Anatomy

The nasal cavities are separated by the nasal septum, and limited by a roof, which is formed by the cribriform plate of the ethmoid, and a floor, which is formed by the hard palate [261]. The lateral walls have three turbinates or conchae, and three horizontal spaces, or meatus, on each side. The nasolacrimal duct opens in the inferior meatus, whereas the middle meatus receives drainage from the frontal, anterior ethmoid and maxillary sinuses. Below the superior turbinate is the sphenoethmoid recess, with the openings of the sphenoid and posterior ethmoid sinuses. Each nasal cavity communicates posteriorly with the nasopharynx through the choanae. The paranasal sinuses are a group of cavities within the corresponding craniofacial bones (maxilla, sphenoid, ethmoid and frontal) that communicate with the nasal cavities through an ostium.

The nasal vestibule and skin share a similar histology. At the level of the limen nasi, the keratinising squamous epithelium gradually changes first to cuboidal or columnar epithelium, and then to ciliated respiratory-type epithelium, which lines most of the nasal cavity and all the

Bacterial rhinosinusitis usually follows a viral infection or allergic rhinitis, and the most commonly involved agents are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis [11, 34]. A dense inflammatory infiltrate mainly made of neutrophils occupies the lamina propria. Acute bacterial rhinosinusitis usually resolves with antibiotic therapy. Complications are rare and include contiguous infectious involvement of the orbit or central nervous system.

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