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Film paranasal sinuses water view of a 62 years old woman with productive cough and post-nasal dripping, demonstrated both frontal and maxillary sinusitis. Film paranasal sinuses antero-posterior view of a 62 years old woman with productive cough and post-nasal dripping, demonstrated both frontal and maxillary sinusitis. Todos los planes comienzan como una Licencia Estandar y pueden actualizarse a una Licencia Mejorada en cualquier momento. When checked, Shutterstock's safe search screens restricted content and excludes it from your search results. These terms are intended to provide clear communication among otorhinolaryngologists and serve as a basis for discussion among anatomists. Recent advances in clinical technology, especially computed tomography (CT) and microscopic and endoscopic sinonasal surgery, have given renewed importance to the standardization of anatomic terminology in sinusitis.
The nomenclature and anatomic concepts presented for the lateral nasal wall and anterior skull base evolved over several decades and have proved to be satisfactory for endoscopic and microscopic diagnosis and surgery as well as for radiology.
Topographic and directional instructions(such assuperior and inferior) are given relative to a standing person.
Confusion and disparate practices exist today concerning the definitions and usage of such terms as hiatus semilunaris, infundibulum, frontal recess, and nasofrontal duct. Anatomists today consider the ethmoid infundibulum to be a three-dimensional structure that is actually a well-defined cleft.
Additional terms for the clefts of the anterior ethmoid region have been invented and applied without regard to consistency.
The structures of the lateral nasal wall and paranasal sinuses fall into two anatomically and physiologically distinct categories, the anterior and posterior ethmoidcomplexes (Fig 1) PNS1.gif.
This structure is actually the third basal lamella of the ethmoturbinals (Fig 2) PNS2.gif . The stability of the middle turbinate accrues largely from its fixation along three planes. The term derives from the Latin, processus uncinatus, meaning hooked outgrowth, and refers to a remnant of the descending portion of the first ethmoturbinal. From the Latin, bulla ethmoidalis,where bulla means a hollow, thin-walled, bony prominence, the name refers to the largest and most nonvariant air cells in the anterior ethmoid complex. The Latin term recessus suprabullaris et retrobullaris has as synonyms the sinus lateralis of Grunwald8 and the susbullar cell of Mouret.9,l0 The suprabullar recess may extend into a retrobullar recess if the posterior wall of the bulla lamella is not in contact with the basal lamella of the middle turbinate. The origin of this termis the hiatus semilunaris inferior of Grunwald.8 The hiatus semilunaris inferior is an anatomic plane that represents the shortest distance between the free posterior margin of the uncinate process and the corresponding anterior face of the ethmoid bulla.
The term infundibulum (plural, infundibula) connotes a funnel shaped structure and comes from the Latin infundere, meaning to pour into. The ethmoid infundibulum is bordered medially by the uncinate process and laterally by the lamina papyracea. At its anterior end, the ethmoid infundibulum ends blindly in an acute angle, giving rise to the V-like shape noted in axial sections and on CT scans. The maxillary sinus ostium usually can be found at the floor and lateral aspect of the infundibulum between its middle and posterior third.
The relationship between the ethmoid infimdibulum and the skull base, especially the frontal recess, depends on the uncinate process. The frontal infundibulum, named from the Latin infundibulum sinus frontalis or infundibulum frontale, is a funnel-shaped narrowing of the inferior aspect ofthe frontal sinus toward the floor of the frontal sinus ostium. Perhaps the most complicated structure in the anterior ethmoid complex, the frontal recessis the most anterior and superior portion of the complex that leads to and communicates with the frontal sinus (Fig 5) PNS5.gif . The medial wall of the frontal recess is the most anterior and superior part of the middle turbinate.
When this communication is narrowed from behind by the ethmoid bulla or the bulla lamella or from in front by a pneumatized agger nasi cell,a short, ductlike structure results. The formation of additional cells in the frontal recess and the infundibulum, apart from agger nasi cells, is highly individual.
Lateral to the lamina cribrosa and to the inserlion of the middle turbinate, the ethmoid bone is open superiorly. Keros11 has described three different and surgically important types of configurations of the ethmoid roof(Fig 6) PNS6.gif . The potential pathophysiologic importance of a Haller' s cell is clear, but the anatomic definition is not. There are only a few terms in anatomic nomenclature that require a better definition and explanation in these regions.
Like the middle turbinate, the superior and, if present, supreme turbinates are attached to the lateral nasal wall and the anterior skull base by means of their basal lamellas. The sphenoethmoid recess (recessus sphenoethmoidalis) is the space between the superior (and supreme, if present) turbinate laterally, the roof of the nose(rima olfactoria) superiorly, and the nasal septum medially. Posterior ethmoid cells can become pneumatized far laterally and to some degree superiorly to the sphenoid sinus, in which case they are called sphenoethmoid cells(cellulae sphenoethmoidales) or Onodi cells (Fig 10) PNS10.gif . The bulge of the medial aspect of the bone surrounding the optic foramen (foramen opticum) is the optic nerve tubercle (tuberculum nervi optici) . Understanding the embryologic development of the turbinates and the ethmoid sheds light on the complex relationships involving the basal lamella.
From these embryologic relationships, one can see that the uncinate process is actually the basal lamella of the first ethmoturbinal. Given the variety of anatomic features of an ethmoid cell, the only fixed point of reference is the ostium. The phrases ethmoid cells of the middle meatus and ethmoid cells of the superior meatus may be more strictly correct than the terms anterior ethmoid sinus and posterior ethmoid sinus, which are currently in use. The Anatomic Temlinology Group's suggestions for a unified system of terminology are designed to provide a current intenational language for otorhinolaryngologic surgeons and to serve as a basis for discussion among anatomists. The main significance of the Onodi or sphenoethmoid cell is that while sinus surgeons expect to find the optic nerve in the sphenoid sinus, they are not routinely looking for it in the posterior ethmoid. Every effort should be made to identify sphenoethmoid cells preoperatively and to be aware of intraoperative clues such as anterior sphenoid wall alignment, which may point to the presence of an Onodi cell. The osteomeatal complex, or OMC - the small compartment located in the region between the middle turbinate and the lateral nasal wall in the middle meatus - represents the key region for drainage of the anterior ethmoid, maxillary and frontal sinuses. The frontal bone may be divided into two main portions, a vertical squamous portion which articulates with the paired parietals along the Coronal Suture and forms the forehead, and two orbital plates, which contribute to the ceiling and lateral walls of the left and right eye orbits. If the sphenoid is the most difficult cranial bone to describe and invision, the Ethmoid is the second most difficult. Descending off each of the Cribriform Plates is a left or right Orbital Plate which aids to form the medial wall of the respective eye orbit. The left and right pterygoid processes project inferiorly from near the junction of each of the greater wings with the body of the sphenoid.
History of Present Illness: A healthy 20-year-old female presented to the Oculoplastics Clinic with a 9-month history of left upper lid droopiness. Given the history of recent growth, the decision was made to perform an excisional biopsy of the lesion.
An osteoid osteoma is a benign skeletal neoplasm of unknown etiology that is composed of osteoid and woven bones. A review of systems is important to perform because if joints are involved, pain and swelling may be among the presenting symptoms. Histopathologically, these lesions have a central nidus of loose fibrovascular tissue surrounded by irregular trabeculae of bone and osteoid (unmineralized, organic bone matrix prior to bone maturation). Todo el que se registra consigue acceso completo a toda nuestra biblioteca, incluyendo nuestras colecciones seleccionadas. Nuestra Licencia Estandar le permite usar imagenes para cualquier cosa, excepto grandes corridas de impresion de mas de 500.000+ o para promocion. Una vez que haya descargado su imagen, tiene derechos de por vida para usarla segun los terminos de la licencia adquirida. Current understanding of the localization and extent of the pathophysiology of sinus and skull base disease is based on detailed knowledge of anatomic structure. Kaufmann's4 "double middle turbinate"(Gedoppelte mittlere Muschel) describes the medially bent uncinate process that curves out of the middle meatus like the brim of a hat.
It is interesting to note, however, that many of the misunderstandings date from the time when the terms were first coined.
Initially, however, Zuckerkandl applied the term only to the depression extending forward from the hiatus semilunaris both inferiorly and superiorly into the lateral nasal wall.
The most anterior and superior insertion of the middle turbinate is adjacent to the crista ethmoidalis of the maxilla.
The anterior third of the middle turbinate inserts vertically into the skull base at the lateral edge of the lamina cribrosa. The anterior segment lies sagittally, attaching to the lateral end of the lamina cribrosa opposite its lamina lateralis. The frontal and posterior portions, which are vertical and horizontal, respectively, are part of the basal lamella of the middle turbinate. An agger nasi cell results when this area of the lateral nasal wall under goes pneumatization. It is formed by pneumatization of the bulla lamella, or second ethmoid basal lamella, and is like a bleb on the lamina papyracea. When well developed, this space is bordered superiorly by the ethmoid roof, laterally by the lamina papyracea, inferiorly by the roofof the ethmoid bulla, and posteriorly by the basal lamella of the middle turbinate. Typically, but not necessarily, it lies in the sagittal plane and does not represent a true space (Fig 3) PNS3.gif .


There are three different infundibula in the paranasal sinuses: the frontal, maxillary, and ethmoid.
The frontal process of the maxilla and the lacrimal bone may constitute parts of the lateral wall anterosuperiorly, but this is rare. Posteriorly, the ethmoid infundibulum extends to the anterior face of the ethmoid bulla and opens into the middle meatus through the hiatus semilunaris inferior.
From the middle meatus, the natural ostium of the maxillary sinus therefore remains hidden, lateral to the uncinate process in the ethmoid infundibulum. Superiorly, the ethmoid infundibulum may end blindly in the terminal recess, or recessus terminalis, if the uncinate process bends laterally and inserts onto the lamina papyracea. When taken together withthe frontal infundibulum, the shape resembles an hourglass, with the constricted portion being at the level of the natural ostium of the frontal sinus. Although the anatomic definitions are clear, there is great confusion in usage among these terms.
The bony walls of the resulting structure are not truly its own, however, so to call it a duct or other tubular structure is not anatomically correct.
The Anatomic Terminology Group recommends that they be described according to their anatomic orientation.
The differentiation depends on the length of thelateral lamella of the cribriform plate, which is the thinnest bone in the entire anterior skull base.l2 In type 1, the olfactory fossa is only 1 to 3 mm deep, the lateral lamella is short (almost nonexistent), and the ethmoid roof is almost in the same plane as the cribriform plate. As described by Haller in 1765, these cells grow into the bony orbital floor that constitutes the roof of the maxillary sinus, are differentiable from the bulla, and have a potential pathophysiologic relationship to a narrowed ethmoid infundibulum or maxillary sinus ostium (Fig 8) PNS8.gif .
Any or all cells, clefts, and ostia, with their dependent sinuses, may become diseased, thereby contributing to the symptoms and pathophysiology of sinusitis. The course of attachment of the supreme turbinate is similar to that of the middle turbinate but of less significance in pathophysiology and surgery.
Pneumatization of the clinoid process in those cases may originate from the posterior ethmoid cell, also. This is clinically significant because the sphenoid sinus is located medially and inferiorly to the most posterior cell of the posteriorethmoid complex.
Depending on the degree of pneumatization and the presence and configuration of sphenoethmoid cells, it can be seen in the posterior ethmoid cells, at the transition between the posterior ethmoid and sphenoid sinuses, or in the sphenoid sinus itself. The ethmoid turbinates form on the lateral nasal wall of the fetus, giving rise to six ridges during the 9th and 10th weeks of fetal development.
The descending portion of the first ethmoturbinal remains as the uncinate process,and the ascending portion remains asthe agger nasi (ie, the nasoturbinal). Similarly, the ethmoid bulla evolves from the second basal lamella, and the middle turbinate from the third basal lamella. Thus, cells are classified as belonging to the anterior ethmoid when they drain into the middle meatus and belonging to the posterior ethmoid when they drain into the superior meatus. The authors refer to "Odoni cells" as, "aerated posterior ethmoid air cells along the optic canal." Could it be that they meant to refer to the cells as "Onodi cells"? Consequently, the chance of iatrogenic injury is likely to be higher in patients with Onodi cells and even higher in patients with extensively pneumatised Onodi cells.5 The exact incidence of Onodi cells is unclear. Attention to these important details will increase the likelihood of uncomplicated endoscopic sinus surgery at the sphenoethmoidal junction. One of the major sources of this controversy is that there are some reports of rhinogenic optic neuritis (RON) in patients with mild paranasal sinusitis or with almost normal paranasal sinuses.
On the external surface the squamous portion frequently possesses a left and right Frontal Eminence. It has a number of features and projections, but unlike the sphenoid it cannot be seen from various views of the skull. Each Orbital Plate is rectangular in shape and gives rise to two medial projections, the Superior and Middle Nasal Concha. It has a number of features and projections, which allow it to be seen from various views of the skull. They are paried left and right and assist in forming the anterior portion of the medial wall of each eye orbit. The patient was taken to the operating room, where an anterior orbitotomy via an upper lid crease incision was performed. Osteoid osteomas can occur in any bone, but in approximately two thirds of patients, the appendicular skeleton is involved.
Skull-based osteomas are often completely asymptomatic, unless they arise in an area that compromises their vision or hearing. Radiographically, these tumors are well-circumscribed with dense cortical sclerosis surrounding a radiolucent nidus.
The amount of osseous (mineralized, mature bone) and osteoid tissue varies within the nidus and is reflected in its radiologic opacity. Si en cualquier momento se siente insatisfecho con su experiencia con nosotros, puede cancelar su suscripcion.
An attempt has been made to reconcile or eliminate duplication, redundancy, and overlap in terminology that have arisen over the past century. Because the opportunities for intervention are virtually unprecedented in their precision, it is imperative that surgeons and radiologists cornmunicate as efficiently and as accurately as possible.
While Zuckerkandl5,6 used the term hiatus semilunaris in much the same way as we do, to signify the two-dimensional cleft between the posterior margin of the uncinate process and the anterior face of the ethmoid bulla, the term ethmoid infundibulumhas been used more loosely.
He attributed the term to Boyer, even though what Boyer described was the cleft that Killian7 later called the frontal recess. For example, what was termed recessus frontalis by one author was called ductus nasofrontalis and recessus anterior meatus medii by later contributors to the literature. The basal lamella of the middle turbinate is the clear and distinct separation between thetwo ethmoid complexes, according to definition, patterns of mucociliary secretion transport, and embryologic development. The posterior end is attached to the crista ethmoidalis of the perpendicular process of the palatine bone(lamina perpendicularis). The middle third turns laterally across the skull base to the lamina papyracea, where it turns inferiorly. Depending on the degree of pneumatization, agger nasi cells may reach laterally to the lacrimal fossa and cause narrowing of the frontal recess.
The bulla lamella can form the posterior wall of the frontal recess if it reaches the roof of the ethmoid. Anteriorly, it is separated from the frontal recess only when the bulla lamella reaches the skull base . The ethmoid infundibulum is the most important pathophysiologically, and the others are notable primarily for historical perspective. Fusion with the anterior border of the uncinate process provides a connection with the inferior turbinate. Periosteum and mucous membrane cover bony defects in the lateral nasal wall, forming the anterior and posterior nasal fontanelles. If the uncinate process reaches to the skull base or fuses with the middle turbinate medially, the ethmoid infundibulum may pass into the frontal recess superiorly. The maxillary infundibulum, after the Latin infundibulum sinus maxillaris or infundibulum maxillare, is the funnel-shaped narrowing of the lumen of the maxillary sinus toward its natural ostium. A discrete posterior margin exists only when the basal lamella ofthe bulla reaches the skull base, separating the frontal recess from the suprabullar recess . For example, if they reach the lacrimal sac and pneumatize into the lacrimal bone, they would be lacrimal cells of the ethmoid infundibulum or lacrimal cells of the frontal recess.
Thus, the mucosa of the maxillary sinus and the middle meatus are separated only by a fibrous layer of periosteum.
Indentations or foveolae in the frontal bone cover the corresponding clefts and cells ofthe ethmoid. The pneumatization of the middle turbinate usually originates from the frontal recess or the agger nasi, and growth of a concha bullosa may begin late in life. The term cellula orbitoethmoidalis or orbitoethmoidcell does not indicate, for example, that the cell grows directly into the floor of the orbit. The superior nasal meatus (meatus nasi superior) and supreme nasal meatus(meatus nasi supremus) lie underneath the respective turbinates. Medially there is no clearcut inferior border, and laterally the inferior border is seen at the inferior margin of the superior turbinate. Consequently, attempts to use instrumentation to locate the sphenoid sinus directly behind the last cell of the posterior ethmoid complex may result in serious damage to the optic nerve or carotid artery. The optic canal (canalis opticus) can project into the sinus lumen, and dehiscences of the bony wall may be present. The middle and posterior sections of the depression between the first and second ethmoturbinals(the descending portion) become the ethmoid infundibulum, and the superior ascending part becomes the frontal recess. Therefore, we continue to use the terms anterior ethmoid and posterior ethmoid and designate the basal lamella of the middle turbinate as their separation. The Onodi cell is a posterior ethmoid cell which pneumatized far laterally and to some degree superiorly to the sphenoid sinus and is intimately associated with the optic nerve. Like the sphenoid, it is a single bone that runs through the mid-sagittal plane and aids to connect the cranial skeleton to the facial skeleton. These projections, like the separate Inferior Nasal Concha, assist in increasing the surface area within the nasal cavity and thereby the exposure of the brachiating olfactory nerve to inhaled odors. It is a single bone that runs thrugh the mid-sagittal plane and aids to connect the cranial skeleton to the facial skeleton.
Each process is formed from a Medial and Lateral Pterygoid Plate to which the respective medial and lateral pterygoid muscle is attached during life.


The dissection was continued superiorly in the preseptal plane to the level of the orbital rim superonasally and continued further through the orbital septum. Among the bony orbital tumors, fibrous dysplasias and osteomas are the most commonly encountered entities (Selva et al 2004). These lesions are encountered infrequently in the skull and facial bones, and they are usually smaller than 1.5 cm in diameter when they occur in these locations (Greenspan 1993). Often, these lesions are detected on imaging inadvertently during a workup for another reason (Benatiya Andaloussi et al 2006).
A key concept is that the ethmoid complex is divided into anterior and posterior sections by the basal lamella of the middle turbinate. Kaufmann' s term may be retained for its historical interest but not used in a rigorous anatomic context.
Since then, others have erroneously used the terms frontal infundibulum and nasofrontal duct synonymously with frontal recess.
For another example, the frontal recess has been called the frontal infundibulum of the hiatus semilunaris, and the terms hiatus semilunaris and ethmoid infundibulum have been used for the same structure.
Cells and clefts that open and drain anteriorly and inferiorly to this lamella belong to the anterior ethmoid complex; those that open or drain posteriorly or superiorly, with the exception of the sphenoid sinus, belong to the posterior ethmoid complex. The posterior segment is attached to the lamina papyracea, the medial wall of the maxillary sinus, or both, to form the roof of the posterior third of the middle meatus. Cells or well-pneumatized clefts of the anterior ethmoid can indent this plate dorsally, giving it a posterosuperior orientation.
Its concave posterosuperior free margin is parallel to the anterior surface of the ethmoid bulla. Failure to reach the skull base, however, results information of the suprabullar recess, an aerated space of varying dimensions between the bulla lamella and the skull base. First, the Latin root translates directly into English as cleft, gap, or passageway; indeed, the hiatus semilunaris inferior is a crescent-shaped cleft. The ethmoid infundibulurn, from infundibulum ethmoidale, is a cleft or true three-dimensional space.
A cell that pneumatizes into the frontal bone is likewise a frontal cell of the anterior ethmoid or a bulla frontalis.
In type 3, the olfactory fossais 8 to 16 mm deep, and the ethmoid roof lies significantly above the cribriform plate.
The term infraorbitalethmoid cell is better because it implies contrast with a supraorbital cell that originates from the frontal or suprabullar recess. Because the individual cells and clefts underneath the supreme(or fourth) turbinate are nowhere defined in the literature, they are considered part of a single posterior ethmoid complex.
The optic nerve may pass through a sphenoethmoid cell or sphenoid sinus like a column, surrounded by pneumatized space.
Like mature turbinates, each ridge and furrow has an anterior ascending and a posterior descending portion.
Coronal CT scanning is requisite to detect the Onodi cell; when it is present, an image of the sphenoid sinus just as if it were divided into top and bottom is characteristic. In early hominids these ridges formed a Torus or large shelf-like process protruding from above the eyes. The Superor or Supreme Nasal Conche are smaller, and cannot be viewed through the anterior nasal opening because it is blocked from view by the the more inferior Middle Nasal Conche.
It consists of a hollow body, which contians the Sphenoidal Sinus, and three pairs of projections: the more superior Lesser Wings, the intermediate Greater Wings, and the most inferior projecting Pterygoid Processes. The muscles run from these attachments to the internal, or medial surface, of the mandible in the area of the gonial angle. The expressions middle ethmoid and middle ethmoid cells should not be used, because in terms of anatomy, physiology, or function, no structure represents the middle of the ethmoid complex. When a retrobullar recess is well developed, anterior ethmoid cells can reach back almost to the sphenoid sinus. The uncinate process attaches to the perpendicular process(lamina perpendicularis) of the palatine bone and the ethmoid process of the inferior turbinate with bony spicules. The suprabullar and retrobullar recess also can be approached medially and inferiorly through the hiatus semilunaris superior. Second, the passageway is like a doorway through which one must pass to arrive at the ethmoid infundibulum, which is a three-dimensional space. Were a cast made of the space, it would typically resemble an inverted segment of grapefruit with the wide edge facing posteriorly.
This may result in a tubular appearance on sagittal section, which is the reason the narrowed recess came to be known, albeit incorrectly, as the nasofrontal duct.
Seen from above, the frontal recess narrows toward its ostium (through the frontal infundibulum).
The anterior fontanelleis inferior and anterior to the uncinate process; the posterior fontanelle is superior and posterior to the part of the uncinate process that fuses with the medial wall of the maxillary sinus.
Because of the danger that instrumentation can penetrate the thin and vulnerable lateral lamella, this is the configuration of greatest concern for the surgeon. For exactitude, the full term is infraorbital cell of the anterior or posterior ethmoids, depending on its origin.
The inferior turbinate, known as the maxilloturbinal, is a single bone unrelated to the ethmoturbinals. In our material from 200 patients (direct coronal CT scans 10 mm in width), the Onodi cell was observed in 7%. Associated with each Superior Orbital Margin of the eye orbit the frontal bone may posses a Supra-Orbital Notch or if completely surrounded by bone, a Supra-Orbital Foramen. The Orbital or Lateral Surface contributes to the eye orbit, while the Medial Surface assists in forming a small portion of the nasal passage.
Conversely, cells of the posterior ethmoid or the superior meatus can create an anterior bulge in the midsection of the basal lamella.
The convex anterior margin ascends to the lacrimal bone,and sometimes to the skull base or lamina papyracea, remaining in contact with the bony lateral nasal wall(Fig 4) PNS4.gif . Under certain conditions, a tubular structure can be the communication between the frontal recess and the frontal sinus. From the level of the ostium, the frontal recess then widens in the inferior and posterior direction, usually in the shape of an inverted funnel. A supraorbital cell is an anatomic variant that develops as an extension, from the posterior aspect, of the frontal or suprabullar recess.
The more pronounced the pneumatization of the anterior clinoid process, the deeper the recess. A case of RON whose pathogenesis was considered to be a direct spread of inflammation from the localized infection of the Onodi cell is reported. Above the fronto-nasal suture which allows articulation between the frontal and nasal bones there is generally a trace of the vertical Metopic Suture.
The smaller lesser wings posssesses the Optic Foramen through which the optic or second cranial nerve passes before giving rise to the eye.
When curved medially to a greater than usual extent, the free margin of the uncinate process may protrude into, and sometimes even out of, the middle nasal meatus.
This is a second, but only vaguely defined, crescent-shaped cleft between the ethmoid bulla and the middle turbinate.
Ethmoiditis localized to the Onodi cell seems to play an important role in the pathogenesis of RON. The Supra-Orbital Fissure separates the lesser wing superiorly from the greater wing below and can best be viewed on the posterior wall of each eye orbit. Anatomic pathology demonstrated histopathologic findings consistent with an osteoid osteoma and no evidence of atypia.
The uncinate process may attach to the middle turbinate superiorly, too, when curved medially in its superior most portion. The suprabullar and retrobullar recess can be entered medially and inferiorly underneath the middle turbinate through the hiatus semilunaris superior. Continued careful documentation of the localized posterior paranasal sinus lesion around the optic canal by detailed diagnostic imaging and endoscopic sinus surgery is necessary to resolve the disease entity of RON.
The left and right greater wings assist in forming the posterior wall of each of the eye orbits where it forms an Orbital Plate. In rare cases, the superior part of the uncinate process may attach with several "fingers" to the middle turbinate, the skull base, and the lateral nasal wall as well. The left and right Frontal Crest, begins at each Zygomatic Process of the frontal bone, and provides the anterior origin of the Temporal Line to which the left and right temporal muscle is attached.
Directly inferior to the Crista Galli and running in the mid-sagittal plane is the Perpendicular Plate of the ethmoid which articulates with the vomer more inferiorly and assists in separating the left and right nasal passages. In addition the external surface of the greater wing can be viewed in the the lateral view of the cranium in an area called the Pterion Region. Just inferior to the supra-orbital fissure near the body of the sphenoid, each of the greater wings also possess a Foramen Rotundum which in life transmits the maxillary branch of the fifth, or trigeminal, cranial nerve. Each of these wings also possesses a much larger Foramen Ovale more laterally, which transmits the the mandibular branch of the same nerve. More posteriorly is the smallest of the three pairs of foramena, the Foramen Spinosum which transmits the middle meningial vessels and nerve to the tissues covering the brain.



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