The nose and paranasal sinuses physiology and anatomy

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Abstract

The paranasal sinuses and nose are much more than two cavities behind a projection on the centre of the face. They humidify, filter, warm, and sense what we breathe. The anatomy and physiology interact forming a dynamic system. The anatomy, airflow, nasal resistance, its turbulence, the nasal cycle – a process by which the turbinates or cushions lining the nose alternatively swell and congest from side to side, can all potentially influence the nasal delivery of drugs. Along with these factors mucus rheology and mucociliary clearance influence the removal of substances delivered to the nose. The health of the nose and its immunological response to what is inhaled, be it pollutants, allergens, drugs or vaccines, all need to be considered. It is a fascinating sensor for the body, not only detecting the potentially harmful substances such as smoke, but its psychosexual aspects have far reaching implications and the olfactory pathway has potential as a pathway for the delivery of drugs.

Section snippets

Physiology

What does the nose do? We breathe in about 12 to 24 times a minute, inhaling approximately 10 000 litres of air a day of differing temperature, humidity and which contains dust and organisms.

It has the following functions that are often taken for granted until they are lost:

  • 1.

    Olfaction

  • 2.

    Sensation

  • 3.

    Immunology

  • 4.

    Mucociliary clearance

  • 5.

    Filtration

  • 6.

    Warm and humidify

  • 7.

    Nasal cycle and airflow dynamics

The external structure

  • The nasal bones usually comprise only the upper third of the nose (Fig. 2).

  • The septum forms the central strut or scaffolding of the nose and separates the two nasal airways (Fig. 3a and b).

  • The anterior part of the central strut or septum is made up of the quadrilateral cartilage which is attached behind to the vomer and vertical plate of ethmoid and below to the maxillary crest and spine.

  • The middle third of the nose is made up of the upper lateral cartilages which are a lateral continuation of

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