Nasal cavities, paranasal sinuses, nasopharynx, larynx

Summary for dissection room

Csaba Szigeti, MSc, PhDDepartment of Anatomy, Histology and Embriology

Szeged, 2014

AB

A. Semilunar hiatus (1), anterior- (2), middle- (3),and posterior (5) ethmoidal air cellsSuperior concha (4), sphenoidal sinus (6), ethmoidal bulla (7), opening of maxillary sinus (8)Perpendicular plate of palatine bone (9), torus tubarius (10), salpingopharyngeal fold (11)

B. Thyrohyoid membrane (1), vestibular fold (2), vestibule (3), ventricle (4), arytenoid m. (5)thyroid cartilage (6, 10), tracheal ring (7), cricoid cartilage(8), cricothyroid membrane (9)Piriform recess (11)

The The laterallateral wallwall of of thethe nasalnasal cavitycavity

1

Frontal sinus(1), nasal bone (2), middle nasal meatus (3), opening ofnasolacrimal duct (4), inferior nasal meatus (5), nasal vestibulum (6),inferior nasal concha(7), hard palate (8), semilunar hiatus (9),opening of middle ethmoidal air cells (10), ethmoidal bulla (11), superior nasal concha (12), Sphenoidal sinus (13),sphenoethmoidal recess (14), middle nasal concha (15)

Frontal sinus (1), superior nasal concha (2), nasal bone (3), superiornasal meatus (4), middle nasal concha (5), inferior nasal concha (6),sphenoethmoidal recess (7), sphenoidal sinus (8), hypophysis (9),choana (10), opening of pharyngo-tympanic tube (11), salpingopharyngeal fold (12) anterior cranial fossa (13)

Conchae partially removedSagittal section

OPENINGS OF BONY NASAL CAVITY *

Opening or passage Where does it lead? Neurovascular structures :

Piriform aperture Face -

Choana Epipharynx -

Cribriform plate Anterior cranial fossa Fila olfactoria (CN.I.); Anterior ethmoidal a. & n.

Sphenopalatine foramen Pterygopalatine fossa Sphenopalatine a. & Sup. post. nasal nn.

Semilunar hiatus Maxillary sinus -

Infundibulum (ethmoidale) Frontal sinus -

Opening of sphenoidal sinus Sphenoid sinus -

Nasolacrimal canal Orbit Nasolacrimal duct

Incisive canal Oral cavity Nasopalatine a. & n. (V/2)

* from Andrea Czigner MD, PhD

BloodBlood supplysupply of of thethe nasalnasal cavitycavity

Internal carotid artery

ophtalmic artery

Anterior ethmoidal and Posterior ethmoidal artery

External carotid artery

Maxillar artery

sphenopalatine artery

Septal rami +

r. septalis post.

nasopalatine artery Greater palatine artery

aa.nasales posttlat.

(Kisselbach area) ( incisive canal)

anterior-superior part of the nasal cavity

posterior-inferior partof nasal cavity

Nasopalatine artery

Kisselbach area

NerveNerve supplysupply of of thethe nasalnasal cavitycavity

Ophtalmic nerve (V/1)

maxillar nerve (V/2)

Frontal sinus

Sphenoid sinus

Maxillary sinus

Ethmoidal sinuses

PARANASAL SINUSES *

F: Frontal sinus

A: Anterior ethmoidal air cells

P: Posterior ethmoidal air cells

Sph: Sphenoid sinus

M: Maxillary sinus

NL Nasolacrimal duct

* from Andrea Czigner MD, PhD

Nasopharynx

behind the nasal cavity and superior to the soft palate, covered with respiratory epithelia Elevation of the soft palate separate the nasopharynx from the oropharynx during swallowing There is a large collection of lymphoid tissue (the pharyngeal tonsil) in the mucosa covering the roof of the nasopharynx The opening of the pharyngotympanic tube is posterior to and slightly above the level of the hard palate the vertical salpingopharyngeal fold, which descends from the tubal elevation and overlies salpingopharyngeus muscle Tubar tonsil: the small follicles around the opening of the pharyngotympanic tube posterior rim of the opening of the pharyngotympanic tube forms an elevation on the pharyngeal wall torus tubarius

Topography of the larynx

C3-C4

C6

clavicle

Jugular notchTendon of the

sternocleidomastoid

External carotid bifurcationUpper margin of thyroidcartilage

Arcus of the cricoidcartilage

Thyroid gland

Aorta

Cartilages of the Larynx

Hyaline cartilages:

Thyroid cartilage

Cricoid cartilage

Arytenoid cartilage

Elastic cartilages:

Epiglottis

Corniculate cartilage

Cuneiform cartilage (in aryepiglottic fold)

Thyroid cartilage:

Cricoid cartilage:

Arytenoid cartilage:

Cartilages of the Larynx

Joints of the larynx

Cricoarytenoid joint:Articular facet of arytenoid + superior articular facet of cricoid

pivot joint (movements around the vertical axis )+ med. et lat. translation (gliding movement)

Cricothyroid joint:Inferior horn + lateral articular facet(Thyroid cartilage) (Cricoid cartilage)

hindge joint (movements around the transverse axis)

Outer ligaments of the larynx(Attach the larynx to the hyoid bone and trachea)

Thyrohyoid membrane,

Median and lateral thyrohyoid lig.

Hyoepiglottic lig.

Thyroepiglottic lig.

cricotracheal lig.

cricopharyngeal lig.

Quadrangular membrane

Vestibular lig.

Conus elasticus (triangular membrane)

Vocal lig.

Median cricothyroid lig. = lig. conicum = parslibera coni elastici CONICOTOMIA

Inner ligaments of the larynx(Membrana fibroelastica laryngis, stabilize the cartilages of the larynx)

Muscles of the larynx

From Andrs Mihly MD. PhD. DSc.

Inferio

rlaryn

gealnerve

superior laryngealnerve

Narrowing the aditus(epiglottis and

arytenoid cartilagescome closer)

Arytenoideusobliquus, aryepiglotticus

Closes rima glottidisAdducts vocalfolds

Cricoarytenoideuslateralis (6)

Opens rima glottidisAbducts vocalfolds

Cricoarytenoideusposterior (5)

Closes rima glottidisAdductsarytenoidcartilages

Arytenoideustransversus (4)

Closes rima glottidisAdducts vocalfolds

Thyroarytenoid (3)

Tightensvocal folds

Vocalis (2)

Tightensvocal folds

Cricothyroid (1)

Muscles of the larynx

Superficial layerDeep layer: cricothyroid m. and the lamina of thyroidcartilage removed, pharyngeal mucosa reflected

Cavity of larynx1

2

3

Laryngeal inlet: aryepiglotticfold, corniculate and cuneiformtubercle, interarytenoid notch.

(1) Vestibule, vestibular fold, rima vestibuli, laryngealventricle (Morgagni), laryngealsaccule

(2) Glottis: vocal fold, rima glottidis (parsintermembranacea, parsintercartilaginea).

(3) Infraglottic space.

Arterial supply of the layrnx

External carotid artery

Superior thyroid artery

Superior laryngeal artery

Subclavian arteryThyrocervical trunk

Inferior thyroid artery

Inferior laryngeal artery

Venous drainage of the larynx

Superior thyroid v.

Middle thyroid v.

Inferior thyroid v.

Internal jugular v.

Left brachiocephalic v.

Plexus thyroideus impar

Superior laryngeal v.

Inferior laryngeal v.

Left brachiocephalic vein

Innervation of the larynx

Nodose ganglion

Superior laryngeal nerve

+ superior cervical ggl.

Internal ramus external ramus

Sensory function:mucosa abovethe vocal fold

motor function:Cricothyroid m.

n. vagus

recurrent laryngeal nerve(sin.: arcus aortae, dext.: a. subcl dext.)sensory: mucosa below the vocal foldmotor: all laryngeal muscles except cricothyroid

Nodose ganglion

LaryngoscopyLaryngoscopy

Indirect method

Direct method

LaryngoscopyLaryngoscopy

Open rima Open rima glottidisglottidis ReinkeReinkess edemaedema of of thethe vocalvocal foldsfolds

epiglottisepiglottis posteriorposterior

from Andrs Mihly MD, PhD, DSc.