Essential Anatomy of the Nose

Jenica Yong

NOSE COURSE 2019

Disclaimers

• No conflicts of interest

• Photos are either courtesy of Dr Park or my own patients

Scope

• Anatomy and how it relates to surgery

• Nasal analysis

Anatomy

• Skin

• Subcutaneous tissue

• Osteocartilaginous complex

– Nasal valves

• Blood Supply

Rhinoplasty Current Concepts 2010 Gruber R

Tip and dorsum augmentation Better contour Take out this mass!

Skin

Surgical Anatomy of the Face W Larrabee 1992

Kim EG, Eom TK, Kang SJ. Severe visual loss and cerebral infarction after injection of hyaluronic acid gel. J Craniofac Surg. 2014;25(2):684-6

• Skin

• Subcutaneous tissue

• Osteocartilaginous complex

– Nasal valves

• Blood Supply

Subcutaneous Tissue

• Superficial fatty panniculus

• Fibromuscular layer: SMAS

• Deep fatty layer

• Periosteum/ Perichondrium

Hedén, Per. Nasal Reshaping with Hyaluronic Acid: An Alternative or Complement to Surgery. Plastic and reconstructive surgery. vol. 4,11 e1120. 28 Nov. 2016

Blood Supply

Gunter JP, Rochrich RJ, Adams WP. Dallas Rhinoplasty 2nd edition 2007

Plunging tip – Optical illusion?

Kosins AM, Lambros V, Daniel RK. The plunging tip: illusion and reality. Asethet Surg. 2014 Jan 1:34(1):45-55.

Muscles

• Intrinsic

– Procerus, pars transversa, pars alaris

• Extrinsic

– Levator labii superioris alaeque nasi

– Zygomaticus minor

– Orbicularis oris

– Depressor septi

Anatomy

• Skin

• Subcutaneous tissue

• Osteocartilaginous complex

– Nasal valves

• Blood Supply

Rhinoplasty Current Concepts 2010 Gruber R

Osteocartilaginous complex

Where is the Radix?

S Park, C Woodard

D Toriumi

Dallas Rhinoplasty

Cummings

Byrd

Upper cartilaginous vault

Nasal Valves

Acta Otolaryngol 2008 Suh MW: CT vs nasal endoscopy for the measurement of the internal nasal valve in Asians

Asians : 21.6 +/- 4.5

Cottle’s maneuver

Modified Cottle’s maneuver

Lower cartilaginous vault

Recurvature of LLC

Septum

DO NOT PERFORATE!

RIGHT PLANE!

Anatomy

• Skin

• Subcutaneous tissue

• Osteocartilaginous complex

– Nasal valves

• Blood Supply

Rhinoplasty Current Concepts 2010 Gruber R

THANK YOU!