Rhinoplasty (Anatomy of Nose)

Prepared by : Ahmad Abid Bin Abas 07-5-2

External Nose

Base 1 – infratip lobule

2 - columella3 – alar sidewall4 – facet, or soft-tissue triangle5 - nostril sill6 - columella-labial angle or junction7 - alar-facial groove or junction8 - tip defining points

Vascular Anatomy of Nose

Nasal Septum

Figure: Septum 1 – quadrangular caratilage

2 – nasal spine3 – posterior septal angle4 – middle septal angle5 – anterior septal angle6 – vomer7 – perpendicular plate of     ethmoid bone8 – maxillary crest,     maxillary component9 – maxillary crest –     palatine component

Vascular Supply of Nasal Septum

Muscles of Nose

1) Procerus muscle2) Frontal sinus3) Frontal bone4) Frontal spine5) Nasal bone6) Transverse part of nasalis muscle7) Alar part of nasalis muscle8) Major alar cartilage and attach of nasal muscles9) Nasal fibro-adipose tissue10) Maxillary bone11) Levator nasal septi muscle12) Depressor nasal septi muscle13) Highest part of alveolar process

Nasal Subunit

1- Tip subunit2- Columellar subunit3- Right alar base subunit4- Right alar side wall subunit 5- Right alar base subunit6- Left alar base subunit7- Dorsal subunit8- Right dorsal side wall subunit9- Left dorsal side wall subunit

Internal Nasal Valve Anatomy

The internal valve is defined by the angle that the septum makes with the upper lateral cartilage.

Usually 10-15 degrees in Caucasian (wider in African or Asian nose)

The narrowest portion of the nasal cavity Superior- Caudal end of ULC and Septum

Posterior – Head of inferior turbinateInferior – Nasal FloorLateral – Bony pyriform aperture and

adjacent fibrofatty tissue.

External Nasal Valve

Nasal Vestibule (compartment caudal to INV) Fibrofatty tissue of alar lobule

and LLC.Fascia continuous w/perichondrium and periosteumCaudal septumPyriform aperture.

Nasal Valve Collapse

This is a condition where the sidewalls of the nostrils collapse as breathe in.

Causes : 1) Post Operative Stenosis (trauma,surgery,iatrogenic,reduction rhinoplasty)2) Deviated Septum : (most common cause of INV collapse)3) Septoplasty and Turbinate Reduction : (Most common procedures addressing nasal valve obstruction)4) Turbinate Hypertrophy : (INV stenosis,mucosal or bony)

Techniques to treat Nasal Collapse

Spreader Grafts (Widely used,correct lack of dorsal support to lateral walls)- Spreader Grafts Placement

Endonasal Placement (Septoplasty approach) Endoscopic Placement (Cadaver study : Increase area on acoustic

rhinometry) Septal Crossbar (Increase nasal valve patency) Spring Graft ULC Suspension( Elevation of dorsal ULC) Flaring Suture (Improve INV angle,open approach) Mini Spreader Grafts Autospreader flap

Conclusion

Nasal obstruction is bad.Nasal surgery is good.

References

References: T . Fattahi - An overview of facial aesthetic units. Journal of Oral and Maxillofacial Surgery http://emedicine.medscape.com/article/835134-overview#aw2aab6b7 http://www.revisionrhinoplasty.com/anatomy.html http://www.todaysface.com/Articles/Ch044thenasalseptum03.html Rhinoplasty and The Nasal Valve, University of Texas Dept of Otolaryngology Jan 16,2008. http://www.docstoc.com/docs/82309760/Rhinoplasty-and-the-Nasal-Valve