Nasal cavity

The nasal cavity forms part of the aerodigestive tract.

Gross anatomy

The nasal cavity is formed by ¹:

• anteriorly: nasal aperture
• laterally: inferior, middle and superior nasal conchae or turbinates
• superiorly: cribiform plate of the ethmoid bone
• inferiorly: palatal processes of the maxilla and horizontal portion of the palatine bone

In the midline, the nasal cavity is divided into right and left halves by a septum composed of fibrocartilage as well as the vomer and the perpindicular plate of the ethmoid bone. 

Anteriorly, it is continuous with the nose at the nasal aperture and posteriorly it is continuous with the nasopharynx. Laterally, the three nasal conchae form three spaces:

• superior meatus
• middle meatus
• inferior meatus

Connections

• superior meatus
  • posterior ethmoidal air cells and sphenoid sinuses via the spheno-ethmoidal recess ²
• middle meatus
  • frontal sinus via frontal recess
  • ethmoid and maxillary sinuses via ostiomeatal complex
• inferior meatus
  • nasolacrimal duct ³

Blood supply

Arterial supply

The arterial supply of the nasal cavity is rich and derives from both the internal and external carotid arteries ^{4, 5}:

• lateral nasal wall
  • superior lateral nasal wall: anterior and posterior ethmoidal arteries
  • inferior and middle turbinates: sphenopalatine artery 
  • posterior lateral nasal wall: pharyngeal artery
• nasal septum
  • anteriorly: greater palatine artery
  • postero-inferiorly: sphenopalatine artery
  • superiorly: anterior and posterior ethmoid arteries
• floor
  • greater palatine and superior labial arteries

Rich arterial supply results in two anastomotic areas, which are common sites of epistaxis ⁴:

• Woodruff area: anastomosis of sphenopalatine and pharyngeal arteries in the inferior lateral nasal wall, posterior to the inferior turbinate
• Kiesselbach plexus: anastomosis of the anterior ethmoid, greater palatine, sphenopalatine and superior labial arteries in the anteroinferior nasal septum (see article on Kiesselbach plexus)

Venous drainage

A rich venous submucosal venous network is formed by veins that accompany arteries. It should be noted that the posterior ethmoid veins anastomose with veins of the dura mater and orbit, making this a potential route of spread of infection. There is also an anastomosis with veins of the external nose ⁶.

Innervation

The olfactory nerve (CN I) supplies the special sensation of smell to the olfactory epithelium in the roof of the nasal cavity, with fibres passing upwards through the cribriform plate to the olfactory bulb.

Mucosal somatic sensation of the nasal cavity is derived from numerous nerves, but in general terms the branches of the ophthalmic division of the trigeminal nerve (CN Va) supply the anterosuperier half whereas branches of the maxillary division of the trigeminal nerve (CN Vb) supply the posteroinferior half. More specifically:

• the nasal septum is innervated by:
  • anterior: anterior ethmoidal nerve
  • posterosuperior: medial branch of the posterior superior nasal nerve
  • posteroinferior: nasopalatine nerve
• the lateral nasal wall is innervated by:
  • anterosuperior: anterior ethmoidal nerve
  • anteroinferior: anterior superior alveolar nerve
  • posterosuperior: lateral branch of the posterior superior nasal nerve
  • posteroinferior: lateral posterior inferior nasal nerve from the greater palatine nerve

Lymphatic drainage

• anterior drainage: to the external nose ⁶
• posterior drainage: via separate pathways to the lateral pharyngeal lymph nodes or deep cervical chain ⁶