The Sinonasal Anatomy: Endoscopic Lacrimal and Orbital Perspectives

  • Hirohiko Kakizaki


Basic knowledge of the sinonasal anatomy is required to safely perform lacrimal and orbital surgeries. We reviewed the anatomy of the nasal cavity (overview, nasal septum, lateral nasal wall including the lacrimal passage, inferior turbinate and meatus, middle turbinate and meatus, and superior and supreme turbinates and meatuses), ethmoid sinus (overview, agger nasi, uncinate process, fontanelle, ethmoid bulla, hiatus semilunaris, ethmoid infundibulum, and ostiomeatal complex), and sphenoid sinus.


Sphenoid Sinus Uncinate Process Inferior Turbinate Middle Turbinate Ethmoid Sinus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Witterick IJ, Hurwitz JJ. Anatomy of the nose and sinuses. In: Hurwits JJ, editor. The lacrimal system’. Philadelphia: Lippincott-Raven; 1996. p. 31–7.Google Scholar
  2. 2.
    Olver J. Colour atlas of lacrimal surgery. Oxford: Butterworth & Heinemann; 2002. p. 14–8.Google Scholar
  3. 3.
    Ohnishi T, Ozawa M, Kasahara Y, et al. Endoscopic sinus surgery. Tokyo Med View. 1995; 32–104. (Japanese)Google Scholar
  4. 4.
    Mirante JP. Nasal anatomy and evaluation. In: Cohen AJ, Mercandetti M, Brazzo BJ, editors. The lacrimal system: diagnosis, management, and surgery. New York: Springer; 2006. p. 25–32.CrossRefGoogle Scholar
  5. 5.
    Leong SC, Eccles R. A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology. Clin Otolaryngol. 2009;34:191–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Elad D, Wolf M, Keck T. Air-conditioning in the human nasal cavity. Respir Physiol Neurobiol. 2008;163:121–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolf M, Naftali S, Schroter RC. Air-conditioning characteristics of the human nose. J Laryngol Otol. 2004;118:87–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Cottle MH. The structure and function of the nasal vestibule. In: Maurice H, Cottle MD, Barelli PA, editors. Rhinology. Philadelphia: American Rhinologic Society; 1987. p. 74–86.Google Scholar
  9. 9.
    Burkat CN, Lucareli MJ. Anatomy of the lacrimal system. In: Cohen AJ, Mercandetti M, Brazzo BJ, editors. The lacrimal system: diagnosis, management, and surgery. New York: Springer; 2006. p. 3–19.CrossRefGoogle Scholar
  10. 10.
    Haruna S. Clinical anatomy for endoscopic endonasal surgery. In: Kishimoto S, editor. Practical otolaryngology: clinical anatomy for otolaryngology, and head & neck surgery. Tokyo: Bunkodo Publishers; 2002. p. 120–5. (Japanese).Google Scholar
  11. 11.
    Chastain JB, Cooper MH, Sindwani R. The maxillary line: anatomic characterization and clinical utility of an important surgical landmark. Laryngoscope. 2005;115:990–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Zhang L, Han D, Ge W, et al. Anatomical and computed tomographic analysis of the interaction between the uncinate process and the agger nasi cell. Acta Otolaryngol. 2006;126:845–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Woo KI, Maeng HS, Kim YD. Characteristics of intranasal structures for endonasal dacryocystorhinostomy in Asians. Am J Ophthalmol. 2011;152:491–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Yung MW, Logan BM. The anatomy of the lacrimal bone at the lateral wall of the nose: its significance to the lacrimal surgeon. Clin Otolaryngol Allied Sci. 1999;24:262–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Hartikainen J, Aho HJ, Seppa H, Grenman R. Lacrimal bone thickness at the lacrimal sac fossa. Ophthalmic Surg Lasers. 1996;27:679–84.PubMedGoogle Scholar
  16. 16.
    Duke-Elder S. The development, form and function of the visual apparatus. In: Elder S, editor. Textbook of ophthalmology, vol. 1. London: Henry Kimpton Publisher; 1932. p. 235–9.Google Scholar
  17. 17.
    Lee H, Ha S, Lee Y, et al. Anatomical and morphometric study of the bony nasolacrimal canal using computed tomography. Ophthalmologica. 2012;227:153–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Takahashi Y, Kakizaki H, Nakano T. Bony nasolacrimal duct entrance diameter: gender difference in cadaveric study. Ophthal Plast Reconstr Surg. 2011;27:204–5.PubMedGoogle Scholar
  19. 19.
    Janssen AG, Mansour K, Bos JJ, et al. Diameter of the bony lacrimal canal: normal values and values related to nasolacrimal duct obstruction: assessment with CT. AJNR Am J Neuroradiol. 2001;22:845–50.PubMedGoogle Scholar
  20. 20.
    Shigeta K, Takegoshi H, Kikuchi S. Sex and age differences in the bony nasolacrimal canal: an anatomical study. Arch Ophthalmol. 2007;125:1677–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Park J, Takahashi Y, Nakano T, et al. The orientation of the lacrimal fossa to the bony nasolacrimal canal: an anatomical study. Ophthal Plast Reconstr Surg. 2012;28:463–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Takahashi Y, Nakamura Y, Nakano T, et al. Horizontal orientation of the bony lacrimal passage: an anatomical study. Ophthal Plast Reconstr Surg. 2013;29:128–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Narioka J, Matsuda S, Ohashi Y. Correlation between anthropometric facial features and characteristics of nasolacrimal drainage system in connection to false passage. Clin Experiment Ophthalmol. 2007;35:651–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Ohnogi J. Endoscopic observation of inferior aperture of the nasolacrimal duct. Jpn J Clin Ophthalmol. 2001;55:650–4. (Japanese).Google Scholar
  25. 25.
    Fayet B, Racy E, Assouline M. Systematic unciformectomy for a standardized endonasal dacryocystorhinostomy. Ophthalmology. 2002;109:530–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Wormald PJ. Powered endoscopic dacryocystorhinostomy. Otolaryngol Clin North Am. 2006;39:539–49.PubMedCrossRefGoogle Scholar
  27. 27.
    Tsirbas A, Davis G, Wormald PJ. Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2004;20:50–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Steadman MG. Transnasal dacryocystorhinostomy. Otolaryngol Clin North Am. 1985;18:107–11.PubMedGoogle Scholar
  29. 29.
    McDonogh M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol. 1989;103:585–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Whittet HB, Shun-Shin GA, Awdry P. Functional endoscopic transnasal dacryocystorhinostomy. Eye. 1993;7:545–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Pearlman SJ, Michalos P, Leib ML, et al. Translacrimal transnasal laser-assisted dacryocystorhinostomy. Laryngoscope. 1997;107:1362–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Wormald PJ, Kew J, Van Hasselt A. Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2000;123:307–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Fayet B, Racy E, Assouline M, et al. Surgical anatomy of the lacrimal fossa a prospective computed tomography densitometry scans analysis. Ophthalmology. 2005;112:1119–28.PubMedCrossRefGoogle Scholar
  34. 34.
    Rose Jr JG, Lucarelli MJ, Lemke BN. Lacrimal, orbital and sinus anatomy. In: Woog JJ, editor. Manual of endoscopic lacrimal and orbital surgery. Philadelphia: Butterworth & Heinemann; 2004. p. 1–16.Google Scholar
  35. 35.
    Henson RD, Cruz HL, Henson Jr RG, et al. Postoperative application of mitomycin-C in endocanalicular laser dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2012;28:192–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Callejas CA, Tewfik MA, Wormald PJ. Powered endoscopic dacryocystorhinostomy with selective stenting. Laryngoscope. 2010;120:1449–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Hatipoğlu HG, Çetin MA, Yüksel E. Concha bullosa types: their relationship with sinusitis, ostiomeatal and frontal recess disease. Diagn Interv Radiol. 2005;11:145–9.PubMedGoogle Scholar
  38. 38.
    Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56–64.PubMedCrossRefGoogle Scholar
  39. 39.
    Orlandi RR, Lanza DC, Bolger WE, et al. The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery. Am J Rhinol. 1999;13:251–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Eweiss AZ, Ibrahim AA, Khalil HS. The safe gate to the posterior paranasal sinuses: reassessing the role of the superior turbinate. Eur Arch Otorhinolaryngol. 2012;269:1451–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Lane AP, Gomez G, Dankulich T, et al. The superior turbinate as a source of functional human olfactory receptor neurons. Laryngoscope. 2002;112:1183–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Ikeda K. Clinical anatomy for endoscopic sinus surgery. In: Kishimoto S, editor. Practical otolaryngology 8: clinical anatomy for otolaryngology, and head & neck surgery. Tokyo: Bunkodo Publishers; 2002. p. 126–31. (Japanese).Google Scholar
  43. 43.
    Wormald PJ. Three-dimensional reconstruction and surgery of the bulla ethmoidalis, middle turbinate, posterior ethmoid and sphenoid. In: Wormald PJ, editor. Endoscopic sinus surgery: anatomy, three-dimensional reconstruction, and surgical technique. 3rd ed. New York: Thieme; 2013. p. 103–16.Google Scholar
  44. 44.
    Chee E, Looi A. Onodi sinusitis presenting with orbital apex syndrome. Orbit. 2009;28:422–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Kitagawa K, Hayasaka S, Shimizu K, Nagaki Y. Optic neuropathy produced by a compressed mucocele in an Onodi cell. Am J Ophthalmol. 2003;135:253–4.PubMedCrossRefGoogle Scholar
  46. 46.
    Klink T, Pahnke J, Hoppe F, Lieb W. Acute visual loss by an Onodi cell. Br J Ophthalmol. 2000;84:801–2.PubMedCrossRefGoogle Scholar
  47. 47.
    Ercan I, Cakir BO, Sayin I, et al. Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: a computer-assisted anatomic study. Otolaryngol Head Neck Surg. 2006;134:1010–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Soyka MB, Treumann T, Schlegel CT. The Agger Nasi cell and uncinate process, the keys to proper access to the nasolacrimal drainage system. Rhinology. 2010;48:364–7.PubMedGoogle Scholar
  49. 49.
    Wormald PJ. The agger nasi cell: the key to understanding the anatomy of the frontal recess. Otolaryngol Head Neck Surg. 2003;129:497–507.PubMedCrossRefGoogle Scholar
  50. 50.
    Yoon JH, Kim KS, Jung DH, et al. Fontanelle and uncinate process in the lateral wall of the human nasal cavity. Laryngoscope. 2000;110:281–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Isobe M, Murakami G, Kataura A. Variations of the uncinate process of the lateral nasal wall with clinical implications. Clin Anat. 1998;11:295–303.PubMedCrossRefGoogle Scholar
  52. 52.
    Whitnall SE. The relations of the lacrimal fossa to the ethmoid cells. Ophthalmic Rev. 1911;30:321–5.Google Scholar
  53. 53.
    Blaylock WK, Moor CA, Linberg JV. Anterior ethmoid anatomy facilitates dacryocystorhinostomy. Arch Ophthalmol. 1990;108:1774–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Tsirbus A. Lacrimal fossa anatomy. Ophthalmology. 2006;113:1475–6.CrossRefGoogle Scholar
  55. 55.
    Simmen D, Jones N. Manual of endoscopic sinus surgery and its extended application. Stuttgart/New York: Thieme; 2005. p. 66.Google Scholar
  56. 56.
    Setliff RC, Catalano PJ, Catalano LA, et al. An anatomic classification of the ethmoidal bulla. Otolaryngol Head Neck Surg. 2001;125:598–602.PubMedCrossRefGoogle Scholar
  57. 57.
    Yanagisawa E, Weaver EM. Endoscopic view of the hiatus semilunaris superior and inferior. Ear Nose Throat J. 1996;75:460–2.PubMedGoogle Scholar
  58. 58.
    Iinuma T. History of infundibulum. Jibiinkoukatembo. 2001;44:168–73. (Japanese).Google Scholar
  59. 59.
    Unlü HH, Gövsa F, Mutlu C, et al. Anatomical guidelines for intranasal surgery of the lacrimal drainage system. Rhinology. 1997;35:11–5.PubMedGoogle Scholar
  60. 60.
    Rice DH. Management of the middle turbinate in endoscopic surgery. Op Tech Otolaryngol Head Neck Surg. 1995;6:144–8.CrossRefGoogle Scholar
  61. 61.
    Prasanna LC, Mamatha H. The location of maxillary sinus ostium and its clinical application. Indian J Otolaryngol Head Neck Surg. 2010;62:335–7.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Gaudino S, Di Lella GM, Piludu F, et al. CT and MRI diagnosis of silent sinus syndrome. Radiol Med. 2013;118:265–75.PubMedCrossRefGoogle Scholar
  63. 63.
    Soparker CNS, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome: a cause of spontaneous enophthalmos. Ophthalmology. 1994;101:772–8.CrossRefGoogle Scholar
  64. 64.
    Ferri A, Ferri T, Sesenna E. Bilateral silent sinus syndrome: case report and surgical solution. J Oral Maxillofac Surg. 2012;70:e103–6.PubMedCrossRefGoogle Scholar
  65. 65.
    Cobb AR, Murthy R, Cousin GC, et al. Silent sinus syndrome. Br J Oral Maxillofac Surg. 2012;50:e81–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Rose GE, Lund VJ. Clinical features and treatment of late enophthalmos after orbital decompression: a condition suggesting cause for idiopathic “imploding antrum” (silent sinus) syndrome. Ophthalmology. 2003;110:819–26.PubMedCrossRefGoogle Scholar
  67. 67.
    Brandt MG, Wright ED. The silent sinus syndrome is a form of chronic maxillary atelectasis: a systemic review of all reported cases. Am J Rhinol. 2008;22:68–73.PubMedCrossRefGoogle Scholar
  68. 68.
    Naik RM, Khemani S, Saleh HA. Frontal silent sinus syndrome. Otolaryngol Head Neck Surg. 2013;148:354–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Leone Jr CR, Piest KL, Newman RJ. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol. 1989;108:160–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Gupta T, Aggarwal A, Sahni D. Anatomical landmarks for locating the sphenoid ostium during endoscopic endonasal approach: a cadaveric study. Surg Radiol Anat. 2013;35:137–42.PubMedCrossRefGoogle Scholar
  71. 71.
    Millar DA, Orlandi RR. The sphenoid sinus natural ostium is consistently medial to the superior turbinate. Am J Rhinol. 2006;20:180–1.PubMedGoogle Scholar
  72. 72.
    Deshazo RD. Syndromes of invasive fungal sinusitis. Med Mycol. 2009;47:S309–14.PubMedCrossRefGoogle Scholar
  73. 73.
    Thurtell MJ, Chiu ALS, Goold LA, et al. Neuro-ophthalmology of invasive fungal sinusitis: 14 consecutive patients and a review of the literature. Clin Experiment Ophthalmol. 2013;41:567–76.PubMedCrossRefGoogle Scholar
  74. 74.
    Duke-Elder S, MacFaul PA. Indirect orbital fractures associated with head injury. In: Duke-Elder S, editor. System of ophthalmology, Injury. Part 1. Mechanical injuries, vol. XIV. London: Henry Kimpton Publisher; 1972. p. 265–8.Google Scholar
  75. 75.
    Guyon JJ, Brant-Zawadzki M, Seiff SR. CT demonstration of optic canal fractures. AJR Am J Roentgenol. 1984;143:1031–4.PubMedCrossRefGoogle Scholar
  76. 76.
    Yang QT, Zhang GH, Liu X, et al. The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognosis of 96 cases of traumatic optic neuropathy. J Trauma. 2012;72:1350–5.Google Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of OphthalmologyAichi Medical UniversityAichiJapan

Personalised recommendations