The structure of the cartilage of the human nose diagram. Anatomy of the nose (outer nose and nasal cavity)

The human nose is a sensory and respiratory organ that performs a number of important functions related to providing tissues with oxygen, speech formation, odor recognition and protecting the body from negative external factors. Next, we will take a closer look at the structure of the human nose and answer the question of what the nose is for.

General structure and functions

It is a unique part of the human body. In nature, there are no living creatures with such a construction of the nose. Even the closest relatives of people - monkeys - are very different as appearance both the internal structure and the principles of its operation. Many scientists associate the way the nose is arranged, and the features of the development of the sense organ with upright posture and the development of speech.

The external nose can vary quite a lot depending on sex, race, age, individual characteristics. As a rule, in women it has a smaller size, but wider than in men.

In groups of European peoples, leptorinia is more often observed (narrow and high organ feelings), among the representatives of the Negroid race, indigenous Australians and Melanesians hamerinia (wider). However, the internal anatomy and physiology of the nose is the same in all people.

The human nose is the initial section of the system of upper respiratory tract. It consists of three main segments:

• nasal cavity;
• outdoor area;
• adnexal voids communicating with the cavity through thin channels.

The most important functions of the nose, which give an answer to the question of why a person needs a nose:

The structure of the outer part

The external nose is located on the outer part of the face, is clearly visible and looks like a trihedral irregular pyramid. Its shape is created by bone, soft and cartilaginous tissues.

The bone section (back, root) is formed by paired nasal bones, which are connected to the nasal processes of the frontal bone and the frontal processes of the upper jaw adjacent to the side. It creates a fixed bone skeleton, to which a mobile cartilaginous section is attached, the components of which are:

• The paired lateral cartilage (cartilago nasi lateralis) has the shape of a triangle, takes part in the creation of the wing and back. With its posterior edge, it adjoins the beginning of the nasal bone (a hump is often formed there), with its inner edge it fuses with the cartilage of the opposite side of the same name, and with its lower edge - to the nasal septum.
• Paired large cartilage of the wing (cartilago alaris major), surrounds the entrance to the nostrils. It is divided into lateral (crus laterale) and medial (crus mediale) legs. The medial ones separate the nostrils and form the tip of the nose, the lateral ones, longer and wider, form the structure of the nasal wings and are supplemented by 2-3 more small cartilages in the back sections of the wings.

All cartilages are connected to the bones and to each other by fibrous tissue and are covered by the perichondrium.

The external nose has mimic muscles located in the region of the wings, with the help of which people can narrow and widen the nostrils, raise and lower the tip of the nose. From above, it is covered with skin, in which there are many sebaceous glands and hairs, nerve endings and capillaries. Blood supply is carried out from the systems of the internal and external carotid arteries through the external and internal maxillary arteries. The lymphatic system is focused on the submandibular and parotid lymph nodes. Innervation - from the facial and 2 and 3 branches of the trigeminal nerve.

Because of its prominent location external nose most often undergoes correction by plastic surgeons, to whom people turn in the hope of getting the desired result.

Correction can be carried out to align the hump at the junction of bone and cartilage, however, the main object of rhinoplasty is the tip of the nose. The operation in clinics can be performed both according to medical requirements and at the request of a person.

Common reasons for rhinoplasty:

• change in the shape of the top of the sense organ;
• reduction in the size of the nostrils;
• congenital defects and consequences of injuries;
• deviated septum and asymmetrical tip of the nose;
• violation of nasal breathing due to deformity.

It is also possible to correct the tip of the nose without surgery, using special Aptos threads or fillers based on hyaluronic acid, which are injected subcutaneously.

Anatomy of the nasal cavity

The nasal cavity is the initial segment of the upper respiratory tract. Anatomically located between the oral cavity, the anterior cranial fossa and the orbits. In the anterior part it goes to the surface of the face through the nostrils, in the posterior part - to the pharyngeal region through the choanae. Its inner walls are formed by bones, it is separated from the mouth by a hard and soft palate, and is divided into three segments:

• vestibule;
• respiratory area;
• olfactory area.

The cavity opens with a vestibule located next to the nostrils. From the inside, the vestibule is covered with a strip of skin 4-5 mm wide, equipped with numerous hairs (there are especially many of them in older men). Hairs are a barrier to dust, but often cause boils due to the presence of staphylococci in the bulbs.

The internal nose is an organ divided into two symmetrical halves by a bone and cartilage plate (septum), which is often curved (especially in men). Such a curvature is within the normal range, if it does not interfere with normal breathing, otherwise it has to be corrected surgically.

Each half has four walls:

• medial (internal) is a septum;
• lateral (external) - the most difficult. It consists of a number of bones (palatine, nasal, lacrimal, maxillary);
• upper - sigmoid plate of the ethmoid bone with holes for the olfactory nerve;
• lower - part of the upper jaw and the process of the palatine bone.

There are three shells on the bone component of the outer wall on each side: upper, middle (on the ethmoid bone) and lower (independent bone). In accordance with the scheme of shells, nasal passages are also distinguished:

• Lower - between the bottom and the lower sink. Here is the exit of the lacrimal canal, through which the eye secretions drain into the cavity.
• Middle - between the lower and middle shells. In the region of the lunar fissure, first described by M.I. Pirogov, the outlet openings of most accessory chambers open into it;
• Upper - between the middle and upper shells, located behind.

In addition, there is a common course - a narrow gap between the free edges of all the shells and the septum. The passages are long and winding.

The respiratory region is lined with a mucous membrane consisting of secretory goblet cells. Mucus has antiseptic properties and inhibits the activity of microbes; in the presence of a large number of pathogens, the volume of secreted secretion also increases. From above, the mucous membrane is covered with a cylindrical multi-row ciliated epithelium with miniature cilia. The cilia constantly move (flicker) towards the choanae and beyond the nasopharynx, which allows the removal of mucus with associated bacteria and foreign particles. If there is too much mucus and the cilia do not have time to evacuate it, then a runny nose (rhinitis) develops.

Under the mucosa is a tissue penetrated by a plexus of blood vessels. This makes it possible, by instantaneous swelling of the mucosa and narrowing of the passages, to protect the sense organ from stimuli (chemical, physical and psychogenic).

The olfactory region is located in the upper part. It is lined with epithelium, which contains receptor cells responsible for smell. Cells are spindle shaped. At one end they come to the surface of the membrane with vesicles with cilia, and at the other end they pass into the nerve fiber. The fibers are woven into bundles, forming the olfactory nerves. Fragrant substances through mucus interact with receptors, excite nerve endings, after which the signal enters the brain, where smells differ. A few molecules of the substance are enough to excite the receptors. A person is able to feel up to 10 thousand smells.

The structure of the paranasal sinuses

The anatomy of the human nose is complex and includes not only the sense organ itself, but also the voids (sinuses) that surround it, and with which it is in close interaction, connecting with the help of channels (acoustia). The paranasal sinus system includes:

• wedge-shaped (main);
• maxillary (maxillary);
• frontal (frontal);
• cells of the ethmoid labyrinth.

The maxillary sinuses are the largest of all, their volume can reach 30 cubic centimeters. The chambers are located on the upper jaw between the teeth and the lower part of the orbits, they consist of five walls:

• The nasal is a bone plate that smoothly passes into the mucous membrane. The hole connecting with the nasal passage is located in its corner part. With difficult outflow of secretions, it develops inflammatory process called sinusitis.
• The facial one is palpable, the densest, covered with cheek tissues. Located in the canine fossa of the jaw.
• The orbital is the thinnest, it has a plexus of veins and an infraorbital nerve, through which the infection can pass to the eyes and the brain membrane.
• The posterior one goes to the maxillary nerve and maxillary artery, as well as the pterygopalatine node.
• The lower one adjoins the oral cavity, the roots of the teeth can protrude into it.

The frontal sinuses are located in the thickness of the frontal bone, between its anterior and posterior walls.

In newborns, it is absent, it begins to form from the age of 3, the process usually continues until the end of a person's sexual development. Approximately 5% of people have no frontal voids at all. The sinuses are made up of 4 walls:

• Orbital. Adjacent to the orbit, it has a long narrow connecting canal, with swelling of which frontitis develops.
• Facial - part of the frontal bone up to 8 mm thick.
• The medulla is adjacent to the dura mater and the anterior cranial fossa.
• The inner one divides the void into two chambers, often unequal.

The sphenoid sinus is located deep in the thickness of the bone of the same name, is divided by a septum into two parts of different sizes, each of which is independently connected to the upper course.

Like, and frontal voids, it is formed in children from the age of three and develops up to 25 years. This sinus is in contact with the cranial base, carotid arteries, optic nerves and pituitary gland, which can lead to serious inflammation. However, diseases of the sphenoid sinus are very rare.

The ethmoid sinus (labyrinth) consists of interconnected individual cells of the ethmoid bone, arranged in a row, 5-15 pieces on each side. Depending on the depth of the location, internal (go to the upper course), middle and front (connect to the middle course) are distinguished.

Nose is the initial part of the upper respiratory tract and is divided into three sections:
- external nose.
- nasal cavity.
- paranasal sinuses.

External nose
The external nose is a bone-cartilaginous pyramid covered with skin. The following elements of the external nose are distinguished: root, back, slopes, wings and tip. Its walls are formed by the following tissues: bone, cartilage and skin.

1. Bone part The skeleton consists of the following elements:
paired nasal bones;
frontal processes of the upper jaw;
nasal process of the frontal bone.
2. Cartilages of the external nose are paired:
triangular; wing; additional.
3. Skin covering the nose has the following features:
an abundance of sebaceous glands, mainly in the lower third of the external nose;
a large number of hairs on the eve of the nose, performing a protective function;
an abundance of blood vessels that anastomose with each other.

nasal cavity
- the space between the anterior cranial fossa and the oral cavity. The nasal cavity is divided by a septum into right and left halves and has anterior openings - nostrils and posterior - choanae leading to the nasopharynx. Each half of the nose has four walls.

Medial wall, or nasal septum, formed:
quadrangular cartilage in the anterior section;
perpendicular plate of the ethmoid bone in the upper section;
vomer in the lower back section.
Top wall consists of a perforated plate of the ethmoid bone, through which the branches of the olfactory nerve and vessels pass.
Inferior wall or floor of the nasal cavity, formed:
alveolar process of the upper jaw;
palatine process of the upper jaw;
horizontal plate of the palatine bone.
Lateral wall, which has the greatest clinical significance, is the most complex in structure. It is formed by the following bones: nasal, lacrimal, ethmoid, main and palatine. On the inner surface of the lateral wall there are three bony protrusions - nasal conchas. The superior and middle turbinates are processes of the ethmoid bone, while the inferior is an independent bone. Under the shells are the corresponding nasal passages - upper, middle and lower. The space between the nasal septum and the edges of the turbinates forms a common nasal passage. In children early age the inferior nasal concha fits snugly to the bottom of the nasal cavity, which leads to a complete shutdown of nasal breathing even with a slight inflammation of the mucosa.

Of great clinical importance are the anatomical formations located in the nasal passages:
into the lower nasal passage the outlet of the nasolacrimal canal opens, a delay in its opening leads to a violation of the outflow of tears, a cystic expansion of the canal and a narrowing of the nasal passages in newborns;
into the middle nasal passage the maxillary sinus opens, in the anterior upper section - the canal of the frontal sinus, in the middle part of the course - the anterior and middle cells of the ethmoid bone;
into the superior nasal passage the sphenoid sinus and posterior cells of the ethmoid labyrinth open.

The nasal cavity can be divided into three regions: vestibule, respiratory and olfactory.

threshold limited by the wings of the nose, its edge is lined with a strip of skin 4-5 mm, equipped with a large number of hairs that perform a protective function, but also create conditions for the occurrence of boils and sycosis.
Respiratory area occupies the space from the bottom of the nasal cavity to the lower edge of the middle turbinate and is lined with mucosa with a cylindrical ciliated epithelium. It contains a large number of goblet cells that secrete mucus, and branched alveolar glands that produce a serous secret. The movement of the cilia of the ciliated epithelium is directed towards the choanae. Under the mucous membrane of the turbinates there is a tissue consisting of a plexus of vessels and resembling cavernous tissue. The latter contributes to the instantaneous swelling of the mucosa and narrowing of the nasal passages under the influence of physical, chemical and psychogenic stimuli.
Olfactory region located in the upper posterior part of the nasal cavity, its border is the lower edge of the middle turbinate. This zone is lined with olfactory epithelium containing olfactory spindle cells, supporting cells and glands that produce a special secret to dissolve organic substances.

Paranasal sinuses are air cavities located around the nasal cavity and communicating with it through excretory openings or ducts.
There are four pairs of sinuses:
maxillary,
frontal,
lattice labyrinth and
wedge-shaped (basic).

Maxillary sinus (aka maxillary sinus) located in the body of the maxillary bone, is an irregularly shaped pyramid ranging in size from 15 to 20 cm3.
Front or front wall sinus has a depression called the canine fossa. In this area, the sinus is usually opened.
medial wall is the lateral wall of the nasal cavity and contains a natural outlet in the region of the middle nasal passage. It is located almost under the roof of the sinus, which makes it difficult for the outflow of contents and contributes to the development of congestive inflammatory processes.
Top wall sinus represents at the same time the lower wall of the orbit. It is quite thin, often has bone clefts, which contributes to the development of intraorbital complications.
bottom wall formed by the alveolar process of the upper jaw and usually occupies the space from the second premolar to the second molar. The low position of the bottom of the sinus contributes to the proximity of the roots of the teeth to the sinus cavity. In some cases, the tops of the roots of the teeth stand in the lumen of the sinus and are only covered by the mucous membrane, which can contribute to the development of odontogenic infection of the sinus, the ingress of filling material into the sinus cavity or the formation of a persistent perforation during tooth extraction.
Back wall the sinus is thick, bordering on the cells of the ethmoid labyrinth and the sphenoid sinus.

frontal sinus is located in the thickness of the frontal bone and has four walls:
inferior orbital- the thinnest
anterior- the thickest up to 5-8 mm,
back separating the sinus from the anterior cranial fossa, and
internal- partition.
The frontal sinus communicates with the nasal cavity through a thin tortuous canal that opens into the anterior middle meatus. The size of the sinus ranges from 3 to 5 cm3, and in 10-15% of cases it may be absent.

lattice maze located between the orbit and the nasal cavity and consists of 5-20 air cells, each of which has its own outlet openings into the nasal cavity. There are three groups of cells: anterior and middle, opening into the middle nasal passage, and posterior, opening into the upper nasal passage.

Sphenoid, or main, sinus located in the body of the sphenoid bone, divided by a septum into two halves, having an independent exit to the region of the upper nasal passage. Near the sphenoid sinus are the cavernous sinus, carotid artery, optic chiasm, pituitary gland. Thereby the inflammatory process of the sphenoid sinus is a serious danger.

Features of the structure of the paranasal sinuses in childhood

Newborns have only two sinuses: the maxillary sinus and the ethmoid labyrinth.

Maxillary sinus is a fold of mucous about 1 cm long at the inner corner of the orbit, laterally, under the lower wall of the orbit, there are two rows of rudiments of milk and permanent teeth. By the end of the first year of life, the sinus acquires a rounded shape. By the age of 6-7, the teeth gradually take their position, and the sinus becomes multifaceted. In early childhood, the canine is closest to the sinus; at 6 years old, two premolars and a molar are located. By the age of 12, the volume of the sinus increases and the topography approaches the norm of an adult.

Cells of the ethmoid labyrinth in newborns, they are in their infancy and fully develop by the age of 14-16.

Frontal and sphenoid sinuses newborns are absent and begin to form from 3-4 years of age. The frontal sinuses develop from the anterior cells of the ethmoid labyrinth and by the age of 6 have a volume of about 1 cm3. The sphenoid sinuses are formed from the cells of the ethmoid labyrinth located in the body of the sphenoid bone. The final development of the sinuses ends by 25-30 years.

Clinical anatomy of the external nose

Hoc (nasus) consists of the external nose and nasal cavity.

The external nose (nasus externus) is represented by a pyramidal bone-cartilaginous framework (Fig. 1.1), covered with skin. It distinguishes the tip, root (bridge), back, slopes and wings.

The bony part of the skeleton consists of paired flat nasal bones and frontal processes of the upper jaw. These bones, together with the anterior nasal spine, form the pear-shaped opening of the facial skeleton. Cartilaginous part of the skeleton consists of paired triangular and pterygoid, as well as additional cartilages; the wings of the nose in their lower posterior part are devoid of a cartilaginous base. The skin in the lower third of the nose has many sebaceous glands. Bending over the edge of the entrance to the nose (nostrils), it lines the walls of the vestibule of the nose (vestibulum nasi) for 4-5 mm. Here on the skin there is a large amount of hair, which causes the possibility of boils and sycosis. In the area of ​​\u200b\u200bthe wings of the nose, under the skin, there are muscles that expand and narrow the entrance to the nose.

The external nose, like all soft tissues of the face, is characterized by an abundant blood supply: branches anastomosing to each other from the maxillary and ophthalmic arteries, from the system of external and internal carotid arteries, respectively, go to it. The veins of the external nose drain blood through the anterior facial vein into the internal jugular vein and in large quantities through the veins of the nasal cavity, then through the ophthalmic veins into the venous plexus of the pterygopalatine fossa (plexus pterygoideus) and into the cavernous sinus (sinus caver-nosus), middle cerebral ( v.meningea media) and then into the internal jugular (v.jugularis interna) veins.

Lymph drainage from the external nose is carried out mainly in the submandibular lymph nodes. The muscles of the external nose are innervated by branches of the facial nerve (n.facialis), the skin - by the first (ophthalmic nerve - n.ophtalmicus) and the second (maxillary nerve - n.maxillaris) branches of the trigeminal nerve, supraorbital (n.supraorbitalis) and infraorbital (n.infraorbitalis) ) nerves.

The plastic skin-cartilaginous structure of the anterior part of the external nose allows, within certain limits, to shift it to the sides without subsequent permanent deformation. However, a strong mechanical impact on the bony part of the nose is often accompanied by fractures of the nasal bones, often with displacement of fragments, and with a more severe injury, a fracture of the frontal processes of the upper jaw.

Clinical anatomy of the nasal cavity

The nasal cavity (cavum nasi) is located between cavitymouth and anterior cranial fossa, and from the sides - betweenpaired upper jaws and paired ethmoid bonesmi. The nasal septum divides it sagittally into two halves, opening anteriorly with the nostrils and backwards, into the nasopharynx, with the choanae. Each half of the nose is surrounded by four paranasal sinuses: maxillary,ethmoidal labyrinth, frontal and sphenoid, which communicate on their side with the nasal cavity (Fig. 1.2). The nasal cavity has four walls: lower, upper, medial and lateral; posteriorly, the nasal cavity communicates with the nasopharynx through the choanae, remains open in front and communicates with the outside air through openings (nostrils).

Inferior wall (bottom of the nasal cavity) formed by two palatine processes of the upper jaw and, in a small area posteriorly, by two horizontal plates of the palatine bone (hard palate). Along an akin line, these bones are connected by a suture. Violations of this connection lead to various defects (non-closure of the hard palate, cleft lip). In front and in the middle in the bottom of the nasal cavity there is a nasopalatine canal (canalis incisivus), through which the nerve and artery of the same name pass into the oral cavity, anastomosing in the canal with the great palatine artery. This circumstance must be taken into account when performing submucosal resection of the nasal septum and other operations in this area in order to avoid significant bleeding. In newborns, the bottom of the nasal cavity is in contact with the tooth germs, which are located in the body of the upper jaw.

Upper wall (roof) the nasal cavity in front is formed by the nasal bones, in the middle sections - by the cribriform plate (lamina cribrosa) and the cells of the ethmoid bone (the largest part of the roof), the posterior sections are formed by the anterior wall of the sphenoid sinus. Threads of the olfactory nerve pass through the holes of the cribriform plate; the bulb of this nerve lies on the cranial surface of the cribriform plate. It must be borne in mind that in a newborn, lamina cribrosa is a fibrous formation that ossifies only by 3 years.

medial wall, or nasal septum(septum nasi), consists of the anterior cartilaginous and posterior bone sections (Fig. 1.3). The bone section is formed by a perpendicular plate (lamina perpendicularis) of the ethmoid bone and a vomer (vomer), the cartilaginous section is formed by a quadrangular cartilage, the upper edge of which forms the anterior part of the back of the nose. In the vestibule of the nose anteriorly and downward from the anterior edge of the quadrangular cartilage, there is a skin-membranous movable part of the nasal septum (septum mobile) visible from the outside. In a newborn, the perpendicular plate of the ethmoid bone is represented by a membranous formation, the ossification of which ends only by 6 years. The nasal septum is usually not exactly in the median plane. Significant curvature of it in the anterior section, more common in men, can cause breathing problems through the nose. It should be noted that in a newborn, the height of the vomer is less than the width of the choana, so it appears as a transverse slit; only by the age of 14, the height of the vomer becomes greater than the width of the choana and it takes the form of an oval, elongated upwards.

Structure lateral (outer) wall of the nasal cavity more complex (Fig. 1.4). In its formation take part in the front and middle parts medial wall and frontalmaxillary process, lacrimal and nasal bone, medialsurface ethmoid bone, in the back, forming the edges of the choana, - the perpendicular process of the palatine bone and the pterygopalatine processes of the sphenoid bone. On the outer (lateral) wall are located three turbinates(conchae nasales): lower (concha inferior), middle (concha media) and upper (concha superior). The lower shell is an independent bone, the line of its attachment forms an arc convex upwards, which should be taken into account when puncturing the maxillary sinus and conchotomy. The middle and superior shells are processes of the ethmoid bone. Often the anterior end of the middle shell is swollen in the form of a bubble (conhae bullosa) - this is an air cell of the ethmoid labyrinth. Anterior to the middle shell there is a vertical bony protrusion (agger nasi), which can be expressed to a greater or lesser extent. All turbinates, attached with one lateral edge to the lateral wall of the nose in the form of oblong flattened formations, with the other edge hang down and medially in such a way that under them are formedvenous lower, middle and upper nasal passages, whose height is 2-3 mm. The small space between the superior concha and roof of the nose, called the sphenoethmoid, is usually referred to as the superior nasal meatus. Between the nasal septum and the nasal conchas there remains a free space in the form of a gap (3-4 mm in size), which extends from the bottom to the roof of the nose - the common nasal passage.

In a newborn, the lower concha descends to the bottom of the nose, there is a relative narrowness of all nasal passages, which leads to the rapid onset of difficulty in nasal breathing in young children, even with a slight swelling of the mucous membrane due to its catarrhal state.

On the lateral wall of the lower nasal passage at a distance of 1 cm in children and 1.5 cm in adults from the anterior end of the shell is the outlet opening of the nasolacrimal canal. This opening is formed after birth; if its opening is delayed, the outflow of tear fluid is disrupted, which leads to cystic expansion of the canal and narrowing of the nasal passages. The bone of the lateral wall of the lower nasal passage at the base is much thicker than at the line of attachment of the inferior shell (this must be kept in mind when puncturing the maxillary sinus). The posterior ends of the inferior conchas come close to the pharyngeal mouths of the auditory (Eustachian) tubes on the lateral walls of the pharynx, as a result of which, with hypertrophy of the conchas, the function of the auditory tubes may be impaired and their disease may develop.

middle nasal passage located between the lower and middle shells, on its lateral wall there is a sickle-shaped (lunate) gap (hiatus semilunaris), the posterior section of which is located below the anterior one (first described by N.I. Pirogov). The following are opened into this gap: in the posterior section - the maxillary sinus through an opening (ostium 1 maxil-lare), in the anterior superior section - the opening of the frontal sinus canal, which does not form a straight line, which must be borne in mind when probing the frontal sinus. The crescent-shaped gap in the posterior region is limited by the protrusion of the ethmoid labyrinth (bulla ethmoidalis), and in the anterior region - by the hook-shaped process (processus uncinatus), which extends anteriorly from the anterior edge of the middle turbinate. The anterior and middle cells of the ethmoid bone also open into the middle nasal passage.

superior nasal passage extends from the middle concha to the roof of the nose and includes the sphenoethmoid space. At the level of the posterior end of the superior concha, the sphenoid sinus opens into the superior nasal passage through an opening (ostium sphenoidale). The posterior cells of the ethmoid labyrinth also communicate with the superior nasal passage.

The mucous membrane of the nasal cavity covers all its walls in a continuous layer and continues into the paranasal sinuses, pharynx and middle ear; she is does not have a submucosal layerrye is generally absent in the respiratory tract, with the exception of the subvocal region of the larynx. The nasal cavity can be divided into two sections: anterior - nasal vestibule(vestibulum nasi) and actually nasal cavity(cavum nasi). The latter, in turn, is divided into two areas: respiratory and olfactory.

The respiratory region of the nasal cavity (regio respiratoria) occupies the space from the bottom of the nose up to the level of the lower edge of the middle shell. In this area, the mucosathe shell is covered with multi-row cylindrical ciliatedepithelium.

Under the epithelium is the actual tissue of the mucous membrane (tunica propria), consisting of connective tissue collagen and elastic fibers. Here there are a large number mucus-secreting goblet cells andtubular-alveolar branched glands producingserous or serous-mucous secret, which through the excretoryduct exits to the surface of the mucous membrane. Somewhat below these cells on the basement membrane are basal cells that do not undergo desquamation. They are the basis for the regeneration of the epithelium after its physiological and pathological desquamation (Fig. 1.5).

The mucous membrane throughout its entire length is tightly soldered to the perichondrium or periosteum, which forms with it whole, therefore, during the operation, the shell is separated along with these formations. In the region of the predominantly medial and lower sections of the inferior shell, the free edge of the middle shell and their posterior ends, the mucous membrane is thickened due to the presence of cavernous tissue, consisting of dilated venous vessels, the walls of which are richly supplied with smooth muscles and connective tissue fibers. Areas of cavernous tissue can sometimes occur on the nasal septum, especially in its posterior section. Filling and emptying of the cavernous tissue with blood occurs reflexively under the influence of various physical, chemical and psychogenic stimuli. The mucous membrane containing the cavernous tissue can instantly swell (thereby increasing the surface and warming the air to a greater extent), causing a narrowing of the nasal passages, or contract, exerting a regulatory effect on the respiratory function. In children, cavernous venous formations reach full development by 6 years. At a younger age, in the mucous membrane of the nasal septum, rudiments of Jacobson's olfactory organ are sometimes found, located at a distance of 2 cm from the anterior edge of the septum and 1.5 cm from the bottom of the nose. Cysts can form here and inflammatory processes develop.

The olfactory region of the nasal cavity (regio olfactoria) is located in its upper sections, from the arch to the lower edge of the middle turbinate. In this area, the mucous membrane covers olfactory epithelium, the total area of ​​which in one half of the nose is about 24 cm 2 . Among the olfactory epithelium in the form of islets is the ciliated epithelium, which performs a cleansing function here. The olfactory epithelium is represented by olfactory spindle-shaped, basal and supporting cells. The central fibers of spindle-shaped (specific) cells pass directly into the nerve fiber (fila olfactoria); the tops of these cells have protrusions into the nasal cavity - olfactory hairs. Thus, the spindle-shaped olfactory nerve cell is both a receptor and a conductor. Surfaceolfactory epithelium is covered with a secret of specific tubeschato-alveolar olfactory (Bowman) glands, whichis a universal solvent of organic substances.

The blood supply to the nasal cavity (Fig. 1.6, a) is provided by the terminal branch of the internal carotid artery (a.ophthalmica), which in the orbit gives off the ethmoid arteries (aa.ethmoidales anterior et posterior); these arteries feed the anterior superior sections of the walls of the nasal cavity and the ethmoid labyrinth. The largest artery of the nasal cavity- a. spherenopalatina(branch of the internal maxillary artery from the systemexternal carotid artery) it leaves the pterygopalatine fossa through an opening formed by the processes of the vertical plate of the palatine bone and the body of the main bone (foramen sphenopalatinum) (Fig. 1.6, b), gives the nasal branches to the side wall of the nasal cavity, septum and all paranasal sinuses. This artery projects on the lateral wall of the nose near the posterior ends of the middle and inferior turbinates, which must be kept in mind when performing operations in this area. Features of vascularization of the nasal septum is the formation of a dense vascular network in the mucous membrane in the region of its anterior third (locus Kisselbachii), here the mucous membrane is often thinned (Fig. 1.6, c). From this place more than from other areas, nosebleeds occur, so it was called the "bleeding zone of the nose." Venous vessels accompany arteries. A feature of the venous outflow from the nasal cavity is its connection with the venous plexuses (plexus pterigoideus, sinus cavernosus), through which the nasal veins communicate with the veins of the skull, orbit and pharynx, as a result of which there is the possibility of infection spreading along these pathways and the occurrence of rhinogenic intracranial and orbital complications, sepsis, etc.

Lymph outflow from the anterior sections of the nose is carried out to the submandibular lymph nodes, from the middle and posterior sections to the deep cervical ones. It is important to note the connection of the lymphatic system of the olfactory region of the nose with the intershell spaces, carried out along the perineural pathways of the olfactory nerve fibers. This explains the possibility of meningitis after surgery on the ethmoid labyrinth.

In the nasal cavity, olfactory, sensitive and secretory innervation are distinguished. Olfactory fibers (fila olfactoria) depart from the olfactory epithelium and through the cribriform plate penetrate into the cranial cavity to the olfactory bulb, where they form synapses with the dendrite of the cells of the olfactory tract (olfactory nerve). The parahippocampal gyrus (gyrus hippocampi), or seahorse gyrus, is the primary center of smell, the hippocampal cortex (Ammon's horn) and the anterior perforative substance are the highest cortical center of smell.

Sensitive innervation of the nasal cavity is carried out by the first (n.ophtalmicus) and second (n.maxillaris) branches of the trigeminal nerve (Fig. 1.7). The anterior and posterior ethmoid nerves depart from the first branch of the trigeminal nerve, which penetrate the nasal cavity along with the vessels and innervate the lateral sections and the roof of the nasal cavity. The second branch is involved in the innervation of the nose directly and through the anastomosis with the pterygopalatine node, from which the posterior nasal nerves depart mainly to the nasal septum. The inferior orbital nerve departs from the second branch to the mucous membrane of the bottom of the nasal cavity and the maxillary sinus. The branches of the trigeminal nerve anastomose with each other, which explains the irradiation of pain from the nose and paranasal sinuses to the area of ​​the teeth, eyes, dura mater (pain in the forehead, back of the head), etc. The sympathetic and parasympathetic innervation of the nose and paranasal sinuses is represented by the nerve of the pterygopalatine canal (Vidian nerve), which originates from the plexus on the internal carotid artery (upper cervical sympathetic ganglion) and the geniculate ganglion of the facial nerve (parasympathetic portion).

Clinical anatomy of the paranasal sinuses

The paranasal sinuses are located around the nasal cavity and communicate with it (Fig. 1.8). There are four pairs of air sinuses: maxillary, cells of the ethmoid labyrinta, forehead and wedge-shaped. There are anterior (maxillary, frontal, anterior and middle cells of the ethmoid bone) and posterior (sphenoid and posterior cells of the ethmoid bone) sinuses. This division is convenient, since the pathology of the anterior sinuses is somewhat different from that of the posterior ones. In particular, anterior sinuses communicate with the cavitynose through the middle nasal passage, and the posterior- through the top what is important in the diagnostic plan; diseases of the posterior sinuses, especially the sphenoid sinuses, are much less common than the anterior ones.

Maxillary sinuses(sinus maxillaris) are paired, located in the body of the upper jaw (see Fig. 1.8). They are the largest: the volume of each of them is on average 10.5-17.7 cm 3 (from 1.5 to 31.5 cm). The inner surface of the sinuses is covered with a mucous membrane about 0.1 mm thick. The multi-row cylindrical ciliated epithelium covering the mucous membrane functions (has clearance) in such a way that the mucus moves in a circle upward, to the medial angle of the sinus, where the fistula with the middle nasal passage of the nasal cavity is located. In the sinus, the anterior and posterior, upper and lower, as well as the medial walls are distinguished.

On the front, or front, wall outside there is a recess - canine, or dog, fossa (fossa canina). It should be borne in mind that when this wall is felt through the soft tissue of the cheek, immediately above the fossa, the infraorbital nerve (n.infraorbitalis) comes out of the bone. The canine fossa can be of various depths (on average 4-7 mm). With its considerable depth, the anterior and upper walls of the sinus are in close proximity to the medial. In such cases, when puncturing the sinus through the lower (and even more so through the middle) nasal passage, the needle, imperceptibly for the surgeon, can penetrate through the anterior or upper wall into the soft tissues of the cheek or orbit, which can lead to the development of purulent complications. In the region of the canine fossa, the anterior wall is the thinnest.

The medial (nasal) wall of the sinus is bone, only in its upper part the bone may be absent, and then in this place the wall is represented only by a duplication of the mucous membrane. The medial wall corresponds to the lower and middle nasal passages. In its anterior section, the nasolacrimal canal passes, and in the upper, corresponding to the middle nasal passage, under the orbital edge, there is a sinus opening into the nasal cavity (ostium maxillare). Sometimes there is not a simple hole, but a channel several millimeters long. The location of the exit from the sinus in its upper section, its relative narrowness (diameter 2-6 mm) and in some cases the presence of not an opening, but a channel (or several openings - fontanel) create unfavorable conditions for the outflow of discharge from the sinus, which contributes to the development of an inflammatory process. In the upper part, the medial wall of the sinus borders on the cells of the ethmoid bone, which often allows the inflammatory process to spread in this direction.

The upper wall of the maxillary sinus is also the lower wall of the orbit; this wall is the thinnest; the canal of the infraorbital nerve and the vessels of the same name pass through it; sometimes dehiscences (congenital clefts in the bones) are formed here, closed only by the mucous membrane. In this regard, during the operation, it is possible to damage the contents of the orbit through such dehiscences. In some cases, the upper and medial walls of the sinus are at a small distance from each other; in such conditions, sinus puncture through the nasal passage is dangerous, since the needle can penetrate the orbit and cause purulent inflammation in it.

The lower wall, or bottom, of the sinus is the alveolar process of the upper jaw; in most cases, in adults, the bottom of the sinus is below the bottom of the nasal cavity. It is important to note that in adults, the 2nd premolar and 1st molar are closest to the bottom of the sinus, in some cases the tops of the roots of the teeth will stand in the sinus and are covered only by the mucous membrane. This explains the often observed spread of the inflammatory process from the corresponding teeth to the sinus.

The posterior wall of the sinus is thick, formed by the maxillary tubercle, which encloses the pterygopalatine fossa in front, where the maxillary nerve, pterygopalatine ganglion, internal maxillary artery, and pterygopalatine venous plexus are located.

ethmoid sinuses, or ethmoid labyrinth (labyrinthus ethmoidalis), are represented by air cells of the ethmoid bone, which are located between the frontal and sphenoid sinuses (see Fig. 1.8). Outside, the ethmoid cells border on the paper plate of the orbit, and the medial wall of the ethmoid bone is the lateral wall of the nasal cavity. The number, volume, and location of the cribriform cells vary, with an average of 8-10 on each side. Often observed variants of the location of the lattice cells are their distribution into the orbit in the anterior or posterior regions. In this case, they border on a different extent and with the anterior cranial fossa. Often there is also a variant when the cells of the ethmoid labyrinth are located lateral to the cribriform plate on both sides of it; in these cases, the border between the cranial cavity and the nasal cavity is both the cribriform plate and the cribriform bone. At the same time, in surgical terms, it is important to note that the ethmoid plate often lies lower than the ethmoid arch on the sides of it, therefore, when opening the cells of the ethmoid labyrinth, one must strictly adhere to the lateral direction so as not to penetrate the cranial cavity through the ethmoid bone.

frontal sinus(sinus frontalis) is located in the scales of the frontal bone (Fig. 1.9). The sinus has four walls: anterior (facial), posterior (cerebral), bordering the cranial fossa, lower (orbital), most of which is the upper wall of the orbit and which, for a short distance, borders on the cells of the ethmoid bone and the nasal cavity, and the medial (intersinus ), which in the lower section is usually located along the midline, and upward may deviate to the sides. The anterior and posterior walls in the upper part of the sinus converge at an angle. On the lower wall of the sinus anteriorly at the septum there is an opening of the fronto-nasal canal, the length of which is about 1 - 1.5 cm; in some cases, the sinus opens into the nasal cavity not with a channel, but with an opening. The canal usually opens in the anterior semilunar fissure in the middle meatus. The configuration and dimensions of this sinus are variable, its average volume is 4.7 cm 3 . Sometimes one or both sinuses are absent, which is important diagnostically. In some cases, the sinuses, spreading laterally, can be large, have bays and partitions.

Sphenoid sinuses(sinus sphenoidalis) are located in the body of the sphenoid bone (see Fig. 1.9). In each sinus, the anterior, posterior, upper, lower, outer and inner walls are distinguished. The sinuses are separated by an inter-sinus septum, or inner wall. In the front wall of each sinus there is an outlet (ostium sphenoidale), leading to the upper nasal passage. Such communication of the sinus with the nasal cavity causes the outflow of discharge into the nasopharynx along its posterior wall. The intersinus septum continues anteriorly to the nasal septum. The lower wall of the sinus partially forms the arch of the nasopharynx, the upper wall is represented by the lower surface of the Turkish saddle; to this wall from above, in addition to the pituitary gland and the optic nerve, there is a part of the frontal lobe of the brain with olfactory convolutions. The posterior wall is the thickest and passes into the basilar region of the occipital bone. The lateral wall of the sphenoid sinus is most often thin (1-2 mm), with it is bordered by the internal carotid artery and cavernousthai sinus(sinus cavernosus); here pass the oculomotor nerve, the first branch of the trigeminal, trochlear and abducens nerves (III, IV, V, VI pairs of cranial nerves).

The newborn has only two pairs of sinuses - maxillary and ethmoid, however, these sinuses are represented only by the rudiments. So, the maxillary sinuses are only diverticula of the nasal mucosa into the thickness of the upper jaw at the inner corners of the orbits in the form of a gap 10 mm long, 2-3 mm wide and high. By the age of 6, these sinuses acquire normal forms, but their sizes are often small; by the age of 8, the bottom of the sinuses descends to the level of the bottom of the nose, and only by the age of 12 - below the bottom of the nasal cavity, as in an adult. Of interest to the clinic is the fact that in infancy, the relationship between the teeth, the orbit and the maxillary sinus have significant features. If an adult has a sinus between the orbit and the teeth, then in an infant, the lower wall of the orbit is located directly above the two rows of rudiments of milk and permanent teeth, and the rudiment of the sinus is medially at some distance from the teeth. With the increase in the age of the child, the teeth gradually take their permanent place, and the maxillary sinus takes on the appropriate size and configuration. In early childhood, the canine is closest to the sinus; at the age of 6, two premolars and a molar are located near the bottom of the sinus, which, for one reason or another, can cause disease of the maxillary sinus (as in an adult). By the age of 12, the topography of these formations approaches the norm of an adult.

The cells of the ethmoid bone are formed by the time of birth, but their number and volume increase with age, especially in the period from 3 to 5 years.

The frontal and sphenoid sinuses are absent in the newborn; their formation begins by 3-4 years. The sphenoid sinuses are, as it were, laced cells of the ethmoid labyrinth, located in the body of the sphenoid bone. The frontal sinuses appear at the upper inner corner of the orbit from the anterior ethmoid cells; the nasal mucosa grows into them, while the spongy bone between the outer and inner cortical plates of the frontal bone continues to dissolve. At the age of 6 years, the height and width of these sinuses are about 8 and 12 mm, respectively; in some cases, only one frontal sinus can form, sometimes both are absent.

Clinical physiology of the nose and paranasal sinuses

Distinguish between the upper and lower respiratory tract. Nose and eyepubic sinuses, pharynx with oral cavity and larynx areto the upper respiratory tract, trachea, bronchi with bronchioles andalveoli- to the bottom.

It is normal for a person to breathe through the nose. The nose performs, in addition to respiratory, protective, resonator and olfactory functions, and also participates in the regulation of the depth of breathing and tear secretion, hemodynamics of the brain.

The respiratory function of the nose is part of the function of the human respiratory apparatus. During inhalation, due to negative pressure in the chest cavity, air rushes into both halves of the nose. Since the plane of the nostrils is located horizontally, the air stream first goes up, most of it - along the common nasal passage, the smaller one - along the middle one. In connection with the continuing thrust towards the choanae, the bulk of the air arcs backwards and goes at the level of the middle nasal passage, although part of the air stream reaches the roof of the nose and here turns towards the choanae. When exhaling, the pressure of air comes from the nasopharynx through the choanae (located vertically) to the nostrils, so the bulk of the air during exhalation goes at the level of the lower nasal passage. Thus, breathing is carried out mainly through the respiratory region (regio respiratoria). When inhaling, part of the air comes out of the paranasal sinuses, which contributes to the warming and humidification of the inhaled air, as well as its diffusion into the olfactory region. When you exhale, warm air enters your sinuses. About half (47%) of the airway resistance falls on the nasal cavity, which is also due to the relative narrowness, curvature of the nasal passages and the uneven surface of their walls. This resistance has a physiological justification: givingblowing a jet of air on the nasal mucosa is involved inexcitation of the respiratory reflex. If breathing occurs through the mouth, the inhalation becomes less deep, resulting in a decrease in the amount of oxygen entering the body. At the same time, the negative pressure from the side also decreases. chest, which in turn leads to a violation of the hemodynamics of the skull (the outflow of venous blood from the head worsens). Compensatory mechanisms, especially in children, are often insufficient, which leads to the development of a number of pathological processes in the nervous, mental, vascular, hematopoietic and other systems. In particular, at chronical violation of nasal breathing in children decreases withmaintenance of hemoglobin in the blood, the color index decreases, the number of white blood cells increases and decreasesthe number of erythrocytes, reserve alkalinity decreasesblood, oxidative processes change, etc. In adults, these tendencies also take place, although they are less pronounced.

The protective function of the nose is represented by the mechanisms by which the air is warmed, moistened and cleaned during its passage through the nasal passages during inhalation.

Warming of air is carried out due to the heat coming from the surface of the walls of the nose, the area of ​​​​which is large due to the unevenness of the walls. The cavernous bodies, located in the mucous membrane of the lower and partially middle turbinates, are a vascular apparatus designed to warm the air. Cold air as an irritating factor causes a very rapid reflex expansion of the cavernous spaces and filling them with blood, while the volume of the shells increases significantly, their surface also becomes larger, and the nasal passages narrow accordingly. Under these conditions, air passes into the nasal cavity in a thinner stream and flows around a large surface of the mucous membrane, as a result of which warming is more intense. The outside air temperature rises from 20 °C to 36 °C after passing through the nasal cavity to the nasopharynx. The warming effect is more pronounced the lower the outside temperature.

Humidification of the air in the nasal cavity occurs due to its saturation with moisture covering the mucous membrane. Nasal mucus is formed by the infiltration of fluid from blood vessels, mucosal glands, lacrimal glands, and lymph from interstitial spaces. In an adult, more than 500 ml of water is released from the nasal cavity in the form of steam within 1 day, however, this volume depends on the humidity and temperature of the outside air, the condition of the nose and other factors.

Air purification in the nose is provided by several mechanisms. When a jet of air passes through the vestibule of the nose, large dust particles are retained by fairly thick hair on the skin of the vestibule. Finer dust, which has passed through the first filter along with microbes, is deposited on the mucous membrane, covered with a mucous secretion; the narrowness and curvature of the nasal passages contribute to the deposition of dust. About 40-60% of dust particles and microbes in the inhaled air are retained in the mucus and removed along with it. The mechanism that removes mucus from the nose is the ciliated epithelium (Fig. 1.10). Through the oscillatory movements of the cilia, the mucus moves towards the nasopharynx in such a way that their working backward movement occurs in a straightened state, and the return is in a curved state. Since there are islands of ciliated epithelium in the olfactory zone, the removal of mucus is also ensured here. The vibrations of the cilia obey a certain rhythm (about 250 cycles per minute), while one area, as it were, transfers a portion of the moving mucus to another. In the anterior and upper sections of the nasal cavity, the movement of mucus is slower than in the middle and posterior; the total time of passage of mucus from the anterior edge of the inferior turbinate to the choanae can reach 20-30 minutes. The movement of cilia is influenced by various factors: inflammatory, physical, chemical, temperature, pH, etc. If normal conditions are violated, the cilia not only stop fluctuating, but even disappear until the conditions on the mucous membrane normalize. In the treatment of nasal diseases, it must be taken into account that any infusion of drops into the nose, especially long-term, not only has a therapeutic effect, but can also have a negative effect on the drainage function of the ciliated epithelium, so it is necessary to avoid prolonged administration of oil, soda, vasoconstrictor and other solutions into the nose. .

A pronounced disinfecting effect is given by lysozyme, which is contained in the secretion of the lacrimal glands and nasal mucus. Mucus from the nasopharynx is usually swallowed along with saliva, and its final disposal takes place in the stomach.

The sneezing reflex and tearing also belong to the protective mechanisms. Dust particles, mechanical, chemical, cold and other factors can be irritants that cause this reflex. When you sneeze, air is suddenly expelled from the nose with a certain force, thereby removing irritating substances. Sneezing may be accompanied by profuse mucus secretion, although it may occur when exposed to various irritants and without sneezing.

The olfactory function in humans is provided by the olfactory zone of the nasal mucosa, which contains neuroepithelial spindle-shaped olfactory cells, which are chemoreceptors. The olfactory region (regio olfactoria) starts from the olfactory fissure (rirnma olfactoria), which is located between the lower edge of the middle shell and the nasal septum and has a width of 3-4 mm. The olfactory fissure leads upwards to the olfactory region, which is located on the lateral and medial walls up to the roof of the nose. To improve sensation, it is necessary that air diffuses into the olfactory region. This is achieved by short forced breaths through the nose, while a large number of vortexes are formed directed to the olfactory zone (a person makes such breaths when he sniffs). The immediate irritant of the olfactory receptor is the molecules of a gaseous substance, as well as steam, fog, dust, smoke, soluble under normal conditions in water and fats. Such molecules having incompletely saturated atomic bonds are called odorivectors. According to Zwaadermaker's chemical theory of smell, an odorous substance (odorivector), dissolving in the secret (mucus) of the Bowman (olfactory) glands with low osmotic pressure, quickly spreads and comes into contact with the hairs of the olfactory spindle cells. Through these hairs, molecules of an odorous substance penetrate into the protoplasm of cells, where they enter into combination with a certain protein, which is accompanied by olfactory excitation. Both this and other theories do not fully explain the mechanism of smell. The sensitivity of the sense of smell to various substances varies from person to person, but the average threshold for smell in terms of the amount of odorous substance in the air is quite low. For strongly smelling substances, it is in the range of 210 7 per 1 liter of air.

The role of the paranasal sinuses in the act of nasal breathing is very conditional. At the same time, they apparently cannot be considered only as rudimentary formations. There are two main functions of the paranasal sinuses - protective and resonant.

The protective function of the paranasal sinuses is expressed, firstly, in the fact that the presence of the sinuses themselves serves as protection from external influences for deeper and vital formations of the facial and cerebral skull; secondly, the sinuses are additional reservoirs of warmed, moistened and purified air. The mucous membrane of the sinuses has properties that prevent the development of an infectious inflammatory process in them. In particular, in the maxillary sinuses, the ciliated epithelium carries out the movement (clearance) of a thin layer of mucus along a certain circular path from the lateral, anterior and posterior walls downwards and towards the medial wall upwards into the area of ​​​​the entrance to the sinus and further into the nasal cavity. This mucosal clearance can easily be reduced, especially in the maxillary sinuses, where the fistula is located against the upper wall, which leads to a violation of the drainage function and explains the more frequent occurrence of inflammation than in other sinuses.

The resonator function of the paranasal sinuses takes an active part in the formation of the original timbre and other characteristics of the voice. This is due to the fact that the sinuses, being air cavities (resonators), surround the nasal cavity and together with it, as well as other parts of the upper respiratory tract and the chest, form a characteristic (and unique) voice for each person.

The resonator function of the nasal cavity and paranasal sinuses is to enhance the various tones of the voice. Small cavities (cells of the ethmoid labyrinth, sphenoid sinuses) resonate higher sounds, and large ones (maxillary and frontal sinuses) resonate lower ones. Since the sinus cavities do not change normally in an adult, the timbre of the voice remains constant throughout life. Small changes in the timbre of the voice occur during inflammation of the sinuses due to thickening of the mucous membrane (singers notice this well). The position of the soft palate to a certain extent regulates the resonance, blocking off the nasopharynx, and hence the nasal cavity, from the middle part of the pharynx and larynx, where the sound comes from. At the moment of pronouncing some sounds (“m”, “n”), the soft palate hangs freely, the nasopharynx and choanae remain open, while the voice acquires a nasal tone. Paralysis (or absence) of the soft palate is accompanied by open nasality (rhinolalia aperta), obstruction of the nasopharynx, choanae, nasal cavity (adenoids, polyps, hypertrophy of the turbinates, swelling, etc.) - closed (rhinolalia clausa).

Nose examination methodsand paranasal sinuses

Examination of the external nose, places of projection of the paranasal sinuses on the face is carried out.

Palpation of the external nose: the index fingers of both hands are located along the back of the nose, with light massaging movements they feel the root, slopes, back and tip of the nose.

Palpate the anterior and lower walls of the frontal sinuses, while finding out the sensations of the patient. The thumbs of both hands are placed on the forehead above the eyebrows and gently pressed, then the thumbs are moved to the region of the upper wall of the orbit to its inner corner and pressed again. The exit points of the first branches of the trigeminal nerve are palpated. Normally, palpation of the sinus walls is painless.

During palpation of the anterior walls of the maxillary sinuses, the thumbs of both hands are placed in the canine fossa on the anterior surface of the maxillary bone and gently pressed, the exit points of the second branches of the trigeminal nerve are palpated.

Palpate the submandibular and deep cervical regional lymph nodes. Deep cervical lymph nodes are palpated alternately on one side and the other. The patient's head should be slightly tilted forward. When palpating the lymph nodes on the right, the doctor's right hand lies on the crown of the subject, and with his left hand he makes massaging movements with the tips of the phalanges of the fingers in front of the anterior edge of the sternocleidomastoid muscle. Palpation of the lymph nodes on the left left hand put on the crown, and the right one is palpated. Submandibular lymph nodes are palpated using the same techniques. With the head slightly tilted forward, the submandibular region is palpated with light massaging movements with the tips of the phalanges of the fingers in the direction from the middle to the edge of the lower jaw. Normal lymph nodes are not palpable.

Determination of respiratory function but-with a. The study is carried out alternately, first for one half of the nose, then for the other. For this purpose, the right wing of the nose is pressed against the nasal septum II with the finger of the left hand, and right hand bring a small piece of cotton wool to the left vestibule and ask the patient to take a short, normal inhale and exhale. According to the deviation of the wool, the degree of difficulty in the passage of air is determined. To determine breathing through the right half of the nose with the second finger of the right hand, press the left wing of the nose to the nasal septum, and with the left hand bring a ball of cotton to the right vestibule and also ask the patient to take a short breath and exhale.

Breathing through the nose may be normal, labored, or absent. The respiratory function of the nose is assessed on the basis of the patient's complaints, the results of the cotton test and the rhinoscopy picture. A more accurate study of the function of nasal breathing is carried out using a rhinopneumometer L. B. Dainyak, N. A. Melnikova.

Determination of the olfactory function of the nose a. The study is carried out in turn for each half of the nose using odorous substances from the olfactometric kit or olfactometer. To determine the olfactory function of the nose on the right, the second finger of the right hand presses the left wing of the nose against the nasal septum, and with the left hand they take a bottle with an odorous substance and bring it to the right vestibule of the nose. The patient is asked to take a short breath in the right half of the nose and name the smell of this substance. The sense of smell through the left half of the nose is determined in the same way, only the right wing of the nose is pressed with the second finger of the left hand, and the odorous substance is brought with the right hand to the left half of the nose.

The sense of smell may be normal (normosmiya), lowerednym (hyposmia), perverted (cocosmia) or missing(anosmia).

Anterior rhinoscopy. To examine the vestibule of the nose I, with the finger of the right hand, lift its tip. Normally, the vestibule of the nose is free, its walls are covered with hair. Alternately produce anterior rhinoscopy of one and the other halves of the nose. On the open palm of the left hand, the nasopharynx is placed with the beak down - the first finger of the left hand is placed on top of the nasopharynx screw, the II and III fingers are placed on the outside on the branch. IV and V fingers should be between the jaws of the nasal dilator. This arrangement of the fingers makes it possible to open and close the nasal dilator. The elbow of the left hand is lowered, the hand with the nasal dilator must be movable; the palm of the right hand is placed on the crown of the subject to give the head the position necessary for rhinoscopy. The beak of the nasal dilator in a closed form is inserted 0.5 cm into the vestibule of the right half of the patient's nasal cavity (Fig. 5.2). The right half of the beak of the nasal dilator should be in the lower inner corner of the nasal vestibule, the left half - in the upper outer corner of the vestibule (near the wing of the nose); II and III fingers of the left hand press on the branch of the nasal dilator and open the right vestibule of the nose so that the tip of the beak of the nasal dilator does not touch the nasal mucosa.

With the head in a straight position, the right half of the nose is examined and characterized: the color of the mucous membrane is pink, the surface is smooth; nasal septum in the midline; the turbinates are not enlarged, the common nasal passage is free. Then examine the left half of the nasal cavity.

The anterior sections of the lower nasal passage and the bottom of the nasal cavity are better seen with a slight inclination of the head of the subject anteriorly; to examine the middle nasal passage, the head is tilted backward and somewhat towards the half of the nose being examined. The doctor tilts the head of the subject with his right hand, located on his crown. Normally, the nasal mucosa is pink and moist, and the nasal passages are free, with an inflammatory process, for example, in the paranasal sinuses, purulent discharge can be determined in the nasal passages (Fig. 5.3).

The nasal dilator is removed in the following order: fingers IV and V move the right handle of the nasal dilator so that the jaws of its working part are not completely closed, and the nasal dilator is removed from the nose (complete closing of the jaws of the working part can lead to infringement of the nasal vestibule hair).

Examination of the left half of the nose is carried out in the same way: the doctor holds a nasopharynx in the left hand, and the right one lies on the crown of the head. In this case, the right branch of the working part of the nasal dilator is located in the upper inner corner of the left nostril, and the left branch is in the lower outer corner.

Microendoscopic examination of the nasal cavity and paranasal sinuses. Microendoscopy of the nasal cavity and paranasal sinuses can be performed using a conventional operating microscope and endonasal endoscopes in order to perform diagnostic studies and surgical interventions. Currently, sets of endoscopes and instruments for endonasal microsurgery from Storz are used more often.

In the practice of an otorhinolaryngologist, an operating microscope is unreasonably little used to examine and perform operations in the nasal cavity. Mastering this technique does not present great difficulties for a doctor who knows the methods of examining ENT organs. The use of an operating microscope during endonasal examinations and interventions makes it possible to obtain a more complete endoscopic picture and refines the operation technique, mainly in the initial parts of the nasal cavity.

Microendoscopy with the help of endoscopes is an original method of examination and surgery of the nose and paranasal sinuses, since, unlike other methods of examination, it makes it possible to perform studies and surgical interventions with an increase in all the details of a complex configuration of intranasal structures throughout the entire depth of the nasal cavity. When viewed with endoscopes at different angles of view (0°, 30°, 70°), all complex surfaces of the nasal cavity and paranasal sinuses are accessible to the eye and instrument, which allows not only to determine the state of one or another object, but also to perform microsurgical intervention.

First, the nasal cavity is examined with an endoscope with direct optics (0 °). Typically, a 4 mm endoscope is used. Endoscopic examination before surgery is performed in a certain sequence. First inspect nose vestibule the narrowest point of entry into the nasal cavity, bounded medially by the nasal septum, from below by the bottom of the nasal cavity, laterally in the lower half by the anterior end of the inferior turbinate and laterally from above by the triangular cartilage above the anterior end of the inferior turbinate. This area is called "anterior (ventral) nasal valve". Normally, the angle of the nasal valve between the triangular cartilage and the nasal septum (Fig. 5.4) is about 15°. A decrease in this angle and a narrowing of the nasal valve causes difficulty in nasal breathing, while a suction effect of the wing of the nose may occur, which indirectly leads to the appearance of snoring during sleep. It is necessary to pay attention to the fact that during conventional anterior rhinoscopy, the nasal dilator, moving the ala of the nose, increases the upper angle and does not allow a complete picture of the state of the ventral nasal valve, so it must be examined with an endoscope.

Next, the endoscope is advanced deep into the nasal cavity along the edge of the inferior turbinate along the common nasal passage. They examine the mucous membrane, the relief of the nasal septum, the posterior end of the inferior nasal concha, the choanae, the nasopharynx, the mouth of the auditory tube. During the reverse movement, all departments of the middle turbinate are sequentially examined; back, middle and especially carefully the front end. In the initial section of the middle nasal passage is the so-called osteomeatal complex, which is a system of anatomical structures in the anterior region of the middle turbinate (Fig. 5.5). It is bounded medially by the middle turbinate, laterally uncinate process(KO), which is presented in the form of a sickle-shaped bone plate of the ethmoid bone of varying severity. KO is attached to the lateral wall of the nasal cavity, goes obliquely from top to bottom and backwards. In front and slightly above the KO at the level of attachment of the middle turbinate there are lattice cells nasal ridge(agger nasi), which open into the lunar fissure. KO is the front wall funnels(infundibulum ethmoidale), the fistula of the maxillary sinus opens into its lower part. Often, with endoscopy, under the middle nasal concha, you can see an enlarged cell of the ethmoid labyrinth - the ethmoid bulla (bulla ethmoidalis). The funnel is located in the semilunar fissure in the middle nasal passage, where the natural fistula of the frontal sinus. natural fistula topnon-maxillary casucha with nasal cavity KO is covered in front, therefore, as a rule, it cannot be seen when examining the nasal cavity with an endoscope. A common variant of the structure is the presence of one or two additional openings (fontanelles) of the maxillary sinus, which are usually located next to the main opening (ostium maxil-lare).

Very often, endoscopy reveals an enlarged anterior end (bulla) of the middle turbinate - the so-called concha bullosa, due to excessive pneumatization of the middle turbinate (Fig. 5.6).

The middle nasal concha is attached in an arcuate fashion from top to bottom to the lateral wall of the nasal cavity and divides lattice labyrinth into two departments front and rear.

The posterior and anterior cells of the ethmoid labyrinth and the sphenoid sinus, unlike the maxillary and frontal sinuses, open directly into the tyoca cavity and nasopharynx. natural openings of the posterior cells of the ethmoid labyrinththat located lateral to the superior turbinate, where there may be polyps, and the openings of the sphenoid sinus are located on its front wall, medial to the superior turbinate closer to the nasal septum.

Endoscopic research methods, in addition to identifying anatomical formations in the nasal cavity, help to identify adenoids, neoplasms, nasopharyngeal cysts,

assess the condition of the nasopharyngeal and tubal tonsils, confirm the presence bags (cysts) of Thornwaldt, which can obstruct nasal breathing, cause snoring and nasality.

Endoscopy of the maxillary sinus. The study is carried out using rigid endoscopes with direct vision (0°), and if necessary, use 30° or 70° optics. After injection of a local anesthetic under the mucosa, using a trocar, the anterior wall of the canine fossa is perforated with uniform rotational movements. The hole is imposed, as a rule, between the roots of the 3rd and 4th teeth. Endoscopes are inserted into the tube (sleeve) of the trocar or funnel, previously inserted into the hole, and a targeted study of the contents and walls of the sinus is carried out, features of the anatomical structure and condition of the sinus mucosa are revealed. At the end of the study, the trocar sleeve is advanced with the same careful rotational movement as during insertion. The perforation site should not be sutured. The patient should refrain from intense blowing of the nose for 5-6 days.

Examination of the anastomosis of the sinus with the nose is carried out with 30° or 70° endoscopes, while determining the presence or absence of pathological changes in the mucous membrane of the anastomosis (swelling, hypertrophy, polypous formations, etc.), its size, filling with liquid contents, etc. The data obtained allow decide on the next treatment strategy. In those cases when, with the help of an endoscope, various microforceps and nippers, it is possible to eliminate a limited pathological process, for example, free and expand the anastomosis, perform a biopsy (including through the nose), etc., the intervention ends there. If extensive pathological changes are detected with the help of microendoscopy, indications for performing a wider surgical intervention are established.

The nose is the initial section of the upper respiratory tract and is divided into the external nose and the nasal cavity with paranasal sinuses.

The external nose consists of bony, cartilaginous and soft parts and has the shape of an irregular trihedral pyramid. The root of the nose is distinguished - the upper section connecting it with the forehead, the back - the middle part of the nose, going down from the root, which ends with the tip of the nose. The lateral convex and movable surfaces of the nose are called the wings of the nose; their lower free edges form nostrils, or external openings.

The nose can be divided into 3 sections: 1) external nose; 2) nasal cavity; 3) paranasal sinuses.

The external nose is called an elevation resembling an irregular trihedral pyramid in shape, protruding above the level of the face and located along its midline. The surface of this pyramid is made up of two lateral slopes, which descend towards the cheeks and converge along the midline, forming here a rounded rib - the back of the nose; the latter is obliquely directed anteriorly and downwards. On the third, lower surface of the pyramid are two nasal openings - nostrils. The upper end of the back of the nose, which rests against the forehead, is called the root of the nose, or nose bridge. The lower end of the back of the nose, where it meets the lower surface, is called the tip of the nose. The lower, movable section of each lateral surface of the nose is called the ala of the nose.

The skeleton of the external nose consists of bones, cartilage and soft tissues. The composition of the external nose includes paired nasal bones, the frontal processes of the maxillary bones and paired cartilages: the lateral cartilage of the nose, the large cartilage of the alar of the nose and the small cartilages located in the posterior part of the alar of the nose.

The skin on the bony part of the nose is mobile, on the cartilaginous part it is inactive. The skin contains many sebaceous and sweat glands with wide excretory openings, which are especially large on the wings of the nose, where the mouths of their excretory ducts are visible to the naked eye. Through the edge of the nasal opening, the skin passes to the inner surface of the nasal cavity. The strip that separates both nostrils and belongs to the nasal septum is called the movable septum. The skin in this place, especially in the elderly, is covered with hair, which delays the penetration of dust and other harmful particles into the nasal cavity.

The nasal septum divides the nasal cavity into two halves and consists of bone and cartilage parts. Its bony part is formed by the perpendicular plate of the ethmoid bone and the vomer. The quadrangular cartilage of the nasal septum enters the angle between these bone formations. To the anterior edge of the quadrangular cartilage adjoins the cartilage of the greater wing of the nose, which is wrapped inwards. The anterior skin-cartilaginous section of the nasal septum, unlike the bone section, is mobile.

The muscles of the external nose in humans are rudimentary and practical value almost do not have. Of the muscle bundles that are of some importance, the following can be noted: 1) the muscle that lifts the wing of the nose - starts from the frontal process of the upper jaw and is attached to the posterior edge of the wing of the nose, partly passes into the skin of the upper lip; 2) narrowing the nasal openings and pulling down the wings of the nose; 3) a muscle that pulls the nasal septum down.

The vessels of the external nose are branches of the external maxillary and ophthalmic arteries and are directed towards the tip of the nose, which is rich in blood supply. The veins of the external nose drain into the anterior facial vein. The innervation of the skin of the external nose is carried out by the first and second branches of the trigeminal nerve, and the muscles - by the branches of the facial nerve.

The nasal cavity is located in the center of the facial skeleton and borders on top of the anterior cranial fossa, on the sides - on the eye sockets, and on the bottom - on the oral cavity. In front, it opens with nostrils located on the lower surface of the external nose, which have a variety of shapes. Posteriorly, the nasal cavity communicates with. the upper part of the nasopharynx through two adjacent oval-shaped posterior nasal openings, called choanae.

The nasal cavity communicates with the nasopharynx, with the pterygopalatine fossa, and with the paranasal sinuses. Through the Eustachian tube, the nasal cavity also communicates with the tympanic cavity, which determines the dependence of some ear diseases on the state of the nasal cavity. The close connection of the nasal cavity with the paranasal sinuses also determines that diseases of the nasal cavity most often to one degree or another pass to the paranasal sinuses and through them can affect the cranial cavity and orbit with their contents. The topographic proximity of the cavity of the spit to the orbits and the anterior cranial fossa is a factor contributing to their combined damage, especially in trauma.

The nasal septum divides the nasal cavity into two not always symmetrical halves. Each half of the nasal cavity has an inner, outer, upper and lower wall. The nasal septum serves as the inner wall (Fig. 18, 19). The outer, or side, wall is the most complex. There are three protrusions on it, the so-called nasal conchas: the largest is the lower, middle and upper. The inferior nasal concha is an independent bone; the middle and upper shells are processes of the ethmoid labyrinth.

Rice. 18. Anatomy of the nasal cavity: lateral wall of the nose.
1 - frontal sinus; 2 - nasal bone; 3 - lateral cartilage of the nose; 4 - middle shell; 5 - middle nasal passage; 6 - lower shell; 7 - hard palate; 8 - lower nasal passage; 9 - soft palate; 10 - pipe roller; 11 - Eustachian tube; 12 - Rosenmuller's fossa; 13 - main sinus; 14 - upper nasal passage; 15 - upper sink; 16 - cockscomb.

Rice. 19. Medial wall of the nose.
1 - frontal sinus; 2 - nasal bone; 3 - perpendicular plate of the ethmoid bone; 4 - cartilage of the nasal septum; 5 - sieve plate; 6 - Turkish saddle; 7 - main bone; 8 - coulter.

Under each turbinate there is a nasal passage. Thus, between the lower concha and the bottom of the nasal cavity is the lower nasal passage, between the middle and lower shells and the side wall of the nose - the middle nasal passage, and above the middle shell - the upper nasal passage. In the anterior third of the lower nasal passage, approximately 14 mm from the anterior edge of the shell, is the opening of the lacrimal canal. In the middle nasal passage, they open with narrow openings: the maxillary (maxillary) sinus, the frontal sinus and the cells of the ethmoid labyrinth. Under the upper shell, in the area of ​​​​the upper nasal passage, the posterior cells of the ethmoid labyrinth and the main (sphenoidal) sinus open.

The nasal cavity is lined with a mucous membrane that continues directly into the paranasal sinuses. Two areas are distinguished in the mucous membrane of the nasal cavity: respiratory and olfactory. The olfactory region includes the mucous membrane of the upper concha, parts of the middle conch and the corresponding section of the nasal septum. The rest of the mucous membrane of the nasal cavity belongs to the respiratory region.

The mucous membrane of the olfactory region contains olfactory, basal and supporting cells. There are special glands that produce a serous secretion, which contribute to the perception of olfactory irritation. The mucous membrane of the respiratory region is tightly soldered to the periosteum or perichondrium. The submucosal layer is absent. In some places, the mucous membrane thickens due to cavernous (cavernous) tissue. This occurs most frequently in the region of the inferior turbinate, the free edge of the middle turbinate, and also the elevation on the nasal septum corresponding to the anterior end of the middle turbinate. Under the influence of a variety of physical, chemical or even psychogenic moments, the cavernous tissue causes an instant swelling of the nasal mucosa. By slowing down the speed of blood flow and creating conditions for stagnation, the cavernous tissue favors the secretion and release of heat, and also regulates the amount of air entering the respiratory tract. The cavernous tissue of the inferior turbinate is connected with the venous network of the mucous membrane of the lower part of the lacrimal canal. Swelling of the lower concha can therefore cause closure of the lacrimal canal and lacrimation.

The blood supply to the nasal cavity is carried out by branches of the internal and external carotid arteries. The ophthalmic artery departs from the internal carotid artery, entering the orbit and giving off the anterior and posterior ethmoid arteries there. From the external carotid artery departs the internal maxillary artery and the artery of the nasal cavity - the main palatine. The veins of the nasal cavity follow the arteries. The veins of the nasal cavity are also connected to the veins of the cranial cavity (hard and soft
meninges), and some flow directly into the sagittal sinus.

The main blood vessels of the nose pass in its posterior sections and gradually decrease in diameter towards the anterior sections of the nasal cavity. This is why bleeding from the back of the nose is usually more severe. In the initial part, right at the entrance, the nasal cavity is lined with skin, the latter folds inward and is provided with hairs and sebaceous glands. The venous network forms plexuses that connect the veins of the nasal cavity with neighboring areas. It has importance due to the possibility of infection spreading from the veins of the nasal cavity to the cranial cavity, orbit and to more distant areas of the body. Particularly important are venous anastomoses with the cavernous (cavernous) sinus located at the base of the skull in the region of the middle cranial fossa.

In the mucous membrane of the anteroinferior part of the nasal septum, there is the so-called Kisselbach place, which is distinguished by a rich arterial and venous network. The Kisselbach site is the most frequently traumatized site and is also the most common location for recurrent nosebleeds. Some authors (B. S. Preobrazhensky) call this place "the bleeding zone of the nasal septum." It is believed that bleeding here is more frequent because in this area there is cavernous tissue with underdeveloped muscles, and the mucous membrane is more tightly attached and less extensible than in other places (Kisselbach). According to other data, the reason for the slight vulnerability of the vessels is the insignificant thickness of the mucous membrane in this area of ​​the nasal septum.

The innervation of the nasal mucosa is carried out by sensory branches of the trigeminal nerve, as well as branches emanating from the pterygopalatine node. From the latter, sympathetic and parasympathetic innervation of the nasal mucosa is also carried out.

The lymphatic vessels of the nasal cavity are connected with the cranial cavity. The outflow of lymph occurs partly to the deep cervical nodes and partly to the pharyngeal lymph nodes.

The paranasal sinuses include (Fig. 20) the maxillary, frontal, main sinuses and ethmoid cells.

Rice. 20. Paranasal sinuses.
a - front view; b - side view; 1 - maxillary (maxillary) sinus; 2 - frontal sinus; 3 - lattice labyrinth; 4 - main (sphenoidal) sinus.

The maxillary sinus is known as the maxillary sinus and is named after the anatomist who described it. This sinus is located in the body of the maxillary bone and is the most voluminous.

The sinus has the shape of an irregular quadrangular pyramid and has 4 walls. The anterior (facial) wall of the sinus is covered by the cheek and is palpable. The upper (orbital) wall is thinner than all the others. The anterior part of the upper wall of the sinus takes part in the formation of the upper opening of the lacrimal canal. The infraorbital nerve passes through this wall, which emerges from the bone in the upper part of the anterior wall of the sinus and branches in the soft tissues of the cheek.

The inner (nasal) wall of the maxillary sinus is the most important. It corresponds to the lower and middle nasal passages. This wall is pretty thin.

The lower wall (bottom) of the maxillary sinus is located in the region of the alveolar process of the upper jaw and usually corresponds to the alveoli of the posterior upper teeth.

The maxillary sinus communicates with the nasal cavity with one, and often two or more openings that lie in the middle nasal passage.

The frontal sinus is shaped like a trihedral pyramid. Its walls are as follows: front - anterior, posterior - border with the cranial cavity, lower - orbital, internal - forms a partition between the sinuses. Up the frontal sinus can rise to the scalp, outwards extends to the outer corner of the eyes, the fronto-nasal canal opens in the anterior part of the middle nasal passage. The frontal sinus may be absent. It is often asymmetrical, being larger on one side. In a newborn, it already exists in the form of a small bay, which increases every year, but their underdevelopment or incomplete absence (aplasia) of the frontal sinus occurs.

The main (sphenoid, sphenoidal) sinus is located in the body of the sphenoid bone. Its shape resembles an irregular cube. Its value varies greatly. It borders on the middle and anterior cranial fossae, with its bony walls adjacent to the cerebral appendage (pituitary gland) and other important formations (nerves, blood vessels). The opening leading to the nose is located on its front wall. The main sinus is asymmetric: in most cases, the septum divides it into 2 unequal cavities.

The lattice labyrinth has a bizarre structure. The cells of the ethmoid labyrinth are wedged between the frontal and sphenoid sinuses. Outside, the lattice labyrinth borders on the orbit, from which it is separated by the so-called paper plate; from the inside - with the upper and middle nasal passages; above - with the cavity of the skull. The size of the cells is very different: from a small pea to 1 cm 3 or more, the shape is also varied.

The cells are divided into anterior and posterior, the first of which open in the middle nasal passage. The posterior cells open in the superior nasal passage.

The ethmoidal labyrinth is bordered by the orbit, the cranial cavity, the lacrimal sac, the optic nerve, and other ophthalmic nerves.

The most prominent part of the face is the nose, which performs certain functions in the body. The structure of the nose is quite complex, and this explains the severe course of some diseases of the upper respiratory system.

The anatomical features of the nose help to understand how inflammatory reactions develop and what changes they cause in the body.

General structure of the nose

A person sees in the mirror only the outer nose, which has a different external shape, but the same structure inside.

In addition to this part, there are internal - actually nasal cavity and paranasal or paranasal sinuses. All together, these structures perform several important functions, and their relationship with each other leads to the fact that the pathology of one area will certainly affect the neighboring departments.

Anatomy of the external nose

The shape of the entire external nose and its inner part formed by bone, cartilage and soft tissue. Distinguish:

• Bridge of the nose or root of the nose. This external department between the eyebrows. The bridge of the nose can be either wide or narrow.
• bridge of the nose. It is formed by two converging side surfaces.
• Side surfaces, which in turn pass into the wings and form the right and left nostrils.
• Top or tip of the nose. This is the place between the nostrils, that is, where the back begins.

The final formation of the shape of the visible part of the nose occurs by about 15 years, but it is believed that the nose may slightly increase in size throughout a person's life.

The soft tissues of the nose are supplied with muscles. Some muscles provide the performance of a facial function, which occurs when a person sniffs smells, sneezes. There is a muscle responsible for the narrowing of the nasal cavity, the expansion of the nostrils. Muscle contraction occurs both voluntarily and on purpose.

Anatomical features of the nasal cavity

The nasal cavity begins with the vestibule, this is the part of the organ located directly next to the nostrils. The internal nose is limited from the inside by the bones of the skull, at the top by the eye sockets and at the bottom by the oral cavity. Behind the nasal cavity has openings communicating with top throats.

The division of the inner nose into two halves occurs due to the septum. It is not always located strictly in the middle, a slight deviation to the right or left side is considered a variant of the norm. But if the septum is strongly curved, then the respiratory function is noticeably impaired. Abnormal curvature may be a pathology of the development of the facial bones or injury.

Each half of the inner nose has walls:

• The inner or medial wall is the nasal septum, that is, its bones and cartilage.
• The outer or lateral wall is formed by the nasal bone, part of the upper jaw, lacrimal, palatine bone and a small part of the ethmoid bone.
• The upper wall is formed by the sigmoid plate of the ethmoid bone. It has openings designed for the passage of the olfactory nerve.
• The lower wall is formed by the process of the palatine bone and part of the upper jaw.

On the bone part of the lateral wall there are shells - upper, middle and lower. Conventionally, the nasal cavity along the lateral edge of the middle of the shells is divided into two parts, they are designated as olfactory and respiratory.

The respiratory part of the internal nose begins with its vestibule. The mucous wall of this zone is supplied with hair follicles and, accordingly, hairs, sweat and sebaceous glands. The vestibule zone is followed by a mucous membrane lined with ciliated epithelium. This part of the nasal cavity is supplied with mucous glands that continuously produce mucus.

Mucus is necessary for the nasal passages to disinfect bacteria and other pathogens of the respiratory tract that enter with the air. The olfactory zone is lined with a different type of epithelium, which has receptors that allow you to distinguish odors.

In the area where the shells are located, there are fistulas that connect the cavity of the internal nose with the paranasal sinuses.

Paranasal sinuses: features and functions

The sinuses are located on the sides of the nose, from above, in depth. The sinus cavities are surrounded by those organs that perform vital functions for a person, so sinus diseases always pose a certain danger.

• The maxillary or maxillary sinus is located on the side of the wings of the nose and below the eyes. It has the largest volume of the cavity, and its inflammation often develops due to the proximity of the teeth of the upper jaw.
• The frontal paired sinuses are located above the superciliary arches. The sinuses are separated by a thin septum, sometimes it has a hole. The frontal sinus in a person can either be completely absent or occupy a significant space.
• The ethmoid sinuses in their structure are represented by a bony labyrinth. The labyrinth is located in the unpaired ethmoid bone.
• The main or sphenoid sinus is one and it is located in the body of the sphenoid bone. This sinus is located deep and adjacent to the brain, carotid artery, ophthalmic and trigeminal nerves.

The human nose, together with the paranasal sinuses, performs several functions at once. This is a protective, respiratory cavity of the nose and sinuses involved in the formation of voice, olfactory receptors allow you to capture odors. All this affects the general well-being of a person and his perception of the world.

Anatomy of the nose: photo