APUNTES DE

AERODINMICA NASAL ,

NEW !

NASAL AERODYNAMICS
AUTHOR: SAMUEL J LIN, MD; CHIEF ED
ITOR: ARLEN D MEYERS, MD, MBA

Seminarios
Clnica de Asma y
Alergia
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Nasal physiology is greatly

dependent on the physical structure
of the nose.
La fisiologa de la nariz est en
estrecha relacin, depende, de la
estructura misma de la nariz.

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Anatomy
External nasal anatomy can best be considered in
structural thirds.
The upper third includes the paired nasal bones.
The middle third is composed of the stiff paired upper
lateral cartilages fused to the septal cartilage in the
midline.
The lower third of the nose consists of softer lower
lateral cartilages.
From a functional standpoint, the lower and middle
thirds of the nose play an important role in the nasal
valve.
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The external nasal valve is defined laterally by the

nasal ala and medially by the septum,
whereas the internal valve is defined by the attachment
of the upper lateral cartilage to the septum, which forms
an angle of approximately 15.[1]
The anterior face of the inferior turbinate defines the
lower boundary of the internal nasal valve.
The entrance of the nasal cavity consists of the piriform
aperture, which is defined as the frontal process of the
maxillary bone, floor of the nose, and lateral fibrofatty
tissue.
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Physiologic function of the nose

The nasal physiologic functions, such as warming and
humidification, are vital for upper airway function. An
adult inspires up to an estimated 10,000 liters of air
daily.[1]
Filtration of environmental particles occurs first in the
nasal cavity. The largest particles are filtered by
vibrissae. Epitelio ciliar (cepillo de limpieza).
Nasal resistance is an important factor in considering
airway resistance. In adults, nasal resistance can
contribute up to half of total airway resistance.
[1]
Through heat exchange, the nasal mucosa maintains
the nasal cavity at a range of 3137 C.[1]
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CONGESTION NASAL

TIP

In adults, nasal resistance can contribute up to half of total airway. [1]

Kerr A, ed. Rhinology.Scott-Browns Otolaryngology. 6th ed. Oxford: ButterworthHeinemann; 1997.
Siempre en un paciente con problemas respiratorios bajos

(asma),

Conviene estimular con Laser , el punto de acupuntura en la valvula

nasal
20 Segundos en cada fosa,
broncodilatadores,

repito la maniobra despus de

Ver atlas de Yu lin lian, C. Focks.

Xiang , LI20

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puntos

Nei ying

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MECANISMO CONTRACORRIENTE PARA

ENFRIAR O CALENTAR EL AIRE.
One theory regarding the efficiency of heat exchange relates to the
location of the sphenopalatine artery.
The sphenopalatine artery courses anteriorly in the nasal cavity over
the turbinates, whereas air flows in a posterior direction forming a
countercurrent exchange.[1]
Thus, the 2 opposing motions create a more efficient heat exchange
process. However, this process remains imperfect, and as much as
10% of heat loss occurs in the nose.

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Humidification is another important process

of nasal physiology.[1] Vascular mucosa increases
relative humidity to 95% before air reaches the
nasopharynx. Physiologic nasal fluids and ciliary
function are vital to maintain immune defense
through normal mucociliary flow. A number of
nasal neurovascular reflexes occur as well.

The nasopulmonary reflex suggests

that pressure on one nasal sidewall
causes ipsilateral pulmonary
congestion.[1]

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The nose may serve as a contributing factor in voice

modification. Previous authors have noted that nasal
aerodynamics may have a role in modifying highfrequency sounds and consonants.[1]
Nasal aerodynamics contribute to the olfactory system.
The active process of sniffing allows environmental
particles to reach the olfactory system, which is
located at the skull base.
Ciliary flow is a vital component of normal sinonasal
function. The ciliary structure in the nose is a 2layered structure, providing an important defense
mechanism. Resting on a pseudostratified ciliated cell
layer, mucociliary flow occurs throughout the nose and
paranasal sinuses.[2]
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Nasal Resistance
Nasal airway resistance accounts for more
than 50% of total airway resistance.[2]
The nasal cavity has been modeled as 2
resistors in parallel.[1, 4]
The 3 components of nasal resistance are as
follows:
the nasal vestibule,
nasal valve
and nasal cavum.[2]

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Both environmental and intrinsic factors affect nasal

resistance. Factors decreasing resistance include exercise,
sympathomimetics, rebreathing, atrophic rhinitis, and erect posture.
[1]

Exercise causes sympathetic vasoconstriction and

contraction of the alae nasi, increasing the capacity of
the nasal passages.

Going from a supine to an upright position

decreases jugulovenous distension and nasal
airway resistance.
Rebreathing causes increased arterial carbon
dioxide levels, which results in nasal
vasoconstriction and reduction in nasal
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Causes of increased nasal resistance

include infective rhinitis, allergic rhinitis,
vasomotor rhinitis, hyperventilation, supine
posture, alcohol, aspirin, and cold air.[6]
In vasomotor rhinitis, vagal overactivity
causes increased resistance.
Nasal resistance increases markedly in the
first 2-3 cm of the nasal airway.[1]

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The nasal vestibule is the first component of nasal resistance. The

nasal vestibule is composed of compliant walls that are liable to
collapse from the negative pressures generated during inspiration.
[1]

The vestibule has been termed the external nasal valve.

Studies have shown 30 L/min is the limiting flow
during inspiration at which nasal airway collapse
occurs in this area.[1]
The nasal vestibule is primarily supported by alar
cartilage and musculofibrous attachments.
Despite the tendency, airway collapse is prevented by
activation of the dilator naris muscles during
inspiration. During expiration, positive pressure is the
driving force for nasal vestibule dilation.
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A major area of resistance occurs at the anterior tip of the

inferior turbinate at the entrance to the piriform aperture.

This important area is called the internal nasal valve.

The nasal valve represents the narrowest segment of the
airway.[1] In total, the valve area includes the distal end of
the upper lateral cartilage, the head of the inferior
turbinate, the caudal septum, the floor of the nose, the
frontal process of the maxilla, the lateral fibrofatty tissue,
and the piriform aperture.[4] The nasal valve area is
considered as a region rather than an oblique crosssectional area of the nasal passageway.
In 1983, Haight and Cole demonstrated that the
anterior end of the inferior turbinate could advance
as much as 5 mm with the administration of
histamine.[6]
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Am J Rhinol. 2007 Jul-Aug;21(4):456-9.

Effects of the Cottle's maneuver on the nasal valve as
assessed by acoustic rhinometry.
Tikanto J1, Piril T.
The Cottle's test

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The nasal cavum is located posterior to the piriform

aperture. Its overall contribution to total airway
resistance is small. The component of nasal cavum
resistance is determined by degree of vascular
engorgement of tissues. Acoustic rhinometry
demonstrates that the tip of the inferior turbinate
narrows the airway immediately posterior to the
nasal valve. The turbinated regions of the nasal
passage have relatively large cross-sectional areas.[1]

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Clinical Evaluation of the Nose

Evaluation of nasal obstruction may consist of a
physical examination, rhinoscopy with adequate
light and a nasal speculum, chemical analysis,
imaging studies, and rhinomanometry.
Chemical analysis may include neutrophil counts relating
to the presence of infection, eosinophil counts in allergic
conditions, and mast cell counts in food allergy.

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Imaging studies include CT scans and MRI.

Rhinomanometric techniques include passive,
active, and acoustic methods.
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RINOMANOMETRIA ANTERIOR

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RINOMANOMETRIA POSTNASAL

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CAUSAS DE OBSTRUCCION NASAL

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Obstruction
RINOMANOMETRIA
POSTERIOR

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CAUSAS DE OBSTRUCCION NASAL

Septal deviation
Turbinate
hypertrophy
Rhinoplasty
Septal
perforation
Valvular collapse
Choanal atresia
Neoplasm
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Polyposis
Allergic rhinitis
Septal hematoma
Septal perforation
Rhinitis
medicamentosa
Vasomotor rhinitis
Sinusitis

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RHINOPLASTY AND NASAL AERODYNAMICS

10 % de los pacientes tienen obstruccin nasal despus de
Rinoplastia.

Terrerno muy especializado.

Mucha cautela especialmente los

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RAMAS OFTLMICA Y MAXILARES, V1,

V2
The
trigemina
l nerve
innervate
s the
posterior
nasal
cavity to
detect
noxious
stimuli.
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BIBLIOGRAFA

Atlas Netter III edicin Interactiva.

Atlas, Anatomy,Carmine de Clemente 3rd ed..
Gray s Anatomy

Ed. Longman 1973.

Emedecine collection

Nasal Cavity Anatomy, Physiology, and Anomalies on CT Scan

Author: Belachew Tessema, MD; Chief Editor:

Arlen D Meyers, MD, MBA. Updated: Mar 29, 2011

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ANATOMA Y FISIOLOGA
Favor leer notas
al pie de
pgina..
Prxima charla

..
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Gracias

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BIBLIOGRAFA EMEDECINE
Nasal Physiology Author: Sanford M Archer, MD; Chief
Editor: Arlen D Meyers, MD, MBA more...
Olfactory System Anatomy Author: Amir Vokshoor, MD;
Chief Editor: Arlen D Meyers, MD, MBA more...
Nasal Aerodynamics Author: Samuel J Lin, MD; Chief Editor:
Arlen D Meyers, MD, MBA more...
Nasal Reconstruction Author: Ali Sajjadian, MD, FACS; Chief
Editor: Arlen D Meyers, MD, MBA more...

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Gracias por la oportunidad

Desde la Clnica de Asma y Alergia

Managua , Nicaragua.
Llmenos:

22781169, 88825513 M, 843156459C

Dr. Juan Herrera Salazar
Favor ver la II Parte

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