Paper - The genesis, development, and adult anatomy of the nasofrontal region in man

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Schaeffer JP. The genesis, development, and adult anatomy of the nasofrontal region in man. (1916) Amer. J Anat. 20: 125-146.

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This historic 1916 paper by Schaeffer describes the development of the human nasofrontal region.

See also 1936 paper by Palmer

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The Genesis, Development, and Adult Anatomy of the Nasofrontal Region in Man

J. Parsons Schaeffer

Daniel Bough Institute of Aiidtoini/ and Biology of the Jefferson Medical College of Philadelphia

Thirteen Figures (1916)

Introduction

Owing to the contradictory and often but general statements extant in the literature on the nasofrontal connections, the writer deemed it important to make a more detailed study of the embryology and adult anatomy of this region. The present communication will in a sense supplement previous studies on the embryology of the nose by the WTiter. Special attention is. here given to an analysis of the adult anatomy, and an effort is made at an intelligent interpretation of the complicated region by referring to the genesis and development of the parts involved. The anatomy of the nasofrontal connections is of considerable importance clinically, since the sinus frontalis is now frequently approached from the nasal cavity in operative procedures. With the latter thought in mind, important anatomic types of the region commonly encountered are illustrated by drawings from actual personal dissections. The embryology is dealt with but briefly; the reader is referred to previous papers by the author for more detailed discussions.

Embryology

The nasofrontal region is genetically an outgrowth from the ventral and cephalic end of the meatus nasi medius, operculated by the concha nasalis media (middle turbinated bone). The mucosa of this part of the meatus nasi medius is, therefore, the proton of what subsequently becomes the recessus frontalis of the meatus nasi medius (early in evidence) and derivatives there from. The recessus frontalis in turn is the anlage of tlie sinus frontahs and certain of the anterior group of cellulae ethmoidales (also called cellulae frontales by Killian, Onodi and others). As early as the end of the third or beginning of the fourth month of embryologic life, one sees evidence of a beginning extension of the meatus nasi medius in a ventrocephalic direction. This early extension is the anlage of the recessus frontalis and is, strictly speaking, the first step in the formation of the sinus frontalis and certain of the anterior group of cellulae ethmoidals. For some time the lateral wall of the recessus frontalis is even and unbroken and gives no evidence of the later configuration and complexity which characterizes the region in the adult nose. Coronal sections and transections of the recessus frontalis of a 4-month fetus show the lateral nasal plate of cartilage thickened at certain points. These thickened cartilaginous areas- -the forerunners of the folds or accessory conchae which later configure the lateral wall of the recessus frontalis — vary in number and are for a period low and inconspicuous and do not throw the nasal mucosa into relief.


Fig. 1 From a term fetus. The recessus frontalis is exposed for study by the removal of the operculatino; concha nasalis media. Note the frontal furrows and the relations of the infundihulum ethnioidalc. Compare with figure 6. The most ventral of the frontal furrows oi- i)its nic referred to throughout this paper as the first (1), the next in order as the second \'l), etc.



Upon examining the recessus frontalis in the late fetus, one finds a variable number of low accessory conchae on its lateral wall (figs. 1 to 4). The folds with the cartilaginous skeleton, now partly ossificil, are at this time sufficiently developed to throw the nasal mucosa into relief. Between the folds are found pits or furrows, the positive growth or outpouching of which aids materially in making more prominent the folds. It is appropriate to speak of the latter as accessory or hidden frontal folds or conchae and the pits as frontal furrows, of the meatus nasi medius. As mentioned above, there is no constancy in the degree of differentiation and development of the frontal folds and furrows. The number varies from a complete absence to four or five. In some instances, therefore, the recessus frontalis remains a simple blind outgrowth from the meatus nasi medius without configuration of its lateral wall (fig. 5).

The processus uncinatus and the folds composing the bulla ethmoidalis likewise should be considered as accessory conchae of the meatus nasi medius (analogues and homologues of the frontal conchae), and the infundibulum ethmoidale and the suprabullar furrow as accessory meatuses or furrows of the meatus nasi medius (analogues and homologues of the frontal furrows).

The accessory furrows of the meatus nasi medius are forerunners of certain of the sinus paranasales, i.e., the sinus frontalis, the sinus maxillaris, and the anterior group of cellulae ethmoidales (by anterior group is meant all those ethmoidal cells which communicate with the nasal fossa caudal to the attached border of the concha nasalis media, including both the anterior and middle group according to another classification) .

The frontal furrows or pits early evaginate and form certain of the anterior group of cellulae ethmoidales or cellulae frontales. Semi-coronal sections through the recessus frontalis show these early cells. When these cells are followed in serial sections toward the recessus frontalis, they are shown to be extensions or outpouchings of the frontal furrows and in communication with the recessus frontalis. Some of the cellulae ethmoidales having their genesis in frontal pits remained diminutive and ethmoidal in topography, while others grow to considerable size and often develop beyond the confines of the ethmoidal bone.


It is a well established fact that the sinus frontalis deA^elops variously by a direct extension of the whole recessus frontahs; from one or other of the anterior group of cellulae ethmoidales which have their point of origin in frontal furrows; and occasionally from the ventral extremity of the infundibulum ethmoidale, either by direct extension or from one of its cellular outgrowths. Indeed, the sinus frontalis may be unilaterally or bilaterally present in duplicate or triplicate, indicating a genesis from more than one of the aforementioned areas. The sinus frontalis is in many instances, embryologically speaking, a cellula ethmoidalis anterior which has grown sufficient!}^ far into the frontal region to be topographically a sinus frontalis.


Fig. 2 From a term fetus. Recessus frontalis exposed. Note frontal furrows and folds. Especially note the continuity of the suprabullar furrow and the fourth (most dorsal) frontal furrow (see reference in text). The infundibulum ethmoidale is in line with the first frontal furrow, hut not directly continuous with it. After Schaeffer.


The first evidence of the sinus frontalis must not be sought in the frontal bone, but in the recessus frontalis of the meatus nasi medius. Lack of observance of this rule has led to such statements as: "in the newborn infant no trace of a frontal sinus is visible," the earliest sign of a frontal sinus is seen about the end of the first year in the form of a shallow depression," "the frontal sinus is completely absent in the newborn infant." Poirier states that the frontal sinus is first seen about the end of the second year. Tillaux puts it as late as the twelfth year. Onodi, Schaeffer, Davis and others recognize the sinus frontalis as such in some instances early in extrauterine life. Killian operated upon a diseased sinus frontalis in a child fifteen months old. As statetl before, the recessus frontalis of the meatus nasi medius is demonstrable as early as the fourth fetal month. During late fetal life the recessus frontalis becomes complex by the formation of frontal furrows or pits, etc. One is not justified at this time to hazard an opinion as to the specific point in the recessus frontalis from which the sinus frontalis will ultimately develop.


Fig. 3 From a term fetus. Here a single fr bordered by a dorsal and a ventral frontal furrow. and the frontal furrows are continuous channels, condition due to growth, i.e., whether the frontal ethmoidale were discontinuous anlagen, cannot series the condition is not common.



ontal fold or concha presents, The infundibulum ethmoidale

Whether this is a secondary furrows and the infundibulum

bo said. According to my


There are exceptions to this rule. Occasionally at birth the genetic point for the sinus frontalis is obvious. Again, one cannot be certain until the second or the third year.

From the suprabullar furrow develop most of those cellulae ethmoidales anterior which in time honeycomb the bulla ethmoidalis. Rarely the suprabullar furrow seems to be the genetic point for the sinus frontalis. This may be apparent only and not the actual condition. The most dorsal of the frontal pits and the suprabullar furrow are at times continuous channels (fig. 2). This might lead to the interpretation that the sinus frontalis developed from the suprabullar furrow, when in reality it developed from a frontal pit (early anterior ethmoidal cell). At times some of the bullar cells develop from occasional furrows on the medial surface of the bulla ethmoidalis. The infundibulum ethmoidale dorsally and caudally gives rise to the sinus maxillaris and ventrally it usually ends blindly by forming a cellula ethmoidalis anterior of variable size, lateral to the recessus frontalis. Various aberrant cellulae ethmoidales anterior (agger, conchal, infundibular, etc.) also frequently develop from the aforementioned points. The posterior or dorsal group of the cellulae ethmoidales do not concern us here.



Fig. 4 From a term fetus. Recessus frontalis exposed by partial removal of concha nasalis media. Note intimate relationship between ventral extremity of the infundibulum ethmoidale and the second or most dorsal frontal furrow or pit. Should the sinus frontalis develop from the second frontal furrow, the adult relationship between the former and the infundibulum ethmoidale would be very intimate. Indeed, there might be direct continuity, allowing for further changes in development. The conclusion would be wrongly drawn, however, to say that the sinus frontalis is a derivative of the infundibulum ethmoidale.


The processus uncinatus and the folds composing the bulla ethmoidalis are often in direct continuity with one or more of the frontal folds or conchae (fig. 1). Again, the bulla ethmoidalis and the processus uncinatus are fused across the ventral extremity of the infundibulum ethmoidale (figs. 1 and 5). Likewise in many instances the dorsal extremity of the processus uncinatus divides, in a sense, into two roots, one of which turns cephalad and fuses with the bulla ethmoidalis, thus causing the infundibulum ethmoidale to end in a blind pouch dorsally (fig. 8).

The infundibulum ethmoidale and one or other of the frontal furrows or pits are in the same axis in the fetus and are at times contiguous (fig. 1). It must, however, here be pointed out that it is unusiial for the infundibuluin cthmoidale to be directly continuous with a frontal furrow or pit (fig 3). The latter embrj^ological fact is significant when one recalls the careless statement frequently made without qualification, that in the adult the infundibulum ethmoidale is continued upwards as the nasofrontal duct into the sinus frontalis."

Because of the intimate relations, in the adult, of the infundibulum ethmoidale and the ductus nasofrontalis or the sinus frontalis directly, the infundibulum ethmoidale serves, in many instances, as a channel to convey secretion from the sinus frontalis to the sinus maxillaris. This is enhanced in those cases in which the infundibulum ethmoidale is deep and ends dorsalh^ in a blind pouch, thus directing drainage through the ostium maxillare into the sinus maxillaris (figs. 8 and 12). In other words the sinus maxillaris is often a cesspool for infectious material from the sinus frontalis and certain of the anterior group of cellulae ethmoidales

The above well known clinical fact has doubtless led to the erroneous belief that the infundibulum ethmoidale is, in the majority of instances, directl}' continuous anatomically with the nasofrontal duct or, in the absence of the latter directly with the sinus frontalis. The inference is also wrongly drawn that in many cases the sinus frontalis is embryologically a direct outgrowth of the ventral and cephalic end of the infundibulum ethmoidale. From what has been said previously on the embryology, it is needless to enter further into a discussion here. Suffice it to say that it is not a common adult anatomic condition to find the infundibulum ethmoidale directly continuous with the ductus nasofrontalis, or in the absence of the latter with the ostium frontale. There are in many instances close relationships established, even a contiguity, but a direct continuity is an occasional occurrence only. According to the series worked it is, likewise, not common for the sinus frontalis to have its genesis in the infundibulum ethmoidale.

It should, however, be pointed out that in probably as many as 50 per cent of adult cases the relationship is so intimate between the infundibulum ethmoidale and the sinus frontalis or its duct (ductus nasofrontalis) and certain of the cellulae ethmoidales anterior that drainage from these paranasal chambers finds its way in whole or in part into the infundibulum ethmoidale, thence via the latter into the sinus maxillaris.

Adult Anatomy

In order to properly interpret points in adult anatomy it is frequently necessary to resort to the embryology of the part or parts involved. This, indeed, is true of the nasofrontal region. Doubtless many of the erroneous statements extant in the literature on the nasofrontal connections are the result of drawing conclusions from a study of too few specimens, of studying adult material alone, and of errors in interpretation due to the fact that embryologic and adult studies were not carried on simultaneously.


Fig. 5 From a child aged fourteen montlis. Note the apparent al).sence of frontal furrows and folds. The whole recessus frontalis is expanding or growing frontalward in the establishment of the sinus frontalis. After SchaefTer.


The adult nasofrontal region presents a varied anatomy, a fact in accord with the varied genesis of the parts involved. In the adult one usually finds evidence of the previous embryologic condition that must have obtained in the particular case. Careful analysis of the nasofrontal region reveals, as a rule, the derivatives of the frontal furrows or pits and of the frontal folds or conchae; provided, of course, these structures were differentiated. As stated before, there are instances in which the lateral wall of the recessus frontalis does not become configured by pits and folds (fig. 5). In some specimens the adult anatomy is so altered that interpretation is very difficult, even impossible.

It may be well here to i-efer to specific dissections of the region for study and analysis. In figure 6, for example, we have represented an adult nasofrontal region exposed for study by the removal of the operculating concha nasalis media. There


Fig. 6 From an adult. Recessus frontalis and nasofrontal connections exposed for study by the removal of part of the concha nasalis media. See text for a discussion of this dissection.


is positive evidence of four embryological frontal furrows or pits. The first or most ventral of the latter differentiated into a cellula ethmoidalis anterior of small dimensions communicating directly with the meatus nasi medius, medial to the processus uncinatus. The third and fourth frontal furrows or pits likewise developed into cellulae ethmoidales anterior both of which communicate with the meatus nasi medius cephalic to the hiatus semilunaris of the infundibulum ethmoidale.

The second frontal furrow or pit after first developing into a cellula ethmoidalis anterior continued to extend its boundaries until it became topographically the sinus frontalis. It should be noted that the duct of the sinus frontalis (ductus nasofrontalis) is in the position of the embryonic second frontal furrow or pit and that it is in the same axis as the infundibulum ethmoidale and the hiatus semilunaris/ but not in direct continuity with them. The sinus frontalis in this instance (fig. 6) communicates, therefore, with the recessus frontalis directly via the ductus nasofrontalis. On the other hand, the infundibulum ethmoidale ends blindly as a cellula ethmoidalis anterior (infundibular cell) lateral to the recessus frontalis and the ductus nasofrontalis.

The anatomy represented in figure 6 is that found in a certain number of adult specimens, and is illustrative of one of the anatomic types of the region. It should be noted that the infundibulum ethmoidale is not directly continuous with the ductus nasofrontalis, but that it bears an intimate and important relation to it. The relation is, in a sense, a contiguous and not a continuous one. Drainage from the sinus frontalis would find its way partly into the meatus nasi medius directly. An exploratory probe passed towards the frontal region via the infundibulum ethmoidale would, of course, find its way into the ventral, blind end of the latter and not into the sinus frontalis. To probe the sinus frontalis in this case it would be necessary to pass through the proximal ostium of the ductus nasofrontalis located in the recessus frontalis.

It is interesting and instructive to compare the embryologic anatomy of the recessus frontalis illustrated in figure 1 with the adult anatomy illustrated in figure 6. In the former the third frontal furrow and the infundibulum ethmoidale are in the same axis; in the latter, the second frontal furrow (now the nasofrontal duct) is in the same axis as the infundibulum eth 1 Tlie term hiatus semilunaris should be applied to the lunate cleft which establishes a communication between the infundibulum ethmoidale and the meatus nasi medius, i.e., the slit between the free border of the processus uncinatus and the bulla ethmoidalis moidale. If in figure 1 the sinus frontalis had developed from the same frontal furrow as in figure 6, the relation between the ductus nasofrontalis and the infundibulum ethmoidale would have been less intimate.

The dissection of the adult nasofrontal region illustrated in figure 9 gives evidence of the early embryologic frontal furrows or pits. The adult derivatives of the latter are readily identi



Fig. 7 From an adult. Recessus frontalis and nasofrontal connections exposed for .study. Especially note the derivatives of the frontal pits, the tortuous and narrow ductus nasofrontalis, and the termination of the ventral extremity of the infundibulum ethmoidale. See text.


fied. The first frontal pit developed into a small cellula ethmoidalis anterior which is in direct communication with the recessus frontalis by means of its ostium. The second and the third frontal pits developed into sinus frontales (sinus frontalis in duplicate). Both of the latter communicate directly by means of independent ostia with the recessus frontalis — no ductus nasofrontalis being present. A study of the dissection shown in figure 9 clearly points out that the infundibulum ethmoidale terminates blindly (indicated by a probe) as a cellula ethmoidalis anterior (infundibular cell) lateral to the recessus frontalis. Loose interpretation of the anatomy of this region in this instance, might lead to the erroneous statement that the sinus frontalis developed as an extension of the infundibulum ethmoidale. One sees even a channel-like depression on the lateral wall of the recessus frontalis connecting in a sense the sinus frontales with the infundibulum ethmoidale. It is obvious that drainage from the sinus frontales would in part find its way into the infundibuhnn ethmoidale, thence via the latter to the ostium maxillare and into the sinus maxillaris (antrum of Highmore).


Fig. 8 From an adult. Dissection shows tlie nasofrontal connections and the ethmoidal labyrinth exposed. Especially note the derivatives of the frontal pits and the direct continuity of the sinus frontalis with the infundibulum ethmoidale. The dorsal blind end of the infundibulum ethmoidale, due to a mucosal fold (A') passing from the free border of the processus uncinatus to the bulla ethmoidalis, should also be noted. In this specimen practically all secretion from the sinus frontalis would find its way into the sinus maxillaris. See text.


In figure 7 we have evidence of four embryologic frontal pits. The derivatives of these pits are two cellulae ethmoidales anterior and two sinus frontales, all in communication with the recessus frontalis of the meatus nasi inedius. The first (most ventral) and fourth (most dorsal) frontal pits developed into two small cells. The second frontal pit developed sufficiently far to be topographically a sinus frontalis (indicated in drawing as an anterior ethmoidal cell). The sinus frontalis proper took its origin from the cellula ethmoidalis anterior which had its genetic point in the third frontal pit. The result of the encroachment of the cell from the second frontal pit is a narrow channel (ductus nasofrontalis) communicating between the sinus frontalis and the recessus frontalis. As in figures 6 and 9, in figure 7 the infundibulum ethmoidale ends blindly lateral to the recessus frontalis.

As stated in previous paragraphs, fewer frontal pits and folds are at times differentiated in the fetus. This changes the picture of the adult anatomy of the recessus frontalis. In figure 12 there is evidence of but two embryologic frontal pits. The first or most ventral of the latter developed into the sinus frontalis. It should be noted that the duct of the sinus frontalis is in the same axis as the hiatus semilunaris and the infundibulum ethmoidale. The latter terminates lateral to the recessus frontalis as a cellula ethmoidalis anterior (infundibular cell). The second or dorsal pit (fig. 12) developed into a small cellula ethmoidalis anterior in line with the suprabullar furrow (now cellula ethmoidalis anterior, honeycombing the bulla ethmoidalis). This same dissection shows a well developed dorsal limb of the processus uncinatus (x). This causes the infundibulum ethmoidale to end in a deep, Wind pocket just over the ostium maxillare.

In an earlier paragraph mention was made of occasional adult specimens in which the ductus nasofrontalis is in direct continuity with the infundibulum ethmoidale. In figure 8 is represented a dissection of an adult nasofrontal region in which the ventral extremity of the infundibulum ethmoidale is directly continuous with the ductus nasofrontalis and secondarily with the sinus frontalis. In this dissection one notes a plate of tissue intervening between the free border of the processus uncinatus and the bulla ethmoidalis, thus bridging over the ventral extremity of the infundibulum ethmoidale and, in a sense, replacing the hiatus semilunaris in this position. One encounters difficulty in interpreting the anatomy of the nasofrontal connections in this specimen. Did the sinus frontalis develop from the infundibulum ethmoidale (by a direct extension or from an infundibular cell) or from the second frontal pit (early cellula ethmoidalis anterior) ?

The infundibulum by its ventral and cephalic extension usually comes into topographic relationship with some of the cellulae ethmoidales anterior which arise from the frontal pits. In this instance (fig. 8), a relationship may early have been established with the second frontal pit (there is e^'idence in support of this belief).


Fig. 9 Dissection from an adult. Xote the two sinus frontales, the absence of ductus nasofrontalis, and thc> ventral termination of the infundibulum ethmoidale. See text.


Resorption of the intervening barrier would, of course, bring the infundibulum ethn:ioidale in direct continuity with the cellula ethmoidalis anterior arising from the second frontal pit, likewise with the sinus frontalis. The dissection gives positive evidence of three frontal pits (now cellulae ethmoidales anterior). Whether an additional frontal pit which gave rise to the sinus frontalis was present in the position of the ductus nasofrontalis is, of course, impossible to say. Two of the cellulae ethmoidals anterior are separated by a considerable interval. This space may have been the second frontal pit. Again, the two frontal pits in question (cellulae ethmoidales anterior) may have been crowded apart by a bullous-like ventral and cephalic growth of the infundibulum ethmoidale in the establishment of the sinus frontalis. My experience has been that it is unusual for the sinus frontalis to arise from the infundibulum ethmoidale.




Fig. 10 Dissection from an adult. Note the sinus frontalis present in duplicate, the proximal ostia frontales in relation to the recessus frontalis, and the ventral termination of the infundibulum ethmoidale. See text.


Drainage from the sinus frontalis in such instances (fig. 8) would almost wholly pass into the infundibulum ethmoidale, and via the latter to the ostium maxillare, thence into the sinus maxillaris. Should the floor of the infundibulum ethmoidale in such cases be largely replaced by an elongated ostium maxillare (a rather common occurrence), the sinus frontahs and the sinus maxillaris would from a practical viewpoint be in direct communication. It should be recalled that the sinus maxillaris is genetically an outgrowth from the floor of the infundibulum ethmoidale. The initial area of the outgrowth varies considerably in extent, thus accounting for the varied size of the adult ostium maxillare.^

The sinus frontalis is occasionally present unilaterally or bilaterally in duplicate or in triplicate. In these cases each sinus frontalis is absolutely independent of others and possesses an individual ostium frontale. The condition of duplicity or triplicity of the sinus frontalis is readily explained when one recalls the potentiality of development referred to in previous paragraphs (figs. 1 to 5). In figures 9 and 10 are represented dissections of adult nasofrontal regions in which two frontal pits (early ventral or anterior cellulae ethmoidales) developed sufficiently far to be topographically sinus frontales. Duplicate sinus frontales are either side by side in the sagittal plane (fig. 10) or are ventral and dorsal in relation, in the coronal plane (fig. 9). Intermediate relations are, of course, encountered. In figure 11 the first and second frontal pits developed into sinus frontales; in figure 10 the second and third. In both instances the sinuses communicate independently with the recessus frontalis of the meatus nasi medius. At times when the sinus frontalis exists in duplicate (or triplicate) one sinus may encroach bullous-like on the other. The name bulla frontahs was, however, applied by Turner to infundibular cells which encroach upon the dorso-caudal boundary of the sinus frontalis.

The ductus nasofrontalis is a very variable channel. One encounters very many specimens in which no true duct is present.

- "In my series of 90 cases it (the ostium maxillare) has a great range of dimensions; varying from 1 to 20 mm. in length and from 1 to 6 mm. in width. In some instances where the ostimii has reached considerable size, it almost entirely replaces the caudo-lateral wall of the infundibulum ethmoidale, thus forming a long, slit-like communication l)etween the sinus maxillaris and the infundibulum ethmoidale." J. P. Schaeffer, Am. Jour. Anat., vol. 10, 1910, p. 351.


Witness, for example, the dissection represented in figui'e 1 1 . Hei'e the sinus frontalis is very small. In fact, partly ethmoidal in topoj2;ra]:)hy. The interesting thing about this case is that the sinus frontalis was bilaterally very diminutive in size. Its communication (fig. 11) with the recessus frontalis of the meatus nasi medius is established by means of a large ostium frontale in the same axis as the infundibulum ethmoidale.


Fig. 11 Dissection from an adult. Recessus frontalis exposed. Note the diminutive sinus frontalis and the absence of a ductus nasofrontalis. "The views held on the presence and absence of the sinus frontalis are, doubtless, largely due to differences of opinion as to what should be called a sinus frontalis, and how far the development must have progressed into the frontal region before the cell has reached the dignity of a sinus frontalis." (J. P. Schaeffer).


The dissection shown in figure 9 likewise presents the sinus frontalis in duplicate in which no ductus nasofrontalis is present. Each sinus communicates with the recessus frontalis by means of a large ostium frontale. On the other hand, one encounters specimens with true ductus nasofrontales. Some of these ducts are straight and short (fig. 6), others straight and long (figs. 12 and 13). Again, the ductus nasofrontalis may be long and more or less serpentine. Witness, for example, the specimen shown in figure 7. Here is a sinus frontalis with a long narrow and curved ductus nasofrontalis. The duct communicates with the recessus frontahs. There are very definitely two ostia frontalia to the duct, one proximal and the other distal in position. The duct is encroached upon by a cellula ethmoidalis anterior (really a second sinus frontalis) which developed from the second frontal furrow. The slightest swelling of the mucosa of such narrow and tortuous ductus nasofrontales (figs. 7 and 10) would, of course, occlude its lumen. In some instances the ductus nasofrontalis is roomy, possessing large proximal and distal ostia, thus affording a better drainage channel for the sinus frontalis (fig. 13).


Fig. 12 Dissection from an adult. Recessus frontalis exposed. Note the discontinuous channels, i.e., the ductus nasofrontalis and the infundibulum ethmoidals.



The ductus nasofrontalis with its proximal ostium or in the absence of a true duct, the proximal ostium frontale (in the latter the distal ostium frontale is wanting) , bears a varied relation to the ventral extremity of the infundibulum ethmoidale. The latter usually ends blindly lateral to the terminal portion of the ductus nasofrontalis. The infundibulum ethmoidale and the ductus nasofrontalis are at times in the same axis (figs. 6 and 12). Again the ductus nasofrontalis with its proximal ostium is not in line with the infundibulum ethmoidale. Witness, for example, figure 10: Here the proximal ostium frontale is located medial to the cephalic extremity of the processus uncinatus. Drainage in such cases would in a large measure be diverted directly into the meatus nasi medius. In figure 7 the relation is not one of alignment. In figure 9, passing from the proximal ostia frontalia, on the lateral wall of the recessus frontalis towards the infundibulum ethmoidale, is a shallow, gutter-like channel. Drainage from the sinus frontales here would largely find its way into the cephalic end of the infundibulum ethmoidale.



Fig. 13 From an adult. Note the roomy ductus nasofrontalis, discontinuous with the infundibulum ethmoidale. The intimate relation between the sinus sphenoidalis and the A. carotis interna is also indicated in the dissection. The section is to the right of the mid-sagittal plane, hence the absence of the hypophysis cerebri.


In the specimen shown in figure 8 in which the infundibulum ethmoidale and the ductus nasofrontahs are in direct continuity, drainage from the sinus frontalis would, of course, readily find its way into the sinus maxillaris. The infundibulum in these cases acts in every sense as a gutter of communication between the sinus frontalis and the sinus maxillaris. The same is true in a large number of cases in which the relations are intimate but not contiriuous between the ventral extremit}^ of the infundibulum ethmoidale and the derivatives of the recessus frontalis. The sinus maxillaris in turn becomes a reservoir for drainage from the sinus frontalis and certain cellulae ethmoidales anterior (some infundibular and others frontal in position). If in those cases in which the sinus frontalis or its duct is directly continuous with the ventral extremity of the infundibulum ethmoidale (fig. 8) the ostium maxillai'e should occupy a goodly or greater portion of the floor of the infundibulum ethmoidale (a condition encountered), the sinus frontalis and the cellulae infundibulares would, from a practical viewpoint, be in direct communication with the sinus maxillaris. This close relationship is, however, secondary and one must not infer that the frontal and maxillary sinuses and the infundibular cells arise from the same point.

Conclusions

The materials studied for this paper seem to justify the following conclusions :

  1. The sinus frontalis is in the vast majority of cases a derivative (a) of the recessus frontalis directly, (b) of one or more of the cellulae ethmoidales anterior which have their genesis in frontal pits, or (c) of both, when present in duplicate or triplicate.
  2. The sinus frontalis appears occasionally to arise from the ventral extremity of the infundibulum ethmoidale. This relationship, however, is in some instances secondary owing to development. It is ciuestionable whether the sinus frontalis ever develops from the suprabullar pit or furrow.
  3. The ductus nasofrontalis (or the sinus frontalis directly in the absence of a ductus) and the infundibulum ethmoidale are in the vast majority of instances, discontinuous channels in the adult. The topographic relationships may, however, be very intimate, i.e., they may be contiguous.
  4. The ductus nasofrontalis (or the sinus frontalis) and the infundibulum ethmoidale are occasionally directly continuous in the adult.
  5. The infundibulum ethmoidale in approximately as many as 50 per cent of adult bodies acts as a channel for the carriage of secretion or infection from the sinus frontalis and certain of the cellulae ethmoidales anterior to the sinus maxillaris: Included in this group are (a) those cases in which the sinus frontalis and the infundibulum ethmoidale are continuous, and (b) those cases in which the sinus frontalis and the infundibulum ethmoidale are discontinuous, but intimately and vitally related topographically.


Literature Cited

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Cite this page: Hill, M.A. (2019, December 15) Embryology Paper - The genesis, development, and adult anatomy of the nasofrontal region in man. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_The_genesis,_development,_and_adult_anatomy_of_the_nasofrontal_region_in_man

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