In the nasal cavity there are departments:

The vestibule of the nasal cavity, vestibulum nasi

The actual nasal cavity, cavitas nasi propria

Nose areas:

1. Olfactory region, regio olfactoria - a section of the mucous membrane within the upper turbinates, the upper part of the middle turbinates and the upper third of the nasal septum (contains olfactory receptors)

2. Respiratory area, regio respiratoria - a section of the mucous membrane from the lower wall of the nasal cavity to the middle of the middle nasal concha.

Innervation of the nasal cavity:

A. Afferent innervation is provided by:

Anterior ethmoid nerve, n.ethmoidalis anterior (from the nasociliary nerve, from the optic nerve). This nerve exits the orbit through the foramen of the same name into the cranial cavity, and then through the cribriform plate enters the nasal cavity, where its nasal branches, rami nasales, innervate the mucous membrane of the anterior parts of the nasal cavity (septum and lateral wall) and the skin of the apex of the nose.

The posterior ethmoid nerve, n.ethmoidalis posterior - through the opening of the same name leaves the orbit (from the nasociliary nerve, from the optic nerve) innervates the mucous membrane of the posterior ethmoid cells and the sphenoid sinus.

Internal nasal branches, rr.nasales interni (branches of the maxillary nerve - V pair of chmn) go to the mucous membrane of the anterior parts of the nasal cavity.

Posterior nasal branches, rr. nasales posteriores (branches of the maxillary nerve - V pair of cranial nerves) pass into the nasal cavity through the sphenoid-palatine opening, innervate the mucous membrane of the posterior parts of the nasal cavity with fibers of general sensitivity. The largest branch of the posterior nasal branches is the nasopalatine nerve, n. nasopalatinus, passes forward along the nasal septum and passes through the incisal canal into the oral cavity.

B. Specific (olfactory) innervation

I pair of cranial nerves - nn.olfactorii.

C. Sympathetic innervation is provided from the superior cervical node of the sympathetic trunk along the periarterial plexuses (via the anterior and posterior ethmoid arteries and from the ophthalmic artery; via the lateral posterior nasal and posterior septal arteries from the sphenopalatine artery, the latter is a branch of the maxillary artery).

D. Parasympathetic innervation is provided from the pterygopalatine ganglion pterygopalatinum. The preganglionic fiber is a large stony nerve, n.petrosus major (branch n.facialis, VII pair of cranial nerves), which fits the pterygopalatine node through the pterygoid canal. The postganglionic branches depart from the node: the medial and lateral superior posterior nasal nerves, rr.nasales posteriors superiors mediales et laterales, penetrate through the pterygopalatine opening along with sensory branches and innervate the glands of the mucous membrane; lower posterior nasal branches, rr. nasales posteriores inferiores are branches of the greater palatine nerve, pass in the palatine canal and innervate the glands of the mucous membrane of the lower parts of the nasal cavity. It is important to note the importance of the pterygopalatine node and its connection: The node is located in the pterygopalatine fossa. On its neurons end the parasympathetic preganglionic fibers of the large stony nerve, which originate from the superior salivary nucleus. Part of the postganglionic fibers formed by the axons of this node, as part of the posterior nasal and palatine nerves, are sent to the glands of the nasal mucosa and hard palate, as well as to the lacrimal gland.

The nasal cavity has communications with other cavities through which neurovascular structures pass:

1. Pterygopalatine opening, foramen sphenopalatinum, nasal posterior superior medial and lateral branches, rami nasales posteriors superiores mediales et laterales - branches of the pterygopalatine node.

2. Incisal canal, canalis incisivus - nasopalatine nerve (branch of the pterygopalatine node)

3. Holes of the cribriform plate, foramina laminae cribrosae - nn.olfactorii (I pair).

Holes open into the nasal cavity accessory sinuses:

1. Maxillary (Gaimorova), sinus maxillaris - in the middle nasal passage

2. Frontal sinus, sinus frontalis - in the middle nasal passage

3. Cells of the ethmoid bone, cellulae ethmoidales

Anterior and middle - in the middle nasal passage

Back - in the upper nasal passage

4. Sphenoid sinus, sinus sphenoidalis - in the upper nasal passage.

Innervation of the paranasal sinuses:

Maxillary (Hymoral) sinus, sinus maxillaris:

A. Afferent innervation is provided by:

The branches of the anterior and posterior lattice nerve (nn.ethmoidales anterior et posterior) from n.nasociliaris from n.ophtalmicus

Rami ganglionares n.maxillaris (rami nasales posteriores superiores mediales et laterales, rami nasales posteriores inferiores, which transit through the pterygopalatine node).

Rami nasales interni from n.infraorbitalis from n.maxillaris

B. Sympathetic innervation is provided from the superior cervical node of the sympathetic trunk along the arteries that vascularize the sinus:

a.nasalis posterior lateralis from a.sphenopalatina, a.alveolaris anterior superior from a.infraorbitalis - branches of a.maxillaris from a.carotis externa.

A.ethmoidalis anterior from a.ophtalmica from a.carotis interna

C. Parasympathetic innervation is provided by ganglion pterygopalatinum (from n.petrosus major - branch of n.facialis).

Frontal sinus, sinus frontalis.

n.ethmoidalis anterior from n.nasociliaris from n.ophtalmicus;

n.supraorbitalis et supratrochlearis from n.frontalis from n.ophtalmicus

B. Sympathetic innervation is provided from the ganglion cervicale superior truncus sympaticus along the course of the arteries that vascularize the sinus:

a. supraorbitalis et supratrochlearis from a.frontalis

a. ethmoidalis anterior - branches of a.ophtalmica from a.carotis interna

Sphenoid sinus, sinus sphenoidalis.

A. Afferent innervation is provided by fibers:

n.ethmoidalis posterior from n.nasociliaris from n.ophtalmicus;

a.nasalis posterior lateralis from a.sphenopalatina;

a.canalis pterygoidea from a.palatina discendens;

a.meningea media - branches of a.maxillaris from a.carotis externa;

C. Parasympathetic innervation is carried out from ganglion pterygopalatinum (from n.petrosus major - branch of n.facialis).

Cells of the ethmoid bone, cellulae ethmoidales

A. Afferent innervation is provided by fibers:

nn.ethmoidales posterior et anterior from n.nasociliaris from n.ophtalmicus;

rr.nasales interni from n.infraorbitalis from n.maxillaris

B. Sympathetic innervation is provided from the ganglion cervicale superior truncus sympaticus along the arteries supplying the sinus:

a.ethmoidales anterior et posterior a.ophtalmica from a.carotis interna;

a.sphenopalatina from a.maxillaris externa;

C. Parasympathetic innervation is carried out from ganglion pterygopalatinum (from n.petrosus major - branch of n.facialis).

The nasal cavity (cavum nasi) is located between the oral cavity and the anterior cranial fossa. It is divided by the nasal septum into two identical halves, which open anteriorly through the nostrils and backwards into the nasopharynx - the choanae. Each half of the nose is surrounded by 4 paranasal sinuses: maxillary, ethmoid, frontal and sphenoid.

The nasal cavity has four walls: inferior, superior, medial (septum) and lateral.

bottom wall(bottom of the nasal cavity) is formed by two palatine processes of the upper jaw behind - two horizontal plates of the palatine bone. AT anterior section in the middle passes the nasolabial canal (canalis incisivus).

Top wall(the roof is formed in front by the nasal bones, in the middle sections - by lamina cribrosa and ethmoid cells, behind - by the anterior wall of the sphenoid sinus. The threads of the olfactory nerve pass through the openings of the lamina cribrosa.

medial wall(nasal septum) consists of anterior cartilaginous (formed by quadrangular cartilage) and posterior bone (formed by a perpendicular plate of the ethmoid bone and vomer) sections.

There are three degrees of curvature of the nasal septum:

1. Simple. (Occurs in 90% of the population.)

2. Accompanied by nasal obstruction.

3. There is a permanent block of one of the halves of the nose.

Lateral (outer) wall formed in the anterior and middle parts by the medial wall and the frontal process of the upper jaw, the lacrimal bone, the nasal bone, the medial surface of the ethmoid bone and in the posterior part (choana) by the perpendicular process of the palatine bone. The lateral wall has three bone formations - nasal conchas. The lower shell is an independent bone, the middle and upper are processes of the ethmoid bone. Often the anterior end of the middle shell is inflated in the form of a bubble (concha bullosa) by an air cell of the ethmoid labyrinth. Under the lower nasal concha passes the lower nasal passage, between the middle and lower nasal conchas - the middle nasal passage. The superior nasal meatus extends from the middle turbinate to the roof of the nose and includes the sphenoethmoid space (from the superior turbinate to the roof of the nose). Between the nasal septum and the nasal conchas there is a gap from the bottom to the roof of the nose - the common nasal passage.

The lacrimal canal opens into the lower nasal passage. The middle nasal passage on the lateral wall has a semilunar fissure (hiatus semihmaris), into which the maxillary sinus, frontal sinus, anterior and middle cells of the ethmoid bone open. The sphenoid sinus and posterior ethmoid cells open into the superior nasal passage.

The nasal cavity is divided into two sections: the nasal vestibule and the nasal cavity proper.

The nasal cavity is divided into 2 functional sections. The boundary between them runs along the outer edge of the middle turbinate. Above the border - the olfactory zone (regio olfactoria); below - respiratory (regio respiratoria).

The olfactory zone is lined with specific olfactory epithelium. Its area is 50 cm2. The olfactory epithelium is represented by spindle-shaped, basal and supporting cells. The spindle cell is both a receptor and a conductor. The central fibers of these cells form fila olfactoria.

The respiratory zone is lined with multi-row cylindrical ciliated epithelium with serous and serous-mucous glands and goblet cells. The mucus contains a large amount of lysozyme and mucin, which has a bactericidal effect. The area of ​​the respiratory zone is 120 cm2. Goblet cells normally produce up to 500 ml of mucus per day. With pathology, mucus production increases. Cilia direct the movement of mucus towards the nasopharynx. There are many venous plexuses in the submucosal tissue, which are located mainly in the lower shell and partially in the middle one. Thanks to this, air flow, heat exchange, moisture exchange can be regulated. This venous network has a high absorption capacity (substances penetrate well).

Blood supply: branches of the internal carotid (a.ophthalmica (aa.ethmoidalis anterior et posterior and a.meningea media) anastomoses with branches of the external carotid (a.maxillaris (rami lateralis et medialis a.sphenopalatinae). Also anastomosis a.dorsalis nasi with a. angularis Bleeding zone of the nose (locus Kisselbachii).Located in the anterior third of the nasal septum due to the presence of a dense vascular network here.This area is the source of 70% of nosebleeds.Also, bleeding can occur from the upper and lower branches of a.sphenopalatina.

The outflow of blood occurs along v.facialis and v.ophtalmica. They anastomose with the plexus pterygoideus, sinus cavernosus, which provides a connection between the nasal veins and the veins of the skull, orbit, and pharynx (this is important for the development of complications).

Lymph drainage is carried out in the submandibular and deep cervical lymph nodes. The lymphatic pathways of the olfactory region of the nose are connected with the intershell spaces of the brain.

Innervation of the nasal cavity:

Olfactory. Olfactory fibers depart from the spindle-shaped cells of the olfactory epithelium and through the lamina cribrosa penetrate into the cranial cavity to the olfactory bulb.

Sensitive. Carried out by I (n.ophthalmicus) and II (n.maxillaris) branches trigeminal nerve. The anterior and posterior ethmoid nerves (nn.ethmoidalis anterior et posterior) depart from the I branch, which innervate the lateral sections and the arch of the nasal cavity. The II 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 II 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, so pain from the nose and paranasal sinuses radiates to the area of ​​the teeth, eyes, forehead, and back of the head.

Secretory. The sympathetic and parasympathetic innervation of the nose and paranasal sinuses is represented by the Vidian nerve, which originates from the superior cervical sympathetic node and from the node of the knee of the facial nerve.

Similar information.

13279 0

general characteristics

When describing the anatomy of the nose, it is customary to distinguish between the following directions, orienting the surgeon to the appropriate location of certain anatomical structures: caudal, cephalic, lateral (external), medial (internal), posterior and anterior (Fig. 36.1.1).

Rice. 36.1.1. The main directions used to describe the anatomy of the external nose.
C - cephalic; K - caudal; L - lateral; M - medial; P - front; Z - back.

The bridge of the nose begins at the bridge of the nose, and the narrowest part of its bony part is located at the level of the medial corners of the eyes. The nasal bones then expand caudally. The bone skeleton of the nose is represented by relatively small nasal bones and the frontal processes of the upper jaw located posteriorly from them.

Adjoining the nasal bones are the lateral cartilages of the nose (superior lateral), which have a triangular or rectangular shape (Fig. 36.1.2).

Rice. 36.1.2. The most important anatomical structures that form the skeleton of the external nose.
1 - nasal bone; 2 - upper lateral cartilage; 3 — edge of a pear-shaped opening; 4 - large alar cartilage; 5 - additional cartilage; 6 - root of the nose; 7 - anterior nasal process; 8 - dome.

The skeleton of the caudal part of the nose is represented by large alar cartilages connected by fibrous bridges to the superolateral cartilages, and the caudal edge of the nasal septum. The domes of the alar cartilages normally form the most protruding part of the nose and appear as two points that are noticeable only in people with thin or normal skin with a sufficient sharpening of the domes.

The configuration of the subapical (located below the tip) part of the nose depends on the location, size and shape of the middle and medial crura of the alar cartilages. In this area of ​​the nose, due to the very thin and fused skin with cartilage, even small changes in the shape of the cartilaginous skeleton become noticeable, which is often the object of the surgeon's influence.

Behind the large alar cartilages are additional cartilages and fibro-fatty tissue that forms the alar of the nose.

Integumentary tissues

Leather. The skin covering the nose has an uneven thickness and becomes thicker from top to bottom. In general, its thickness is directly dependent on the severity of the subcutaneous layer of soft tissues, which has a significant impact on both the content of operations and their results. Thus, thin skin and a thin subcutaneous layer of tissues can shrink after reducing certain sizes of the nose to a much greater extent than thick skin with a more significant subcutaneous tissue layer.

This allows the surgeon to plan thin skin making relatively large changes in the shape of the nose and obtaining a clearer relief of the seal of the nose. On the other hand, in these cases, even minimal irregularities of the bone-cartilaginous skeleton of the back and nasal seal become noticeable, which, in turn, can lead to patient dissatisfaction.

With thick skin and significant thickness subcutaneous tissue A “chiseled” tip of the nose with two distinct points standing under the skin will not work, and the dimensions of the nose themselves can only be changed to a relatively small extent.

The subcutaneous tissues are represented by four layers. Subcutaneous adipose tissue penetrated by vertical fibrous bridges connecting the deep layer of the dermis with the fibromuscular layer. The fiber thickness is greatest in the region of the bridge of the nose, decreases to a minimum in the zone of the osteo-cartilaginous junction of the back of the nose, and then increases again above the tip of the nose and above the cephalic edges of the large alar cartilages.

The fibromuscular layer is represented by bundles of collagen fibers that surround the muscles of the nose, forming a superficial and deep fascia for each muscle so that all these formations act as one functional unit. Thus, a superficial muscular-aponeurotic system of the nose is formed, all parts of which are interconnected.

The deep fat layer is represented by loose fiber, which separates the periosteum (perchondrium) from the muscle layer, thereby increasing muscle mobility in relation to the nasal skeleton.

The periosteum (perchondrium) covers the bony (cartilaginous) structures and, going beyond the large alar and superolateral cartilages, creates additional support for the accessory cartilages. The corresponding parts of the large alar cartilages are connected by fibrous bridges, which are a continuation of the perichondrium.

Blood supply and innervation of the external nose

The sources of blood supply to the tissues of the external nose come from the system of internal and external carotid arteries (Fig. 36.1.3).

Rice. 36.1.3. The main sources of arterial blood supply to the external nose (explanation and text).
1 - supraorbital artery; 2 - supratrochlear artery; 3 - dorsal nasal artery; 4 - external nasal branch of the anterior ethmoid artery; 5 - infraorbital artery; 6 - lateral nasal artery; 7 - angular artery; 8 - superior labial artery; 9 - facial artery.

Two things are of the greatest importance. First, the branches of the corresponding paired arteries anastomose with each other at the level of the back of the nose, forming a wide anastomotic network. Secondly, the blood supply to the tip of the nose is carried out from three main sources: 1) arteries descending along the back of the nose; 2) lateral nasal artery and 3) superior labial artery. Damage to the latter when using open access does not lead to disruption of the blood supply to the skin, if other sources of blood supply are preserved.

Sensitive innervation of the nose is provided by the cutaneous branches of the fifth pair of cranial nerves (Fig. 36.1.4).

Rice. 36.1.4. main sources sensitive innervation external nose.
1 - supraorbital nerve; 2 - supratrochlear nerve; 3 - subtrochlear nerve; 4 - external nasal branch of the anterior ethmoid nerve; 5 - infraorbital nerve.

A special role among these branches is played by the external nasal branch of the anterior ethmoid nerve, which appears between the nasal bone and the upper lateral cartilage, accompanying the artery of the same name. This branch innervates the skin of the dorsum of the nose at a more caudal level, including the tip of the nose, and damage to it during rhinoplasty causes numbness. To prevent this complication, the surgeon should limit the volume of endonasal intervention as much as possible and separate the tissues, moving directly along the surface of the cartilage.

The skin of the caudal part of the nose is innervated by a branch of the infraorbital nerve, the blockade of which is necessary during operations under local anesthesia.

base of the nose

The base of the nose is divided into the following main parts: lobe, skin-membranous movable part of the nasal septum, or column (from the English columella), the bottom of the nostrils, the vestibule, the base of the wing, the wall of the wing of the nose. The characteristics of these parts are largely determined by the shape and size of the large alar cartilages .

Each large alar cartilage is conditionally divided into three legs (sections): lateral, medial and middle (intermediate—Fig. 36.1.5). The lateral crura of the greater alar cartilages are also called the inferolateral cartilages.

Rice. 36.1.5. Anatomical zones of the large alar cartilages.
1—lateral leg; 2 - middle leg; 3 - medial leg; 4 - dome of the middle leg; 5 - slice of the middle leg; b - column (columel) of the medial pedicle; 7 — the basis of a medial leg.

The medial crus is not simply seen as a link between the medial and lateral crura. Its shape and dimensions play an extremely important role in the formation of the shape of the nose, its evaluation and in the preparation of the operation plan.

The medial pedicles are divided at the top of their curvature into two sections: the base and the segment of the column. The magnitude of the angle of this curvature significantly affects the location of the base of the medial crura and, in turn, how much they protrude under the skin, narrowing the entrance to the nasal canal. The position of the base of the medial crus is also affected by the location of the caudal edge of the nasal septum, as well as the volume of soft tissues at the base of the column.

The length of the nostril also depends on the length of the column segment, and three main options are distinguished in the location of the medial legs: 1) asymmetric parallel, 2) symmetrical extended and 3) symmetrical straight (Fig. 36.1.6).

Rice. 36.1.6. The main options for the location of the medial legs and the lobules of their middle segments.
a - asymmetric parallel; b - symmetrical extended; c - symmetrical straight line.

Between the two paired segments is loose connective tissue, including blood vessels. Therefore, with open access, this tissue should be included in the formed flap, which contributes to the maximum preservation of its blood supply.

The segment of the column passes into the lobule of the middle stem at the break point, the location and angle of which significantly affect the profile of the nose. Excessive or, on the contrary, insufficient protrusion of this point is a frequent reason for surgical correction.

The middle (intermediate) legs are conditionally divided into a lobule and a dome. The cephalic edges of the cartilage at the level of the lobule are located close to each other, while the caudal ones are deviated outwards. Their location, length and shape also determine the shape of the subapical region of the nasal tip.

The domes are usually the thinnest and narrowest portions of the large alar cartilages and may be asymmetrical due to congenital anomalies or childhood trauma. Their size and shape, as well as the volume of soft tissues located between them, are key indicators, defining the shape of the cat's nose. The appearance of the latter largely depends on three main characteristics: 1) features of the curvature of the stem at the level of the dome; 2) the relative position of the domes and 3) the thickness of the soft tissues covering the domes. The first two indicators are most often corrected during rhinoplasty.

Play a significant role appearance and the location of the points of the tip of the nose (domes of the large alar cartilages protruding under the skin), which are very important in its aesthetic characterization. The indicators of the supraapical zone of the tip of the nose are also significant, largely determined by the thickness of the soft tissues. With their excess, the contour of the nose in the supraapical zone shifts in the cephalic direction, and with a deficiency, the so-called split nose is formed.

The lateral crura are the largest part of the large alar cartilages and play an important role in determining the shape of the anterolateral part of the nose, and in particular the lateral wall of the wing. The outer edge of the lateral legs rests on additional cartilages located along the edge of the piriform opening, and may have a different (concave or convex) shape. However, due to the masking effect of soft tissue, this can often only be determined by exposing the cartilage. With excessive size and convex shape of the lateral crura (in combination with smoothed domes), the tip of the nose loses its outline and acquires a bulbous appearance.

The structure of the contact zone of the cephalic edges of the lateral crura and the caudal edges of the superolateral cartilages is different: they can interlock, overlap each other (the most common option) or be matched "edge to edge".

Osteocartilaginous vault of the nose

The bone vault has a pyramidal shape and is covered with a significant layer of soft tissues in the cephalic part. Together, this determines the depth and height of the bridge of the nose, which are the most important characteristics of the nose profile and are often corrected during rhinoplasty.

According to PSullivan et al., the average width of the nasal bones is greatest in the region of the nasolabial suture (14 mm), minimal in the region of the bridge of the nose (10 mm), below which it widens again (9–12 mm). The nasal bones are thickest (mean 6 mm) above the bridge of the nose and progressively thinner caudally. In the place where bone grafts are usually fixed with screws (5-10 mm below the bridge of the nose), the thickness of the nasal bones is 3-4 mm.

The cartilaginous arch is a single cartilaginous unit, which can be located at different distances from the bridge of the nose and is formed by a pair of superolateral cartilages connected to the dorsal edge of the cartilaginous part of the nasal septum. At different levels, the osteochondral arch has a different cross section, the variants of which have a great influence on the technique for correcting the shape and size of the back of the nose.

Nasal septum

The nasal septum is represented in the posteroanterior direction by various components: bone, cartilage and a membranous portion (Fig. 36.1.7). Deformities of the nasal septum are often manifested by impaired nasal breathing, the improvement of which is one of the tasks of rhinoplasty.

Rice. 36.1.7. Components of the nasal septum.
1 - perpendicular plastic of the ethmoid bone; 2 - coulter; 3 - septal cartilage; 4 - nasal bone; 5 - anterior septal angle; 6 - posterior septal angle; 7 - anterior nasal process; 8 - nasal crest of the upper jaw.

The perpendicular plate of the ethmoid bone forms the cranial third of the nasal septum and connects anteriorly to the nasal bone, caudally to the cartilage of the nasal septum, and inferiorly to the vomer. The contact zone of the vomer with the plate of the ethmoid bone depends on how much the septal cartilage is introduced between them.

The vomer is shaped like a "keel of a ship" and is attached to the crest of the upper jaw. The most caudal part of this connection is the anterior nasal process of the maxilla.

The cartilage of the nasal septum has an irregularly rectangular shape and takes part in the formation and support of the cartilaginous part of the back of the nose. The thickness of the cartilage usually decreases significantly in its anterior sections.

The size of the cartilaginous plate can significantly affect the contours of the nose, and in particular the height of the bridge of the nose, the projection of the nasal seal, as well as the location of the medial crura of the alar cartilages.

There are two septal angles in the nasal septum: anterior and posterior. The anterior septal angle is formed by the dorsal and anterior edges of the cartilaginous plate and is directly connected with the cartilaginous formations that make up the tip of the nose. The posterior septal angle is formed by the anterior margin of the septal cartilage and its base. It is in direct contact with the nasal process of the maxilla (see Fig. 36.1.7).

IN AND. Arkhangelsky, V.F. Kirillov

Before proceeding to the description of the respiratory system, we present a drawing for consideration.

Human respiratory system (above - sagittal section of the nasal cavity, mouth and larynx): 1 - nasal cavity; 2- oral cavity; 3 - larynx; 4 - trachea; 5 - left main bronchus; 6 - left lung; 7 - right lung; 8 - segmental bronchi; 9 - right pulmonary arteries; 10 - right pulmonary veins; 11 - right main bronchus; 12 - pharynx; 13 - nasopharyngeal passage.

upper respiratory tract

To the top respiratory tract include the nasal cavity, the nasal part of the pharynx, the oral part of the pharynx.

The nose, according to E. Alcamo, consists of an outer part that forms the nasal cavity.

The external nose includes the root, back, apex and wings of the nose. The root of the nose is located in the upper part of the face and is separated from the forehead by the nose bridge. The sides of the nose join in the midline to form the back of the nose. From top to bottom, the back of the nose passes into the top of the nose, below the wings of the nose limit the nostrils. The nostrils are separated along the midline by the membranous part of the nasal septum.

The outer part of the nose (outer nose) has a bony and cartilaginous skeleton formed by the bones of the skull and several cartilages.

The nasal cavity is divided by the nasal septum into two symmetrical parts, which open in front of the face with the nostrils. Posteriorly, through the choanae, the nasal cavity communicates with the nasal part of the pharynx. The nasal septum is membranous and cartilaginous anteriorly, and bony posteriorly.

Most of the nasal cavity is represented by the nasal passages, with which the paranasal sinuses (air cavities of the skull bones) communicate. There are upper, middle and lower nasal passages, each of which is located under the corresponding nasal concha.

The superior nasal passage communicates with the posterior ethmoid cells. The middle nasal passage communicates with the frontal sinus, maxillary sinus, middle and anterior cells (sinuses) of the ethmoid bone. The lower nasal passage communicates with the lower opening of the nasolacrimal canal.

In the nasal mucosa, the olfactory region is distinguished - a part of the nasal mucosa covering the right and left upper nasal conchas and part of the middle ones, as well as the corresponding section of the nasal septum. The rest of the nasal mucosa belongs to the respiratory area. In the olfactory region there are nerve cells that perceive odorous substances from the inhaled air.

In the anterior part of the nasal cavity, called the vestibule of the nose, there are sebaceous, sweat glands and short stiff hairs - vibris.

The blood supply to the nasal cavity comes from a.sphenopalatina, aa. ethmoidales anterior et posterior, a. nasopalatina (branch fffi^jcx^ /i of the carotid artery). These arteries anastomose in the anterior and lower section partitions with a.alveolans inferior and a.palatina major.

Bleeding area of ​​the nose (locus Kisselbachii). It is located in the region of the anterior third of the nasal septum due to the presence of a dense vascular network here. This site is the source of 70% of nosebleeds. Also, bleeding can occur from the upper and lower branches of a.sphenopalatina.

The outflow of blood occurs along v.facialis and v.ophtalmica. They anastomose with the plexus pterygoideus, sinus cavernosus, which provides a connection between the nasal veins and the veins of the skull, orbit, and pharynx (this is important for the development of complications).

Lymph drainage is carried out in the submandibular and deep cervical The lymph nodes. The lymphatic pathways of the olfactory region of the nose are connected with the intershell spaces of the brain.

Innervation of the nasal cavity:

Olfactory. Olfactory fibers depart from the spindle-shaped cells of the olfactory epithelium and through the lamina cribrosa penetrate into the cranial cavity to the olfactory bulb.

Sensitive. It is carried out by I (n.ophthalmicus) and II (n.maxillaris) branches of the trigeminal nerve. The anterior and posterior ethmoidal nerves (nn.ethmoidalis anterior el posterior) depart from the I branch, which innervate the lateral sections and the arch of the nasal cavity. The 11th 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 II 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, so pain from the nose and paranasal sinuses radiates to the area of ​​the teeth, eyes, forehead, and back of the head.

Secretory. The sympathetic and parasympathetic innervation of the nose and paranasal sinuses is represented by the vidian nerve, which originates from the superior cervical sympathetic ganglion and from the ganglion node of the facial nerve.

More on the topic Features of the blood supply and innervation of the nasal cavity:

1. Structural and functional features of autonomic and somatic innervation. Sympathetic and parasympathetic divisions of the autonomic nervous system. The concept of metasympathetic innervation.