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1. Respiratory system – an overview2. Embryonic development
of the respiratory system3. Respiratory passages – structure principles4. Nose:
� external nose� nasal cavity
5. Paranasal sinuses
Respiratory system. Nose
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Respiratory system
2
� Respiratory system, systema respiratorium
� gas exchange –
negative pressure
breathing
� conducting portion –
respiratory tract
� respiratory portion –
lungs
� voice formation
(phonation) – larynx
� olfaction (sense of smell)
– nasal cavity
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 3
The air passages� Conducting portion – respiratory tract:
� Upper respiratory tract� nasal cavity� pharynx
� Lower respiratory tract� larynx� trachea� bronchi –
external and internal� distributing bronchioles
� Respiratory portion– lungs� respiratory
bronchioles� alveolar ducts� alveolar sacs� alveoli
� Conditioning of the air:� warming� moistening� removal of particulate materials
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 4
Embryonic development
� Embryogenesis of the upper respiratory tract –origin:
� ectoderm of the foregut
� epithelium and nasal glands, nasopharynx
� endoderm of the foregut
� epithelium and glands of oropharynx and hypopharynx
� mesenchyme
� bony and cartilaginous frameworks
o nasal prominences
� Nose:
� frontonasal prominence � root
� two medial nasal prominences
� nasal dorsum and apex
� two lateral nasal prominences
� sidewalls and alae nasi
� nasal (olfactory) placode � nostrils
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 5
� Embryogenesis of the lower respiratory tract –
3rd week of pregnancy:
� respiratory diverticulum (lung bud)
� blind-ended sac
� larynx and trachea
� lung buds
� Larynx:
� epithelium – endoderm of the foregut
� cartilages and muscles – splanchnic mesoderm
Embryonic development
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 6
� Embryogenesis of the lungs:� lung buds �
bronchial buds – Hox genes
� bronchi and bronchioles – 4th mo.
� alveolar ducts and sacs – 6th mo.
� endodermal epithelium� mesenchymal elements� maturation of lungs:
Embryonic development
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Nose
7
� Nose – nasus (Gr. rhis, rhinos):
� both respiratory and olfactory organ
� role in “forming” the timbre of the voice
� Anatomical parts:
� external nose, nasus externus
� nasal cavity, cavitas nasi
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
External nose
8
� External nose, nasus externus:
� side at the middle and upper
parts of the face
� generally pyramidal in shape
� human trait – different types:
� straight, humpy and saddle nose
� Anatomical parts:
� base, basis nasi
� lateral side
� wings, alae nasi
� dorsum, dorsum nasi
� root, radix nasi
� free tip, apex nasi
� nostrils, nares
� columella
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
External nose framework
9
� Bony framework –piriform aperture:
� nasal bones, ossa nasalia
� frontal processes of maxilla
� Cartilaginous framework,cartilagines nasi:
� unpaired� septal cartilage, cartilago nasi septi
� paired:� lateral nasal cartilage,
cartilago nasi lateralis
�major alar cartilage,cartilago alaris major
�minor alar cartilages, cartilagines alares minores
� cartilagines nasales accessoriae
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 10
� Nasal musculature –
rudimentary muscles:
� the procerus, m. procerus
� the nasalis, m. nasalis
� m. depressor septi nasi
� m. apicis nasi – variable
� m. compressor nares
� m. levator labii superioris alaequae nasi
� Connective tissue
� Skin:
� fine hairs
� sweat glands
� numerous large sebaceous glands
External nose sidewall
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
� crooked nose, rhinoscoliosis
� saddle nose, rhinolordosis
� humpy nose, rhinokyphosis
� rhinophyma
� nasal bone trauma and fracture
� squamous cell carcinoma
� nasal anomalies
External nose – clinical relevance
11
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Nasal cavity
12
� Nasal cavity, cavum (cavitas) nasi:� vestibule, vestibulum nasi� nasal cavity proper,
cavum nasi proprium
� Nasal septum,septum nasi:� bony part, pars ossea
� vomer� lamina perpendicularis
ossis ethmoidalis
� pars cartilaginea� cartilago septi nasi� cartilagines alares majores� organum vomeronasale
(Jacobsoni) – pheromones
�Kiesselbach’s area
� membranous part, pars membranacea� nasal septum deviation, deviatio septi nasi
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Vestibule of the nasal cavity
13
� Nasal cavity, cavum (cavitas) nasi:
� entrance – nostrils, nares
� shape – racial trait
� exit – posterior nasal apertures, choanae
� Nasal vestibule, vestibulum nasi:� limen nasi
� agger nasi
� regio cutanea� stiff hairs, vibrissae
� sweat and sebaceous glands
� transition area
� stratified squamous �pseudostratified epithelium
� seromucous glands
� absent sweat and sebaceous glands
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Nasal cavity proper
14
� Nasal cavity proper, cavitas nasalis ossea:�bone skeleton – walls
�floor, inferior – hard palate
�roof, superior wall:
o nasal bone
o ethmoid bone
o sphenoid bone
�medial wall – nasal septum
� lateral wall:
o maxilla
o lacrimal bone
o ethmoid labyrinth
o palatine bone
o sphenoid bone
o conchae nasales, superior, media et inferior
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 15
Nasal cavity proper
� Nasal mucous membrane:�medial wall
�respiratory segment, regio respiratoria
�olfactory segment,regio olfactoria
� lateral wall�nasal conchae�nasal meatuses:
o meatus nasi superior
o meatus nasi medius
o meatus nasi inferior
o meastus nasi communis
o meatus nasopharyngeus
�openings of the paranasal sinuses:o recessus sphenoethmoidalis
o hiatus semilunaris, infundubulum, plica lacrimalis
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 16
Nasal cavity proper
� Nasal mucous membrane:�medial wall
�respiratory segment, regio respiratoria
�olfactory segment,regio olfactoria
� lateral wall�nasal conchae�nasal meatuses:
o meatus nasi superior
o meatus nasi medius
o meatus nasi inferior
o meastus nasi communis
o meatus nasopharyngeus
�openings of the paranasal sinuses:o recessus sphenoethmoidalis
o hiatus semilunaris, infundubulum, plica lacrimalis
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 17
Nasal cavity proper� Microscopic anatomy:
�olfactory segment –5-10 mm2; yellowish-brown
�olfactory mucosa, tunica mucosa
o olfactory epithelium –
• receptor (olfactory) cells
• supporting cells (sustentacular)
• basal cells – stem cells
• brush cells
o lamina propria
• olfactory(Bowman’s) glands
�absent submucosa, tela submucosa
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 18
� Microscopic anatomy:
� respiratory segment,
regio respiratoria – 1-3 mm
� lamina epithelialis – ciliated,
pseudostratified columnar epithelium
– five cell types:
o ciliated cells
o goblet cells
o brush cells
o small granule cells
o basal cells
� lamina propria
o nasal glands – seromucous, tubular
o venous plexuses, stratum cavernosum
� plexus cavernosi concharum �
epistaxis
o Kiesselbach’s area, locus Kiesselbachi
o broad lymphatic network –
lymphatic nodules
Nasal cavity proper
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov 19
Blood supply of the nose
� External nose:� facial artery� ophthalmic artery
� Nasal cavity:� respiratory segment
� sphenopalatine artery (external carotid artery)
� olfactory segment� anterior and posterior
ethmoidal arteries (internal carotid artery)
� Venous drainage:� facial and ophthalmic veins
� Lymphatic drainage:� deep neck lymph nodes
(internal jugular vein)� retropharyngeal lymph nodes
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Innervation of the nose
20
� Sensory innervation –trigeminal nerve:
� ophthalmic nerve
�nasal nerve
� maxillary nerve
� infraorbital nerve,
infratrochlear nerve (root),
anterior ethmoidal nerve
�posterior nasal nerves
� Autonomic innervation:
� sympathetic
�carotid plexus
� parasympathetic
�pterygopalatine ganglion
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Innervation of the nose
21
� Sensory innervation –trigeminal nerve:
� ophthalmic nerve
�nasal nerve
� maxillary nerve
� infraorbital nerve,
infratrochlear nerve (root),
anterior ethmoidal nerve
�posterior nasal nerves
� Autonomic innervation:
� sympathetic
�carotid plexus
� parasympathetic
�pterygopalatine ganglion
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Paranasal sinuses, sinus paranasales
� sinus maxillaris (antrum Highmori)
� sinus frontalis
� sinus ethmoidalis
� sinus sphenoidalis
22
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Paranasal sinuses, sinus paranasales
� sinus maxillaris – developed in newborns� sinus frontalis – during the 2nd year of life� sinus ethmoidalis – 3-4 years after birth� sinus sphenoidalis� pneumatization – around 20 years
23
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Maxillary sinus, sinus maxillaris
� maxillary sinus (antrum of Highmore):
� the largest air sinuses
� pyramidal cavity in the maxillary body
�hiatus maxillaris �
hiatus semilunaris
�drainage �
meatus nasi medius
24
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Maxillary sinus, sinus maxillaris
� maxillary sinus (antrum of Highmore):
� the largest air sinuses
� pyramidal cavity in the maxillary body
�hiatus maxillaris �
hiatus semilunaris
�drainage �
meatus nasi medius
25
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Frontal sinus, sinus frontalis
� frontal sinus, sinus frontalis:� two sinuses in the frontal bone
�septum sinuum frontalium
�ductus nasofrontalis – 12-16 mm
�drainage � infundibulum of the
meatus nasi medius
26
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Ethmoidal sinus, sinus ethmoidalis
� Cellulae ethmoidales – 10 (5-16):
� cellulae ethmoidales anteriores
�2-3 in number
�drainage � meatus nasi medius
� cellulae ethmoidales medii, incl.
bulla ethmoidalis
�3-4 in number
�drainage � meatus nasi medius
� cellulae ethmoidales posteriores
�4-5 in number
�drainage � meatus nasi superior
(meatus nasi supremus)
27
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Sphenoidal sinus, sinus sphenoidalis
� Sinus sphenoidales:� two sinuses within
the sphenoid bone body�septum sinuum sphenoidalium
�apertura sphenoidalis
�drainage � sphenoethmoidal recess
28
SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
Clinical significance
29
� sinus infection – sinusitis
� paranasal sinus tumors, cysts
� sinus drainage
� spread to adjacent structures