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Paranasal Sinuses

The paranasal sinuses are air cavities that help circulate the air that is breathed in and out of the respiratory system. They are situated around the nasal cavity and they are all paired and sometimes symmetrical, while always being bilateral. There are four different pairs of sinuses and they are called the:

  • maxillary sinuses
  • frontal sinuses
  • sphenoidal sinuses
  • ethmoidal sinuses
Key Facts
Maxillary sinuses Superior wall - bony orbit
Inferior wall - alveolar bone of the maxilla
Medial wall - nasal cavity
Lateral and anterior walls - cheekbones
Posterior wall - pterygopalatine fossa, infratemporal fossa

Innervation - anterior superior alveolar, middle superior, posterior superior nerves (branches of the maxillary nerve)
Vascularization - anterior superior alveolar, middle superior alveolar, posterior superior alveolar arteries (branches of the maxillary artery)
Frontal sinuses Anterior wall - forehead and superciliary arches
Superior and posterior walls - anterior cranial fossa
Inferior wall - bony orbit
Medial wall - contralateral sinus

Innervation - supraorbital nerve, supratrochlear nerve (branches of the ophthalmic nerve)
Vascularization - anterior ethmoidal, supraorbital, supratrocheal arteries (branches of the ophthalmic artery)
Sphenoidal sinuses Anterior wall - nasal cavity
Superior wall - hypophyseal fossa
Inferior wall - nasopharynx and pterygoid canal

Innervation - posterior ethmoidal nerve (branch of the nasociliary nerve)
Vascularization - posterior ethmoidal, posterior lateral nasal arteries (branches of the ophthalmic artery)
Ethmoidal sinuses Superior wall - anterior cranial fossa, frontal bone
Lateral wall - bony orbit
Medial wall - nasal cavity

Innervation - anterior and posterior ethmoidal nerves (branches of the nasociliary nerve)
Vascularization - anterior and posterior ethmoidal arteries (branches of the ophthalmic artery)
Clinical relation Sinusitis

This article will discuss detailed anatomy of the paranasal sinuses.

The Maxillary Sinuses

Anatomy

The maxillary sinuses are the largest of the all the paranasal sinuses. They have thin walls which are often penetrated by the long roots of the posterior maxillary teeth. The superior border of this sinus is the bony orbit, the inferior is the maxillary alveolar bone and corresponding tooth roots, the medial border is made up of the nasal cavity and the lateral and anterior border are limited by the cheekbones.

Posteriorly, two anatomical spaces known as the pterygopalatine fossa and the infratemporal fossa exist.

Vascularization, Innervation & Lymphatics

The submandibular lymph nodes are the main destination during lymphatic drainage. The blood supply includes a contribution from the: 

  • anterior superior alveolar artery
  • middle superior artery
  • posterior superior alveolar artery

Innervation occurs through nerves of the same names as the arteries.

The Frontal Sinuses

Anatomy

Anteriorly, the frontal sinuses are contained by the forehead and the superciliary arches, superiorly and posteriorly by the anterior cranial fossa and inferiorly by the bony orbit, the anterior ethmoidal sinuses and the nasal cavity. Medially the sinuses face one another, separated by the midline.

This pair of sinuses are irregular in shape when compared to one another and is underdeveloped at birth. They reach their full size and shape around seven to eight years of age.

Vascularization, Innervation & Lymphatics

They drain primarily into the ethmoidal infundibulum and the corresponding lymph drainage occurs via the submandibular lymph nodes. It is innervated by the ophthalmic nerve, including the supraorbital and supratrochlear branches.

The frontal sinuses are supplied by the: 

  • anterior ethmoidal artery
  • supraorbital artery
  • supratrochlear artery

The Sphenoidal Sinuses

Anatomy

The most posterior of all the sinuses in the head, the sphenoidal sinuses are large and irregular, just like their septum, which is made by the sphenoid bone. Laterally, a cavernous sinus exists which is part of the middle cranial fossa and also the carotid artery and cranial nerves III, IV, V/I, V/II and VI can be found.

The anterior wall separates this pair of sinuses from the nasal cavity, as does the hypophyseal fossa, the pituitary gland and the optic chiasm superiorly and the nasopharynx and pterygoid canal inferiorly.

Vascularization, Innervation & Lymphatics

The lymphatic drainage occurs in the same way as the posterior ethmoid sinus. The posterior ethmoidal artery and the posterior lateral nasal branches supply the sphenoidal sinuses.

The posterior ethmoidal nerve and the orbital branch of the pterygopalatine ganglion innervate them.

The Ethmoidal Sinuses

Anatomy

Superior to the ethmoidal sinus is the anterior cranial fossa and the frontal bone, laterally the orbit can be found, while the nasal cavity is situated medially. The ethmoid sinuses are unique because they are the only paranasal sinuses that are more complex than just a single cavity.

On each side of the midline, anywhere from three to eighteen ethmoidal air cells may be grouped together. These air cells are smaller individual sinuses grouped together to form one large one which encompass the anterior, middle and posterior nasal meatuses.

Vascularization, Innervation & Lymphatics

The anterior and middle ethmoid sinuses send their lymphatic drainage to the submandibular lymph nodes while the posterior ethmoid sinus sends its own to the retropharyngeal lymph nodes.

The anterior and posterior ethmoidal arteries, as well as the posterior lateral nasal branches provide an ample blood supply to this region. Meanwhile the anterior and posterior ethmoidal nerves and the posterior lateral superior and inferior nasal nerves help innervate it.

Sinusitis

Sinusitis is an extremely common outpatient case which presents as an inflammation of the epithelia of the sinuses. The causes can be either a viral or bacterial infection, or an allergic reaction. The inflammation can be acute or chronic and the maxillary sinuses are the most frequently affected. Antivirals, antibiotics and antihistamines are prescribed in persistent cases.

Paranasal Sinuses - want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster.

Sign up for your free Kenhub account today and join over 852,397 successful anatomy students.

“I would honestly say that Kenhub cut my study time in half.” – Read more. Kim Bengochea Kim Bengochea, Regis University, Denver

Show references

References:

  • Neil S. Norton, Ph.D. and Frank H. Netter, MD, Netter’s Head and Neck Anatomy for Dentistry, 2nd Edition, Elsevier Saunders, Chapter 12 The Paranasal Sinuses, Page 300 to 324.

Author:

  • Dr. Alexandra Sieroslawska

Illustrators:

  • First Illustration Gallery - Yousun Koh, Samantha Zimmerman
  • Second Illustration Gallery - Yousun Koh
  • Third Illustration Gallery - Yousun Koh, Paul Kim
  • Fourth Illustration Gallery - Yousun Koh
  • Fifth Illustration Gallery - Yousun Koh, Paul Kim
  • Sixth Illustration Gallery - Yousun Koh
  • Seventh Illustration Gallery - Samantha Zimmerman
  • Eighth Illustration Gallery - Yousun Koh
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Related Atlas Images

Lateral wall of the nasal cavity

Medial wall of the nasal cavity

Midsagittal skull

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