidal sinus
body of sphenoid Middle meatus Anterior ethmoidal sinus
- Floor – palatine process of maxilla and horizontal plate Middle ethmoidal sinus
of palatine Maxillary sinus
- Receives the openings of Nasolacrimal ducts and Frontal sinus
paranasal sinuses Inferior meatus nasolacrimal duct inferior
- Functions: nasal concha
o Reduce the weight of skull
o Produce mucus act as resonators Blood supply of nasal cavity
o Maxillary, frontal, ethmoidal and sphenoidal a. Superior nasal artery
sinus b. Superior labial artery
c. Lateral nasal artery
d. Sphenopalatine artery

Kisselbach’s plexus (Little’s area)

Greater palatine artery
Anterior ethmoidal artery
Sphenopalatine artery
Superior labial artery
*trauma – MC cause of epistaxis
PARANASAL SINUSES
1. Sphenoidal sinus Woodruff’s plexus
 Resonance of sound - Posterior nasal cavity
 Makes head lighter - Ascending pharyngeal artery – common to both
2. Ethmoidal sinus - Posterior nasal artery
 Anterior
 Middle
 Posterior
3. Frontal sinus
- Last to develop (7-8 years)
4. Maxillary sinus
- Largest(MAXillary), first to develop

Anterior Epistaxis vs posterior epistaxis

Kisselbach woodruff
Mgmt: nasal packing, epinephrine
Anterior epistaxis is easier to manage

SALIVARY GLAND
*present at birth (ME) = Maxillary and Ethmoidal  Histology
*infection of sinus  brain abscess  Parotid gland
 Sublingual gland
 Submandibular gland
 Mucus

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#PLEMARCH2019 ANATOMY [Type text]
 Round, elongated instead
 Flattened mucus at bae
 Pale staining, mucin droplets
 Lubricant – main function
 Serous
 mixed

PAROTID GLAND
- largest, Side
- purely Serous
- duct: Stensen duct SUBMANDIBULAR GLAND
- opens into the oral vestibule opposite the Second molar - lies at the floor of the mouth
- secretion mixed (serous > mucous)
- duct: Wharton’s duct

Parotitis – inflammation of the parotid gland(s)

What is the nerve supply of parotid gland

a. facial nerve – common mistake SUBLINGUAL GLAND
b. oculomotor nerve - smallest
- secretion: mixed =mucous>serous
c. glossopharyngeal nerve –CN 9 (mirror image P=9)
- ducts: rivinu and bartholin’s duct
d. vagus nerve

Be careful not to damage the facial nerve(divides parotid gland

in 2 lobes) in surgery in cases like parotid gland tumor, warthin’s
tumor, pleomorphic adenoma)
Pa-pa = parotid= pacial

FREY’S SYNDROME
Surgery (From Schwartz)
- post-gustatory sweating due to damage of
Benign Epithelial and Nonepithelial tumors
Auriculotemporal nerve and great Auricular nerve
Epithelial tumors
(AGA)
 Pleomorphic adenoma
- innervate a sweat gland, a stimulus intended for
o Most common benign salivary tumor, 80%
saliva production results to sweat secretion

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o Parotid gland
 Monomorphic adenoma
 Warthin’s tumor
o 2nd MC benign salivary tumor
o 95% in parotid 3% bilateral
 Oncocytoma

Non-Epithelial tumors
 Hemangioma
 Neural sheath tumor
 Lipoma

Malignant tumors
 Mucoepidermoid carcinoma
o MC malignant salivary gland tumor
o Low grade
o High grade
o MC parotid maligmancy
 Adenoid cystic carcinoma
o 2nd MC

Legend:
Black – ECDB module
Green – topnotch handout/pearls
Red - emphasized
Blue – notes/remarks
Different font and in a box - Clinical/board correlate