This document provides an overview of the anatomy of the nose, including both the external nose and nasal cavity. It describes the skin, muscles, bones, and cartilages that make up the external nose. It then details the structures within the nasal cavity, including the nasal septum, lateral wall with its turbinates and meatuses, roof and floor. Throughout, it emphasizes the applied clinical significance of various anatomical structures and relationships as they relate to nasal function, trauma, and surgery.

2. Applied Anatomy of
Nose
Dr. Basit Ali Khan,
House officer, ENT Dep., HFH.

3. Nose
 External nose
 Nasal cavity

4. External Nose

5. EXTERNAL NOSE

6. Skin and Soft Tissue
 Upper/bony part Thin and loosely adherent
 Tip / cartilaginous part Thick and strongly adherent
contains numerous sebaceous glands

7. Subcutaneous Tissue
 The subcutaneous tissue of the
nose is made up of four layers:
1. Superficial fatty layer,
2. Fibromuscular layer (comprises
the nasal SMAS)
3. Deep fatty layer (contains the
neurovascular system)
4. Periosteum / perichondrium.

8.  Applied !
During external approach
rhinoplasty dissection deep to the
third layer of the nose (deep fatty
layer) minimizes post-operative
scarring and retraction because the
neurovascular and SMAS structures
are preserved.

9. Muscles of nose
.
Elevators
Procerus,
Levator labii-superioris
alaeque nasi
Compressors
transverse nasalis
compressor narium
minor.
Depressors
alar nasalis
depressor septi
Dilator
dilator naris

11. Skeleton of External Nose
1/3
2/3

12. Skeleton of external nose
 Bony skeleton/vault
• Nasal bones,
• Frontal processes of the
maxillae,
• The nasal part of the frontal
bone.

13. Applied!
Nasal bone is the most
commonly fractured bone in
facial trauma.

14. Upper Cartilaginous Vault
 Paired upper lateral cartilages (ULC)
 Part of septal cartilages

15. Upper Lateral Cartilage (ULC)
 Triangular
 Superiorly, the upper lateral
cartilages are overlapped by nasal
bones
 Caudally, the upper lateral cartilage
curves under and articulates with the
lower lateral cartilages in the scroll
region.
 Medially, the upper lateral cartilages
fuse with the septal cartilage

16. Upper Lateral Cartilage (ULC)
 Inferiorly, the medial edge of the
cartilage is often free.
 The lateral aspect of the upper
lateral cartilage is adherent to
fibrous tissue that approaches the
piriform aperture and, if present,
the sesamoid cartilages.

17. Upper Cartilaginous Vault
 Keystone area: centre of support
of nasal roof
 Scroll area: nasal tip support.

18. Upper Cartilaginous Vault
• Internal nasal valve
• The narrowest portion of the nasal
cavity
• The apex of the internal nasal valve
is approximately 10–15 degrees in
Caucasians and wider in non-
Caucasian populations.
 Septum medially (1). Caudal edge of the upper
lateral cartilage (2) and head of the inferior
turbinate (3) laterally. Nasal floor inferiorly
Applied!
Changes in the relationship of any
structure within this space can cause
symptoms of nasal obstruction.

19. • Applied !
Violation of the support for the upper
lateral cartilages can cause cosmetic
and functional problems, including nasal
obstruction and the inverted-V
deformity.

20. Lower Cartilaginous Vault
 Paired alar cartilages (lower lateral
cartilage)
 Lower lateral cartilage
 C-shaped cartilage
 Parts…..medial, intermediate and
lateral crura
 Angulations or ‘domes’ between
the medial and lateral crurae of the
LLCs are separated by a notch
palpable at the tip of the nose.

21. Lower Cartilaginous Vault
 Tripod theory
 Anderson has compared Lower Lateral
Cartilage to a tripod
1. Two lateral crura forming the cephalic
lateral legs,
2. The adjoining medial crura as the third,
caudal-medial leg.

22. Applied!
Re-establishment of this
tripod should be the goal
of any major nasal-tip
correction.

23. External Nasal Valve
 Comprised of
 The septum medially,
 Alar rim (lateral crus, sesamoid
complex and fibrofatty tissue)
laterally,
 Nasal sill inferiorly.

24. Applied!
Anatomical abnormalities or
compromise in the structural integrity
of these components can cause
external valve narrowing, stenosis or
dynamic valve collapse

25. Factors Affecting Shape & Position of
Nasal Tip
1. Lower lateral cartilages (major
support)
2. Ligaments and fibrous
attachments of nasal tip
structures
3. Thickness of overlying skin

26. Features of Nasal Tip
 A pleasing appearing nasal tip will
usually have the following
components:
1. The basal width of the nose
should be approximately the same
as the intercanthal distance.

27. Features of Nasal Tip
2. Four landmarks should be highlighted
on the frontal view:
 Supra-tip break,
 Paired tip defining points (most anterior
projection of the tip cartilages)
 The most inferior portion of the infra-tip
lobule.
 These points should divide the tip
complex into two equal and opposite
equilateral triangles

28. Features of Nasal Tip
3. From the basal view, the base
should form an equilateral triangle
with rounded corners, side walls and
a lobule to nostril ratio of 1 : 2

29. Features of Nasal Tip
4. On lateral view, a straight line drawn from the naso-
frontal angle to the TDP should be 2–3 mm anterior
to the nasal dorsum in females. This should result in
a slight supra-tip break.
 Generally, this is not necessary in males and one
should err on the side of a straight nasal dorsum to
prevent the nose from appearing feminine.

30. Columella
 Extends between upper lip and tip
of the nose
 Anteriorly- diverging crura form
an angle of 30 degrees for tip
formation.
 Posteriorly - also diverge to
receive septal cartilage.
 Shape of columella depends on size
and shape of medial crura.

31. Applied!

32. Blood supply of external nose
1. Dorsal and external nasal branch
of ophthalmic artery
2. Infraorbital br. of maxillary artery
3. Angular and superior labial
branches of facial artery.
 The venous networks do not parallel
the arterial supply. Drain into facial
and ophthalmic veins.

33.  Applied!
 The upper lip and nose are
considered the danger area of the
face because infections in this
region may be transmitted through
a valve-less venous system to the
cavernous sinus.

34. NASAL CAVITY

35. NASAL CAVITY
 Communicates with the exterior
through naris or nostril
 and with the nasopharynx through
posterior nasal aperture or the
choana.
 Each nasal cavity consists of a
skin-lined portion—the vestibule
and a mucosa-lined portion, the
nasal cavity proper.

36. A. Vestibule
 Anterior and inferior part of nasal cavity is
called vestibule.
 Lined by skin and contains sebaceous
glands, hair follicles and the hair called
vibrissae.
 Its upper limit on the lateral wall is marked
by limen nasi, located at the caudal border
of the lower lateral cartilage.

37. B. Nasal Cavity Proper
 Each nasal cavity has a
• Lateral wall,
• Medial wall,
• Roof and
• Floor.

38. ROOF

39. FLOOR

40. Medial Wall (Nasal Septum)
A. Bony septum
 The posterosuperior vomer
 The anterosuperior perpendicular
plate of the ethmoid .
 Minor contributions
1. Nasal bones + the nasal spine of the
frontal bones.
2. The rostrum and crest of the sphenoid.
3. The nasal crests of the maxilla and
palatine bones.

41. Medial Wall (Nasal Septum)
B. Cartilaginous septum
 Septal/quadrilateral cartilage.
 Anterosuperior margin is connected
to internasal suture,
 Distal end of its superior portion is
continuous with the ULC
 The anteroinferior border is
connected to the medial crurae of the
major alar cartilage.

42. Medial Wall (Nasal Septum)
 The posterosuperior border
joins the perpendicular plate of
the ethmoid,
 Posteroinferior border is
attached to the vomer and
anterior to that to the nasal
crest and anterior nasal spine of
the maxilla.

43. Applied!
The inferior attachment sits within the
nasal crest of the maxilla and is
bounded by looser connective tissue.
This joint allows mobility of the septal
cartilage base during flexion thereby
reducing the risk of fracture or
dislocation with trauma.

44. Medial Wall (Nasal Septum)
 Septal tail
 A projection of the septal cartilage
called the sphenoidal process or
septal tail extends posteriorly between
the vomer and perpendicular plate of
the ethmoid.
The septal tail can serve as an
additional source of cartilage to
harvest especially during revision
rhinoplasty.

45. Applied!
Different studies* showed that a long SP, a
remnant cartilaginous tail of the nasal septum
resulting from delayed ossification of the nasal
septum, contributes to the worsening of septal
deviation.
*
1. Kim J, Kim SW, Kim SW, Cho JH, Park YJ. Role of the sphenoidal process of the septal cartilage in the development of septal deviation. Otolaryngol Head Neck Surg.
2012;146(1):151‐155. doi:10.1177/0194599811425000
2. Kim, J, Han, SH, Kim, SW. Clinical significance of the sphenoidal process of the cartilaginous nasal septum: a preliminary morphological evaluation. Clin Anat. 2010;23:265-
269.

46. Medial Wall (Nasal Septum)
C. Membranous septum
 Lies b/w septal cartilage &
columella
 Consists of vestibular skin with
intervening areolar tissue.
It acts as a shock absorber between the
columella and the cartilaginous septum,
softening blows to the lower nose.

47. Medial Wall (Nasal Septum)
D. Columellar septum.
 It is formed of columella containing
the medial crura of alar cartilages
united together by fibrous tissue and
covered on either side by skin.

48. Medial Wall (Nasal Septum)
 The nasal septal swell body
 A widened region of the anterior nasal
septum located anterior to the middle
turbinate at the internal nasal valve.
 Histological analysis of this tissue
demonstrates an increased amount of venous
sinusoids and fewer glandular elements
compared to adjacent septal mucosa.

49. Applied!
The high proportion of venous
sinusoids suggests the capacity to
alter nasal airflow in a similar
manner to the inferior turbinates.

50. Lateral Wall
 Lateral wall (osteology)
 Maxilla
 Perpendicular plate of the
palatine bone;
 Labyrinth of the ethmoid bone.
 Turbinates
 Three projections
 Meatus
 The space below the turbinate

51. Lateral Wall
 Inferior turbinate and inferior
meatus
 Independent bone
 The nasolacrimal duct drains
into the inferior meatus
approximately 1 cm posterior to
the head of the inferior turbinate.
 Guarded by mucosal valve
(Hasner’s valve)

52. Lateral Wall
 Middle Turbinate.
 A part of ethmoid bone.
 Its attachment is not straight but in
an S-shaped manner.

53. LATERAL WALL
(Middle Meatus)
 Middle meatus
 Uncinate process
 Hook-like structure
 Running from AS to PI direction.
 PS border runs parallel to anterior
border of bulla ethmoidalis; the gap
between the two is called hiatus
semilunaris

54. LATERAL WALL
(Middle Meatus)
 The anteroinferior border is attached to
the lateral wall.
 Posteroinferior end of uncinate process
is attached to inferior turbinate dividing
the membranous part of lower middle
meatus into anterior and posterior
fontanelle. The fontanel area is devoid of
bone and consists of membrane only and
leads into maxillary sinus when
perforated.

55. LATERAL WALL
(Middle Meatus)

56. LATERAL WALL
(Middle Meatus)

57. LATERAL WALL
(Middle Meatus)
 Bulla Ethmoidalis
 It is an ethmoidal cell situated
behind the uncinate process

58. LATERAL WALL
(Middle Meatus)
 Agger Nasi.
 Anterior ethmoid air cells
 Anterior to the attachment of
middle turbinate.

59. Applied!
An enlarged agger nasi cell may encroach on
frontal recess area, and cause mechanical
obstruction to frontal sinus drainage.

60. LATERAL WALL
(Middle Meatus)
 Concha Bullosa
 Pneumatization of middle turbinate
leads to an enlarged ballooned out
middle turbinate. (30%)

61. LATERAL WALL
(Middle Meatus)
 Haller cells
 Air cells situated in the roof of
maxillary sinus.
Applied!
Enlargement of Haller cells
encroaches on ethmoid infundibulum,
impeding draining of maxillary sinus.

62. LATERAL WALL
(Superior Meatus)
 Superior Turbinate. (Part of
ethmoid bone)
 Superior Meatus.
 It is a space below the superior
turbinate.
 Posterior ethmoid cells open into
it.

63. Lateral Wall
 Spheno-ethmoidal recess.
 It is situated above the superior
turbinate.
 Sphenoid sinus opens into it.

64. Bloodsupply

65. Bloodsupply
(Lateralwall)

66. Innervation
Lateral wall Medial wall

67. Thank you !