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angles, respectively; the superior angle is cut off by the cribriform plate; whilst the sides correspond to the frontal and nasal bones anteriorly, and the sphenoidal conchæ, sphenoidal process of the palate, and the ala of the vomer posteriorly. The cavity is therefore deep towards its middle, but gradually becomes shallower in front and behind where the piriform aperture and choana are situated. The piriform opening of the nose, which is of half-heart shape, is larger than that of the choanæ (0.9. posterior nares), and is directed forwards and downwards; the choanæ are of rhomboidal form, and slope backwards and downwards. The inferior meatus is the channel which is overhung by the inferior concha, and its floor is formed by the side-to-side concavity of the upper surface of the hard palate. Opening into it above, under cover of the anterior part of the inferior concha, is the canal for the naso-lacrimal duct; whilst its floor is pierced in front near the middle

line by the canalis incisivus. The middle meatus is the hollow between the | middle and inferior conchæ; it slopes from above downwards and backwards,

and is overhung by the free curved edge of the middle conchæ, beneath which there is a passage called the infundibulum, leading upwards and forwards to open superiorly into the frontal sinus, as well as into some of the anterior ethmoidal cells. Under cover of the centre of the middle concha and continuous with the infundibulum in front there is a curved groove, the hiatus semilunaris, into which open one or more orifices from the maxillary sinus.

Above this groove there is a rounded eminence, the bulla ethmoidalis, overlying the middle ethmoidal cells, which usually open on its surface. The superior meatus, about half the length of the middle meatus, is placed between the superior and middle concha in the posterior and upper part of the cavity; it receives the openings of the posterior ethmoidal cells. Near its posterior extremity the spheno - palatine foramen pierces its lateral wall, and brings it in relation with the pterygopalatine fossa. The sphenoidal sinus opens on the roof of the nose, above the level of the superior conchæ, into a depression called the spheno-ethmoidal recess.

Septum Nasi.-If the opposite half of the section in which the osseous nasal septum is retained be now studied, it will be seen to be formed by the crests of the maxillary and palate bones below, on which rests the vomer, the posterior border of which being free, forms the posterior edge of the nasal septum, which slopes obliquely upwards and backwards towards the inferior surface of the body of the sphenoid.

Here the vomer articulates with the rostrum of the sphenoid. In front of this the vomer articulates with the perpendicular part of the ethmoid, and between them anteriorly there is an angular recess into which the cartilaginous septum fits. Superiorly and anteriorly the osseous septum is completed by the articulation of the perpendicular part of the ethmoid with the nasal spine of the frontal, together with the nasal crest formed by the union of the nasal bones ; whilst posteriorly and superiorly the perpendicular plate of the ethmoid articulates with the median sphenoidal crest of the sphenoid. In most instances the osseous septum is not perfectly vertical, but is deflected towards one or other side.

Air-sinuses in Connexion with the Nasal Cavities.Connected with the nasal cavities are a number of air-sinuses. These are found within the body of the sphenoid, the labyrinth of the ethmoid, the orbital process of the palate bone, the body of the maxilla, and the superciliary arch of the frontal bone.

The sphenoidal sinus, of variable size, occupies the interior of the body of the sphenoid. In some cases it extends towards the roots of the pterygoid processes. In front it is formed in part by the absorption of the sphenoidal conchæ and is divided up into two cavities by a sagittally placed partition, which, however, is frequently displaced to one or other side. It opens anteriorly into the roof of the nose in the region of the spheno-ethmoidal recess.

The ethmoidal sinuses are placed between the lateral aspects of the upper part of the nasal cavities, and the cavities of the orbits, from which they are separated by thin and papery walls. These air-spaces

These air-spaces are completed by the articulation of the ethmoid with the maxilla, lacrimal, frontal, sphenoid, and palate bones, and are divided into three groups—an anterior, middle, and posterior. The latter communicates with the superior meatus; the anterior and middle open either independently or in conjunction with the infundibulum into the middle meatus.

The sinus in the orbital process of the palate bone either communicates with the sphenoidal sinus, or else assists in closing in some of the posterior ethmoidal cells. Its communication with the nasal cavity is through one or other of these spaces.

The maxillary sinus lies to the lateral side of the nasal cavity, occupying the body of the maxilla. Its walls, which are relatively thin, are directed upwards to the orbit, forwards to the face, backwards to the infra-temporal and pterygo-palatine fossæ, and medially to the nose. In the latter situation the perpendicular part

of the palate bone, the un

cinate process of the ethmoid, Frontal sinus

the maxillary process of the

inferior concha, and a small Crista galli of ethmoid

part of the lacrimal bone

assist in the formation of Perpendicular

Cribriform plate of ethmoid

the thin osseous partition part of ethmoid

Sphenoidal sinus

which separates it from the Nasal spine of frontal

nasal cavity. The floor correFossa hypophyseos sponds to the alveolar border

Dorsum selle
of sphenoid

of the maxilla, and differs
from the other walls in being
stout and thick ; it is, how-

ever, deeply pitted inferiorly Anterior

by the alveoli for the teeth. nasal

The sinus

opens by a spine

narrow orifice in the floor
of the hiatus semilunaris
into the middle meatus.

Occasionally there are two
Angular spine openings.
Vomer of sphenoid

The frontal sinuses lie,
Lateral pterygoid lamina

one on either side, between Hamulus of medial pterygoid lamina

the inner and outer tables of the frontal bone over the root

of the nose, and extend FIG. 174.—THE NASAL SEPTUM AS SEEN FROM THE LEFT SIDE. laterally under the superThe frontal, inaxillary, and sphenoid bones are coloured red; the nasal, ciliary arches. The parti

vomner, and basi-occipital blue; the perpendicular part of the ethmoid tion which separates them and the horizontal part of the palate bone are left uncoloured.

is usually central, though it may be deflected to one or other side. Each communicates with the nose through a passage called the infundibulum, which opens inferiorly into the anterior part of the corresponding middle meatus, below the ethmoidal bulla and continuous with the hiatus semilunaris.

The fact should not be overlooked that the air-spaces within the temporal bone, viz., the tympanic cavity and the mastoid air-cells, are brought into communication with the naso-pharynx through the auditory tubes. Further details regarding the air-sinuses and the mode of their growth will be found under the description of the individual bones.

[graphic]

Foramen incisivum

Frontal Sections. The relations of many parts of the cranium are best displayed in a series of frontal (coronal) sections.

By sawing off a thin slice from the front of the lower part of the frontal bone above, and carrying the section downwards through the medial wall of the orbit and the frontal process of the maxilla, into the piriform aperture below, a number of important relations are revealed (see Fig. 175). In the frontal region the extent and arrangement of the frontal sinuses are displayed. The partition between the two sinuses, be it noted, is usually complete and central in position, though it may occasionally be perforated or oblique. The sinuses are hardly ever symmetrical, the right being usually the smaller of the two. "(Logan Turner, Edin. Med. Journ. 1898.)

The infundibulum on either side, leading from the frontal sinus above to the middle

meatus below, is seen with the middle concha medial to it, and the anterior ethmoidal cells to its lateral side above. If the section passes through the canal for the nasolacrimal duct the continuity of that channel leading from the orbit above to the inferior meatus of the nose below is clearly shown. Its medial wall above, by which it is separated from the cavity of the nose, is formed by the thin lacrimal bone ; below, it passes under cover of the inferior concha to open into the anterior part of the inferior meatus. It is

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FIG. 175.–PART OF THE FRONTAL, Nasal, AND MAXILLARY BONES REMOVED IN ORDER TO

DISPLAY THE RELATION OF THE VARIOUS CAVITIES EXPOSED. The frontal and maxillary bones, where cut, are coloured blue ; the ethmoid and the inferior concha red ;

the lacrimal and vomer yellow. 1. Frontal sinus.

7. Cavity of maxillary sinus laid open. 2. Septum of frontal sinus deflected towards the right. 8. Middle meatus of nose. 3. Infundibulum leading from sinus to middle meatus. 9. Inferior meatus of nose. 4. Anterior ethmoidal air-sinuses.

10. Inferior concha. 5. Middle concha.

11. Nasal septum. 6. Red line in upper part of osseous canal for naso- 12. Canal for naso-lacrimal duct laid open through. lacrimal duct, laid open throughout its entire

out its entire length. length on the right side.

13. Anterior nasal spine.

separated from the maxillary sinus laterally by a thin lamina of bone. The cavity of the maxillary sinus is seen to extend upwards and forwards so as to pass over the lateral side as well as slightly in front of the canal for the naso-lacrimal duct.

The lower margins of the middle conchæ lie pretty nearly on a level with the most dependent parts of the orbital margins, whilst the lower borders of the inferior conchæ are placed a little above the lower margin of the piriform opening on a level with the lowest point of the zygomatico-maxillary suture.

Such a section will reveal any deflection of the nasal septum should it exist, and will also show that but a narrow cleft separates the upper part of the septum, on either side, from the medial surface of the superior conchæ.

The next section (Fig. 176) passes through the anterior part of the temporal fossa just

behind the zygomatic process of the frontal bone above; inferiorly it passes through the alveolar process of the maxilla in the interval between the first and second molar

teeth. The cranial, orbital, nasal, and maxillary cavities are all exposed, together with the roof of the mouth.

The anterior cranial fossa is deepest in its centre, where its floor is formed by the cribriform plate of the ethmoid ; this corresponds to the level of the zygomatico-frontal suture laterally. On either side the floor of the fossa bulges upwards, owing to the arching of the roof of the orbit. Of the orbital walls, the lateral is the thickest and stoutest;

the superior, medial, and inferior 11 walls, which separate the orbit

from the cranial cavity, the eth

moidal cells, and the maxillary 13 sinus, respectively, are all thin.

The cavity of the maxillary sinus lying to the lateral side of the nasal cavity is well seen. Its roof, which separates it from the orbital cavity, is thin and traversed by the infraorbital canal. Its medial wall, with which the inferior concha articulates, is very slender, and forms the lateral walls of both the middle and inferior meatuses of the nose. Its lateral wall is stouter where it arches up to bracket the temporal process of the zygomatic bone. Its floor, which rests upon the superior surface of the alveolar border of the maxilla, sinks below the level

of the hard palate. The fangs FIG. 176.–FRONTAL SECTION PASSING INFERIORLY THROUGH

of the teeth sometimes project THE INTERVAL BETWEEN THE First and Second Molar Teeth. into the floor of the cavity. The frontal and maxillary bones, where cut, are coloured blue ;

The nasal cavities are narrow the ethmoid, inferior conchæ, and zygomatic red; the vomer yellow. above, where they lie between 1. Groove for sagittal sinus. 12. Zygomatico-frontal suture. the orbital cavities, from which 2. Crest for attachment of falx 13. Infra-orbital groove. they are separated by the cells cerebri. 14. Maxillary sinus.

within the labyrinth of the 3. Crista galli of ethmoid. 15. Canal for the anterior alveolar 4. Cribriform plate of ethmoid.

The roof which cor

ethmoid.

nerve and vessels exposed. 5. Perpendicular part of eth- 16. Inferior concha.

responds to the cribriform plate moid, assisting in the forma- 17. Inferior meatus of nose. is narrow, and lies between the tion of the nasal septum. 18. Alveolar process of maxilla.

septum medially and the laby6. Labyrinth of ethmoid con- 19. Groove for posterior palatine sisting of the ethmoidal cells.

nerve and greater palatine rinth on either side. 7. Lamina papyracea of ethmoid. vessels.

At the level of the orbital floor 8. Middle meatus of nose. 20. Palatine process of maxilla. the nasal cavities expand later9. Middle concha.

21. Maxillary crest forming part ally, the middle meatus running 10. Opening from middle meatus of nasal septum.

into maxillary sinus. 22. Vomer forming part of nasal longitudinally in the angle formed 11. Orbital surface of maxilla.

septum.

by the labyrinth of the ethmoid

with the body of the maxilla, overhung by the middle concha. This channel is seen to have the ethmoidal cells superior to it, the orbital cavity above and to the lateral side, the maxillary sinus laterally, whilst its floor is formed by the superior surface of the inferior concha.

The inferior meatus, much more roomy, runs along under cover of the inferior

[graphic]

22

21

20

19

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concha. Laterally it is related to the maxillary sinus, whilst its floor is formed by the concave superior surface of the hard palate.

The hard palate is arched below, whilst its superior surface is concave upwards on either side of the median crest which supports the nasal septum. The sides of the arch below correspond to the medial surfaces of the alveolar processes and fall in line with the lateral walls of the nasal cavities superiorly. The summit of the arch lies a quarter of an inch above the level of the floor of the maxillary sinus.

The next section (Fig. 177) passes through the pterygo - palatine and temporal fossæ inferiorly, and cuts the cranial vault about half an inch in front of the bregma. The floor of the anterior cranial fossa is seen to be formed by the upper surface of the body and small wings of the sphenoid, and is almost horizontal. At the median plane the sphenoidal sinuses are exposed, separated by a thin bony partition, on either side of which the openings by which they communicate with the nasal cavities are seen. The section passes in front of the optic foramen, the

groove of which may be seen on the inferior surface of the small wing of the sphenoid close to the body, and lays open the superior orbital fissure which here leads forwards into the orbit, and which, inferiorly and laterally, is continuous with the cleft between the maxilla and the lower edge of the great wing of the sphenoid—the inferior orbital fissure. This also leads into the orbit.

The nasal cavities, now much diminished in height, are roofed in above by the inferior surface of the body of the sphenoid and the alæ of the vomer, whilst the lateral walls are seen to be Fig. 177.-FRONTAL SECTION PASSING THROUGH THE formed by the thin perpendicular parts

PTERYGO-PALATINE Fossa. of the palate bones, lateral to which

1. Depression for arach- 10. Zygomatic process of the rounded posterior surface of the

noideal granulation.

maxilla. maxilla is directed backwards, here 2. Groove for sagittal sinus. 11. Surface of maxilla which forming the anterior wall of the 3. Crista galli of ethmoid. forms the anterior wall pterygo - palatine fossa - the space

4. Opening of sphenoidal of the pterygo-palatine

sinus into superior fossa. which lies between the anterior part of

meatus of nose through 12. Spheno-palatine foramen. the pterygoid process behind and the

spheno - ethmoidal re. 13. Opening of pterygo-palamaxilla anteriorly. As will be seen,

tine canal. the medial wall of this space is formed 5. Superior orbital fissure. 14. Perpendicular part of

palate bone. by the perpendicular part of the palate, 6. Part of middle fossa

formed by cerebral 15. Pterygoid fossa. which is, however, deficient above im

surface of great wing 16. Superior meatus of nose. mediately below the inferior surface of of sphenoid.

17. Middle meatus of nose. the body of the sphenoid. In the in- 7. Zygomatic crest of great 18. Inferior meatus of nose. terval between the orbital process, which

wing of sphenoid. 19. Inferior concha.

8. Inferior orbital fissure. 20. Middle concha. lies in front of the section, and the

9. Zygomatic process of 21. Maxillary crest and vomer sphenoidal process, which lies behind, temporal.

forming nasal septum. this forms the spheno-palatine foramen. Laterally the section has passed through the inferior orbital fissure, which is continuous above with the pterygo-palatine fossa. Inferiorly the section passes through the line of fusion of the pterygoid processes with the pyramidal process of the palate

[graphic]

cess.

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