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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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Fig. 1.84High magnification of detail of ▶ Fig. 1.83. Vomer (1); sphenoidal process with
its perichondrial envelope (2).
Vomeral Spur
Vomeral spurs or spines may occur at the junction of the
cranial margin of the vomer, the caudal margin of the
perpendicular plate, and the posterior border of the
cartilaginous septum. They are found at the posterior
septum at the level of the middle of the inferior turbinate,
where they often impact the conchal parenchyma. They
usually consist of a bony (vomeral) part and a dislocated
outgrowth of the sphenoidal process of the cartilaginous
septum (▶ Fig. 1.85 and ▶ Fig. 1.86).
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Fig. 1.85Vomeral spur (coronal section at the posterior part, MC staining).
Perpendicular plate (1); vomer (2); dislocated sphenoidal process of cartilaginous
septum (3); impression in the inferior turbinate (4).
Fig. 1.86High magnification of detail of ▶ Fig. 1.85. Perpendicular plate (1); vomer (2);
dislocated sphenoidal process of cartilaginous septum (3).
1.2.2Turbinates
Humans have three or four protruding turbinates with a
bony skeleton on each lateral nasal wall (▶ Fig. 1.87). These
are combined with mounds (intumescentias) with a
turbinate-like parenchyma. These are mainly located on the
septum (septal turbinate) and on the lateral nasal wall in
front of the middle turbinate (▶ Fig. 1.78, ▶ Fig. 1.81, and ▶
Fig. 1.87). Of the protruding lateral turbinates, the inferior,
middle, and superior turbinate are invariably present in all
human beings. A small, rudimentary fourth lateral
turbinate, the supreme turbinate, is found in only about
30% of the population (▶ Fig. 1.87). The inferior turbinate is
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a “maxilloturbinate” because it is part of the maxillary
bone. The middle, superior, and supreme turbinates, on the
other hand, are part of the ethmoidal complex. Accordingly,
they may be called “ethmoidal turbinates.”
Fig. 1.87The turbinates (axial section at the level of the cranial part of the middle nasal
passage, MC staining). Middle turbinate (1); superior turbinate (2); supreme turbinate (3)
on the left; septal turbinates (4); bullous middle turbinate on the right (5). Note the
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obstruction of the left middle meatus with impression and atrophy of the middle
turbinate due to a septal deviation.
As a result of these protruding turbinates and the various
thickenings, the anterior part of the nasal cavity (area 3
and 4) has the form of a slit. This geometry increases the
turbulence of inhaled air and enhances the contact of the
inspired air with the mucosa and the olfactory organ.
Inferior Turbinate
The inferior turbinate is part of the maxilla. It is
comparable to the maxilloturbinates in mammals. Its bony
skeleton consists of a curved lamella of solid, more or less
spongiotic bone. A bulla within the inferior turbinate is
extremely rare. The inferior turbinate has a large amount
of parenchyma and an extensive vascular bed with many
venous sinoids or capacitance vessels. As a consequence,
the inferior turbinate may congest to more than twice its
normal size in its resting state (▶ Fig. 1.88). The angle
between the lateral nasal wall and the turbinate bone
varies greatly from about 20° (“laterally positioned”) to 90°
(“medially positioned”), as illustrated in ▶ Fig. 1.89.
Compare also ▶ Fig. 1.45.
Fig. 1.88Inferior turbinate (coronal section through its anterior part, MC staining).
Ciliated mucosa (1); extensively vascularized parenchyma (2); turbinate bone, partially
spongiotic (3); lacrimal duct (4).
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Fig. 1.89Inferior turbinates (coronal section at the posterior part of the nasal cavity;
detail of ▶ Fig. 1.85, MC staining) demonstrating a huge difference between the angle of
attachment of bony lamella of the inferior turbinates, almost 90° on the right, 40° on the
left.
Middle Turbinate (Concha Bullosa)
The middle turbinate is the first ethmoidoturbinate. Its
skeleton is part of the ethmoid bone. The presence of a cell
or small sinus in its anterior part with an ostium at its
medial side is seen in about 25% of the population (▶ Fig.
1.90 and ▶ Fig. 1.91).
Fig. 1.90Concha bullosa (coronal section at the level of the ostia of the maxillary
sinuses; MC staining). Bullous middle turbinate or concha bullosa (1); uncinate process
(2); ostium of the maxillary sinus (3).
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