Nasal turbinate
Paranasal sinuses
; frontal sinus, maxillary sinus, ethmoid sinus, sphenoid sinus
Uncinate process
; sickle-shaped, thin, bony plate ; attachment anterior : anterosuperiorly, attached to the MT : form the inferomedial wall of agger nasi cell inferior : inferior turbinate and palatine bone posterior : parallel to the curvature of bulla ethmoidalis superior : attach to lacrimal bone base of the skull or LP always fuses with the MT anterosuperiorly
Uncinate process 2
Middle turbinate
- conchal head, conchal neck, conchal sinus - conchal sinus, cavity between ethmoid bulla and MT - 3 discernible component 1st. Part ; anterior and medial position, sagittal plane attach vertically to the skull base, LT, lateral lamella 2nd. Part ; frontal plane attach laterally to the lamina papyracea in an oblique fashion 3rd. Part ; (basal lamella) horizontal plane attach laterally to the perpendicular plate of palatine
Middle turbinate 2
Plane Vertical(Sagittal plane) Oblique(Frontal plane) Horizontal plane Attachment Crista ethmoidalis and the skull base Lamina papyracea Lamina papyracea & lamina perpendicularis
Basal lamella
1st. Uncinate process 2nd. Bulla ethmoidalis 3rd. Basal lamella of the middle turbinate 4th. Lamella of the superior turbinate 5th. Lamella of the supreme turbinate
Bulla Ethmoidalis
- most constant landmark - Boundary anterior ; convex curvature posterior free border of UP superior ; Fovea posterior ; basal lamella(variable) lateral ; lamina papyracea medial ; covered by middle turbinate
Ethmoid infundibulum
- well-defined 3D cleft between anterior wall of ethmoidal bulla and posterior wall of uncinate process - medial ; uncinate process lateral ; formed by LP, frontal process of the maxilla depth ; average depth, 2mm(variable, 0.5~10mm)
Lateral sinus
- not always present - boundary superior ; fovea inferior ; roof of the ethmoid bulla posterior ; basal lamella of the MT lateral ; lamina papyracea medial ; middle turbinate dorsal ; space between bulla ethmoidalis and basal lamella open ; between bulla ethmoidalis and middle turbinate
Lateral sinus 2
- divided into suprabullar recess and retrobullar recess a. suprabullar recess ; a space bordered by the ethmoidal bulla(inferiorly) ethmoidal fovea(superiorly) b. retrobullar recess ; bordered by ethmoidal bullar(anteriorly) basal lamella(posteriorly)
Fontanelle area
- 2 distinct areas on the lateral nasal wall where the nasal muconsa and mucoperiosteum of the maxillary sinus - anterior fontanelle : anterior and inferior to the inferior attachment of the uncinate process - posterior fontanelle : superior to the posterior insertion of the uncinate process
cf. posterior ethmoid artery : ophthalmic artery : posterior ethmoid canal - optic foramen(5~10mm)
Roof of Ethmoids
- anterior 2/3, frontal bone, fovea ethmoidalis - medially, join the lamina cribrosa - height of the roof(Keros)
Lateral lamella
- thinnest at the location of anterior ethmoid arterial passage (0.05mm. 1/10 of thickness of fovea ethmoidalis)
Cribriform plate
- perforated by the olfactory nerve fiber - attach to the crista gali and perpendicular plate middle turbinate lateral lamella
Olfactory fossa
- located between the crista gali medially cribriform plate inferiorly lateral lamella laterally - olfactory bulb
Frontal recess
- the space where the frontal sinus open - boundary anterior ; uncinate process and agger nasi cell posterior ; bulla ethmoidalis and suprabullar lamella lateral ; lamina papyracea medial ; hiatus semilunaris inferior or neck of MT inferior ; ethmoid infundibulum superior ; fovea ethmoidalis, supraorbital cell, anterior ethmoid artery, frontal ostium
Frontal recess
Frontal recess 2
- size of the frontal recess, determined by the size of the surrounding anterior ethmoid air cell(bulla ethmoidalis, agger nasi cell, supraorbital cell and frontal cells)
Frontal cells
- Kuhn type I : a single small cell above the agger nasi cell II : multiple small cells above the agger nasi cell III : a single large cell above the agger nasi cell extending to the frontal sinus IV : a single small cell inside the frontal sinus
Spatial relationship
- superior ; anterior cranial fossa - anterior ; spheno-ethmoid recess, superior turbinate, and posterior ethmoid - inferior ; nasopharynx - posterior ; basi-sphenoid sella posterior cranial fossa - lateral ; middle cranial fossa, cavernous sinus
Classification
: basis of pneumatization - conchal(2~3%) - presellar(11%) - sellar(86%)
Neurovascular relationship
- optic nerve - internal carotid artery - maxillary nerve(V2) in the foramen rotundum - Vidian nerve in the pterygoid canal
Sphenoid rotrum
- midline projection of anterior sphenoid wall - articulate, perpendicular plate of ethmoid and vomer
Sphenoethmoid recess - a space behind and above the most superior turbinate - boundary superior ; cribliform plate inferior ; nasopharynx anterior ; uppermost concha (superior or supreme turbinate) posterior ; anterior wall of sphenoid sinus medial ; nasal septum
- Reference
1) N.J. Bhatt Endoscopic Sinus Surgery new horizons p.48~51 2) 3) R. Kamel. Endoscopic anatomy of the lateral nasal wall, ostiomeatal complex and anterior skull base