 Today's program starts with endoscopic surgery, so you encounter some of the basic anatomy then you see endoscopic part. So first we will see the nose and paranozolysinuses, we will recapitulate some of our anatomy knowledge about nose and paranozolysinuses. So when you are putting a endoscope through the nose you must know something about the nasal cavities and the nose, the pyramidal shape nose, this is the anterior nares which is mostly formed by the cartilages and connective tissue, the cartilages are connected by connective tissues, this is the anterior nares, the height is 2 centimeter, breadth is 1.5 centimeter and this is the posterior nares where the nose opens into the nasopharynx, posterior nares is larger than the anterior nares, dimensions are also larger. This part is mostly bony, in between you can see the nasal septum, posterior part of the nasal septum which is mostly formed by the gomerd and by the sides you see the part of the palatine bone which is articulating with the spinoid, pterigoid processes of the spinoid and the floor is also formed by the palatine bone. In this part the most important is that if you damage these parts there are fibrous tissue. So the chances of repair is very less and if it is repaired there will be more of fibrous tissue. Then I will tell you about the nasal cavities, see the nasal cavity, this is the anterior part of the nose, the anterior inferior part is mostly cartilaginous, this is the lateral wall of the anterior and the lateral wall of the nose and the posterior part is the bony part of the nose where you see the most three prominent the nasal concave. The superior and middle concave which is green colored is part of the ithmoid bone and the inferior concave is a separate bone. This pink colored bone is the part of the maxilla and maxillary hiatus you can see and already in your anatomy teachings you have learned the maxillary hiatus when you see in maxilla it is large but it is covered by descending process of the palatine bone and from below unscene process here also the unscene process of the ithmoid bone is there and the processes of the maxilla and the palatine bone goes and it covers. So there are two opening remains, the anterior opening and posterior opening normally it is covered by the mucus membrane, the anterior opening is covered by the mucus membrane only the posterior opening remains. See the roof of the nasal cavity is formed by the cubiform plate, it is very thin plate and there are openings through which the olfactory nerve enters into the upper part of the nose, this is very thin. So if you hit with your endoscope the roof there will be fracture of the anterior cranial fossa and there may be cerebrospinal, there is a rhinorrhea, CSF rhinorrhea may be there. The roof the middle part is horizontal but anterior part is formed by the nasal bones and the posterior part is slightly slanting it is formed by the anterior wall of the sphenoidal sinus mostly you will work today on the sphenoidal sinus. Then floor of the cavity nasal cavity is formed by the horizontal process of the palatine bone here this is the horizontal process of the palatine and this is the palatine process of the maxilla. The medial wall of the nasal cavity is the nasal septum anteriorly this part is covered by the septal cartilage then if you see the posterior part which is formed by the perpendicular plate of the ith moite bone and the lower part this is formed by the vomer. The anterior part of the nasal septum is mobile this is the nasal cavity with the mucosa. This nasal mucosa it has a physiology there are two spinters has been described two valves actually the anterior valve which is the anterior nares which is formed by the cartilages and the skin and the posterior valve which is formed by the metasis this elevations and the depressions and there is a physiological cycle it is 4 to 6 hours you have seen that one of the nasal cavity is always open and other nasal cavity is closed. This is continuously going on we do not notice it is already programmed which nasal cavity will breathe through which one will be closed and there is a mucosiliary escalation. So this whole cavity is lined by serostratified cillated columnar epithelium and the cilia directs the mucous towards the nasopharynx. So basic purpose of telling is that if the conchi and metasis are damaged this natural physiology is lost. So it is better to preserve most of the conchi and the mucosa. So here is the inferior metas where the nasal acrimonial duct opens here and anterior part this is the middle metas and this is the bula ith modelis which is formed by the ith model air cells and just below the bula the maxillary sinus opens and anterior to this hiatus this is the hiatus similarities where the orifice of the anterior and middle ith model group of sinuses opens into this space this is the superior metas and the superior concha. Here the posterior ith model group of air cells opens and this is the spinoid model recess this is the opening of the spinoid layer sinus where there may be sometimes say highest concha also sinus frontal sinus and this is the spinoid layer sinus the spinoid layer sinus is very irregular but most of the textbooks writes that it is a cuboidal space which is lined by the nasal mucosa this is the opening of the pharyngo timpaniq tube it is in line with the inferior metas if your concha actually and when you do the endoscopy you can recognize it also. The blood vessels and the knobs the most prominent blood vessel is there is an opening here through this opening the spino pyrotent branch and the nasopyrotent branches of the blood vessels and the knobs comes through this opening here is the artery actually the branches of the maxillary artery supplies the nasal cavity here the postage model artery and the antiage model artery which are the branches of the ophthalmic artery it supplies the upper part and the antia part of the nose and the metae the posterior part is supplied by the the spino pyrotent branches of the spino pyrotent artery that comes from the third part of the maxillary artery from the fissure here and the gator pyrotent artery passes through the gator pyrotent foramen and comes on the roof of the floor then it goes through the incisive foramen and it makes an anastomosis in the antia part of the septum so that already you know that this is called the little's area there are four arteries coming labial branches of the facial artery antiaid model artery the spino pyrotent artery and the branches of the gator pyrotent artery four sets of arteries comes here and is very vascular it may gets damaged and there may be severe hemorrhage. This is the venous drainage venous drainage is very important because the nasal cavity the nasal mucosa is a erectile tissue these are mainly sinuses and the venous sinuses there are lots of arterial venous anastomosis in this region and the corresponding veins are there those veins ultimately drain into the cavernous sinus. The nerve supply of this you see the upper one fourth of the nasal cavity the olfactory nerves are there so the basically this part has to be preserved otherwise there may be the loss of smell and the main nerve which is coming through the spino pyrotent foramen this artery also comes through this foramen and the nerves also comes through this foramen if this nerves and the blood vessels are damaged there may be some sensation loss here and the spino pyrotent artery in case of the severe bleeding from the nose the spino pyrotent artery can be ligated through endoscopy in the spino pyrotent foramen. The nasal septum is also supplied by branches of the nasal pyrotent artery which is a branch of the maxillary artery. Now you will see the spinoid this is showing the body of the spinoid anterior surface of the body of the spinoid this is the crest of the spinoid and rostrum of the spinoid is here and here is the opening of the spinoidal layer sinus on the anterior wall it is slightly away from the midline and these are the teriguard processes the lesser wing greater wing and this is the superior orbital fissure through which all the blood vessels and the nerves to the eye comes. So, this is spinoid from the anterior surface now you are looking the spinoid from above and this is from the posterior surface this is from above. So, here is the junction between the occipital and the spinoid greater wings and the lesser wing this is dorsum celli from superior surface this is the jugum spinoidally and tuberculum celli this is the anterior cannoid process the middle cannoid processes and just on the medial side of the anterior cannoid process here the internal carotid artery makes a bend you see the optic for amens are here this is the cellar tarsica and the dorsum celli is here the cavernous sinus lies here these are the pictures I have taken from our specimens anterior wall of the spinoid this is the opening of the spinoidal layer sinus the crest of the spinoid and rostrum is damaged here the knob of the teriguard opening for the knob of the teriguard canal is here the lesser wing and the greater wing are here now the anterior wall is broken and you see the spinoidal layer sinus. So, this is the roof of the spinoidal layer sinus this is the lateral wall this is the floor and this is the medial wall which is formed by the septum. Septum the there is a septum and septum is present always but sometimes septum may be absent but septum is not in midline in 75 percent cases this septum is slightly away from the midline sometimes there may be incomplete septum also the roof is formed by the jugum spinoidally and the cellar tarsica the lateral wall here in the lateral wall what you see you will see the most prominent things in the lateral wall this is the lateral wall of the spinoidal layer sinus what I was talking I was showing the roof of the spinoidal layer sinus the posterior part of the roof is formed by the cellar tarsica if you go more posteriorly this is the cleavus which forms the posterior wall of the spinoidal layer sinus this is the floor of the spinoidal layer sinus and anterior wall is here where the opening of the spinoidal layer sinus is there here more or less same things are shown the anterior wall floor posterior wall this is the roof of the spinoidal layer sinus here and sometimes you can see the elevations for the tuberculum celli there or cellar tarsica also they may project into this area and these are the it model groups of cells the posterior model group of cell this is one of the large posterior model group of cell which is called nodi sinus and you have to be very careful that it lies in contact with the optic nerve this may be confused with the spinoidal layer sinus the internal carotid artery is in the lateral wall of the sinus and internal carotid artery produces an elevation even the optic nerve also produces elevations on the lateral wall and towards the floor you can see sometimes elevations will be there for the median nerve or the teriguard canal sometimes the bone is absent in these regions especially the carotid elevation or for the optic elevation so if you damage the mucosa directly you will come in contact with the dura in the lateral wall. So the lateral wall the superior part and the inferior part is very important because this is the lateral wall this is an intersite this is the eminence for the elevation for the optic nerve and this is the elevation for the internal carotid artery sometimes the internal carotid artery elevation becomes so large or so big this elevation may come in contact with the other side carotid elevation and in that case it is called the kissing carotid and this is the elevation for the optic nerve and in between the carotid and the optic elevation this is the optic carotid recess you have to very carefully identify the optic carotid recess and this is one of the large cell large sinus this is onod sinus this one you can see very nicely you can see this is the pediatric gland and this is the elevation for the optic nerve and this elevation for the carotid artery and these are the recesses and the nasal cavity you can identify the metis and the conchi inferior conchi the metis is close this is the middle metis and the superior one is here the opening of the station tube is here the septum I was telling that there may be a vertical septum also and different kinds of spinodal ursinuses are there there are precellar type and cellar type and conchal type sometimes there may be a vertical septum also means there may be a septum which is positioned coronally so this is one of the coronal septum there may be two or three coronal septums and one of the septum may touch the carotid elevation if the coronal septum said they are incomplete coronal septums so it may touch the carotid elevation this is a vertical septum this is actually the cellar type of spinodal ursinus and its description is there the cellar type extends beyond the cellar tersica you can see a vertical septum here and this sinuses extended into the occipital bone and precellar type normally is limited up to the cellar tersica only this is sometimes there may be two sinuses so this is one sinus and another one is slightly above it may be this is one is onodisinus also this is the posterior group of sinuses are here so this is the anterior surface I can show that this is the rostrum and here is the crest here the perpendicular plate of the ith moite bone articulates to form the nasal septum and these two are the openings of the ith model sinuses now the posterior group of ith model air sinuses they articulate in this region now I am showing the superior surface so these are the dorsum celli and posterior kinode process these two are the anterior kinode processes here is the cellar tersica zogamsis spinoidally and these two are the middle skinner process tuberculums celli and the lateral end of is the middle kinode process and here lies the cavernous sinus this is the posterior surface if you can see this for a means the median canal is here now I am showing the lateral wall here lies the cavernous sinus and below it is the spinoidally air sinus so median canal is in the lower part of the floor of the spinoidally air sinus the sinus is here my purpose was to show the sinus this is the inferior metis the middle metis superior metis and the spinoidally air sinus is here so very nicely you can see the nasal cavity the inferior metis the conca the middle metis and the opening of the maxillary hiatus this anterior model air cells the middle are broken even the posterior one also you can see a septum here the vertical septum this may be the onody sinus or the spinoidally air sinus and here is the vertical coronal septum is present here the cellar tersica is here this is the base of the occipital bone and here you can see the opening of the extrusion tube in line with the inferior conca so these you are going to identify by through endoscopy