Paranasal sinuses are a group of four paired air-filled spaces that surround the

nasal cavity The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal c ...

. The

maxillary sinus The pyramid-shaped maxillary sinus (or antrum of Highmore) is the largest of the paranasal sinuses, and drains into the middle meatus of the nose through the osteomeatal complex.Human Anatomy, Jacobs, Elsevier, 2008, page 209-210 Structure It is ...

es are located under the

eyes Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conve ...

; the

frontal sinus The frontal sinuses are one of the four pairs of paranasal sinuses that are situated behind the brow ridges. Sinuses are mucosa-lined airspaces within the bones of the face and skull. Each opens into the anterior part of the corresponding middle na ...

es are above the eyes; the ethmoidal sinuses are between the eyes and the

sphenoidal sinus The sphenoid sinus is a paired paranasal sinus occurring within the within the body of the sphenoid bone. It represents one pair of the four paired paranasal sinuses.Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, ...

es are behind the eyes. The

sinuses Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoid ...

are named for the

facial bones The facial skeleton comprises the ''facial bones'' that may attach to build a portion of the skull. The remainder of the skull is the braincase. In human anatomy and development, the facial skeleton is sometimes called the ''membranous viscerocr ...

in which they are located.

Structure

Humans possess four pairs of paranasal sinuses, divided into subgroups that are named according to the

bone A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...

s within which the sinuses lie. They are all innervated by branches of the

trigeminal nerve In neuroanatomy, the trigeminal nerve ( lit. ''triplet'' nerve), also known as the fifth cranial nerve, cranial nerve V, or simply CN V, is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewin ...

(CN V). * The

es, the largest of the paranasal sinuses, are under the eyes, in the maxillary bones (open in the back of the

semilunar hiatus The semilunar hiatus or hiatus semilunaris, is a crescent-shaped groove in the lateral wall of the nasal cavity just inferior to the ethmoid bulla. It is the location of the openings of the maxillary sinuses. It is bounded inferiorly and anterior ...

of the nose). They are innervated by the

maxillary nerve In neuroanatomy, the maxillary nerve (V) is one of the three branches or divisions of the trigeminal nerve, the fifth (CN V) cranial nerve. It comprises the principal functions of sensation from the maxilla, nasal cavity, sinuses, the palate a ...

(CN V2). * The

es, superior to the eyes, in the

frontal bone The frontal bone is a bone in the human skull. The bone consists of two portions.''Gray's Anatomy'' (1918) These are the vertically oriented squamous part, and the horizontally oriented orbital part, making up the bony part of the forehead, par ...

, which forms the hard part of the forehead. They are innervated by the

ophthalmic nerve The ophthalmic nerve (V1) is a sensory nerve of the face. It is one of three divisions of the trigeminal nerve (CN V). It has three branches that provide sensory innervation to the eye, the skin of the upper face, and the skin of the anterior sc ...

(CN V1). * The

ethmoidal sinus The ethmoid sinuses or ethmoid air cells of the ethmoid bone are one of the four paired paranasal sinuses. The cells are variable in both size and number in the lateral mass of each of the ethmoid bones and cannot be palpated during an extraoral ...

es, which are formed from several discrete air cells within the

ethmoid bone The ethmoid bone (; from grc, ἡθμός, hēthmós, sieve) is an unpaired bone in the skull that separates the nasal cavity from the brain. It is located at the roof of the nose, between the two orbits. The cubical bone is lightweight due to a ...

between the

nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...

and the eyes. They are innervated by the

ethmoidal nerves The ethmoidal nerves, which arise from the nasociliary nerve, supply the ethmoidal cells; the posterior branch leaves the orbital cavity through the posterior ethmoidal foramen and gives some filaments to the sphenoidal sinus. There are two ethm ...

, which branch from the

nasociliary nerve The nasociliary nerve is a branch of the ophthalmic nerve, itself a branch of the trigeminal nerve (CN V). It is intermediate in size between the other two branches of the ophthalmic nerve, the frontal nerve and lacrimal nerve. Structure The na ...

of the ophthalmic nerve (CN V1). * The

es, in the

sphenoid bone The sphenoid bone is an unpaired bone of the neurocranium. It is situated in the middle of the skull towards the front, in front of the basilar part of occipital bone, basilar part of the occipital bone. The sphenoid bone is one of the seven bones ...

. They are innervated by the ophthalmic and maxillary nerve (CN V1 and V2). The paranasal sinuses are lined with

respiratory epithelium Respiratory epithelium, or airway epithelium, is a type of ciliated columnar epithelium found lining most of the respiratory tract as respiratory mucosa, where it serves to moisten and protect the airways. It is not present in the vocal cords o ...

(ciliated pseudostratified columnar epithelium).

Functions

One known function of the paranasal sinuses is the production of

nitric oxide Nitric oxide (nitrogen oxide or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes denoted by a dot in its che ...

, which also functions as a facilitator of oxygen uptake. There is no consensus regarding the physiological functions of the paranasal sinuses. The most likely are: * Decrease in the relative mass of the anterior sections of the skull, especially the bones of the facial skull, against the background of their large volume. The shape of the bones of the facial skull is important because the bones are the attachment points for the facial muscles. * Providing a shock-resistant "buffer" in case of injuries * Isolation of sensitive structures (roots of teeth, eyeballs) from rapid temperature fluctuations in the nasal cavity during inhalation and exhalation. * Humidification and warming of inhaled air, as a result of slow airflow in the sinuses. * Perform the function of a sensory system of air signals (a baroreceptor organ that responds to changes in environmental pressure).

Development

Paranasal sinuses form developmentally through excavation of bone by air-filled sacs ( pneumatic diverticula) from the

. This process begins prenatally (intrauterine life), and it continues through the course of an organism's lifetime. The results of experimental studies suggest that the natural ventilation rate of a sinus with a single

sinus ostium The human nose is the most protruding part of the face. It bears the nostrils and is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones ...

(opening) is extremely slow. Such limited ventilation may be protective for the sinus, as it would help prevent drying of its mucosal surface and maintain a near-sterile environment with high

carbon dioxide Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...

concentrations and minimal

pathogen In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...

access. Thus composition of gas content in the maxillary sinus is similar to

venous blood Venous blood is deoxygenated blood which travels from the peripheral blood vessels, through the venous system into the right atrium of the heart. Deoxygenated blood is then pumped by the right ventricle to the lungs via the pulmonary artery whic ...

, with high carbon dioxide and lower

oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...

levels compared to breathing air. At birth, only the

and the

ethmoid sinus The ethmoid sinuses or ethmoid air cells of the ethmoid bone are one of the four paired paranasal sinuses. The cells are variable in both size and number in the lateral mass of each of the ethmoid bones and cannot be palpated during an extraoral e ...

are developed but not yet pneumatized; only by the age of seven they are fully aerated. The

sphenoid sinus The sphenoid sinus is a paired paranasal sinus occurring within the within the body of the sphenoid bone. It represents one pair of the four paired paranasal sinuses.Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012 ...

appears at the age of three, and the

es first appear at the age of six, and fully develop during adulthood.

CT scans, radiographs (x-ray) and other illustrations

File:CT Paranasal Sinuses Coronal MPR Soft Tissue Window.ogg, Coronal CT scan of the paranasal sinuses (Soft Tissue) File:CT Paranasal Sinuses Coronal MPR Bone Window.ogg, Coronal CT scan of the paranasal sinuses (Bone) File:Paranasal sinuses radiograph occipitofrontal.jpg, Paranasal sinuses radiograph (occipitofrontal) File:Paranasal sinuses radiograph occipitomental.jpg, Paranasal sinuses radiograph (occipitomental) File:Paranasal sinuses radiograph lateral.jpg, Paranasal sinuses radiograph (lateral) File:3DPX-002305 Upper respiratory cast 3DFile Nevit Dilmen.stl, 3D cast of maxillary, frontal, ethmoid and sphenoid sinuses, nasal cavity and hypopharynx.

Clinical significance

Inflammation

The paranasal sinuses are joined to the

via small orifices called ostia. These become blocked easily by allergic inflammation, or by swelling in the nasal lining that occurs with a

cold Cold is the presence of low temperature, especially in the atmosphere. In common usage, cold is often a subjective perception. A lower bound to temperature is absolute zero, defined as 0.00K on the Kelvin scale, an absolute thermodynamic ...

. If this happens, normal drainage of

mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...

within the sinuses is disrupted, and

sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the nasal mucosa, mucous membranes that line the paranasal sinuses, sinuses resulting in symptoms that may include thick Mucus#Respiratory system, nasal mucus, a nasal congestion, plugg ...

may occur. Because the maxillary posterior teeth are close to the maxillary sinus, this can also cause clinical problems if any disease processes are present, such as an infection in any of these teeth. These clinical problems can include secondary sinusitis, the inflammation of the sinuses from another source such as an infection of the adjacent teeth.Illustrated Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, p. 68 These conditions may be treated with drugs such as

decongestant A decongestant, or nasal decongestant, is a type of pharmaceutical drug that is used to relieve nasal congestion in the upper respiratory tract. The active ingredient in most decongestants is either pseudoephedrine or phenylephrine (the latter of ...

s, which cause

vasoconstriction Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessel ...

in the sinuses; reducing inflammation; by traditional techniques of

nasal irrigation Nasal irrigation (also called nasal lavage, nasal toilet, or nasal douche) is a personal hygiene practice in which the nasal cavity is washed to flush out mucus and debris from the nose and sinuses, in order to enhance nasal breathing. Nasal ir ...

; or by

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involv ...

Cancer

Malignancies of the paranasal sinuses comprise approximately 0.2% of all malignancies. About 80% of these malignancies arise in the maxillary sinus. Men are much more often affected than women. They most often occur in the age group between 40 and 70 years.

Carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal ...

s are more frequent than

sarcoma A sarcoma is a malignant tumor, a type of cancer that arises from transformed cells of mesenchymal (connective tissue) origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular, or hematopoietic tissues, and sarcom ...

s. Metastases are rare.

Tumours A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

of the sphenoid and frontal sinuses are extremely rare.

Etymology

Sinus is a

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...

word meaning a "fold", "curve", or "bay". Compare ''

sine In mathematics, sine and cosine are trigonometric functions of an angle. The sine and cosine of an acute angle are defined in the context of a right triangle: for the specified angle, its sine is the ratio of the length of the side that is oppo ...

''.

Other animals

Paranasal sinuses occur in many other animals, including most

mammal Mammals () are a group of vertebrate animals constituting the class Mammalia (), characterized by the presence of mammary glands which in females produce milk for feeding (nursing) their young, a neocortex (a region of the brain), fur or ...

bird Birds are a group of warm-blooded vertebrates constituting the class Aves (), characterised by feathers, toothless beaked jaws, the laying of hard-shelled eggs, a high metabolic rate, a four-chambered heart, and a strong yet lightweigh ...

s, non-avian

dinosaur Dinosaurs are a diverse group of reptiles of the clade Dinosauria. They first appeared during the Triassic period, between 243 and 233.23 million years ago (mya), although the exact origin and timing of the evolution of dinosaurs is t ...

s, and

crocodilia Crocodilia (or Crocodylia, both ) is an order of mostly large, predatory, semiaquatic reptiles, known as crocodilians. They first appeared 95 million years ago in the Late Cretaceous period ( Cenomanian stage) and are the closest living ...

ns. The bones occupied by sinuses are quite variable in these other species.

Illustrations

File:Paranasal sinuses numbers.svg, Paranasal sinuses File:Blausen 0800 Sinusitis.png, Illustration depicting sinusitis

References

External links

{{Authority control Human head and neck Bones of the head and neck