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Rhinoplasty (Nose Anatomy)


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Rhinoplasty (Nose Anatomy)

  1. 1. Rhinoplasty(Anatomy of Nose) Prepared by : Ahmad Abid Bin Abas 07-5-2
  2. 2. External Nose
  3. 3.  Base 1 – infratip lobule 2 - columella 3 – alar sidewall 4 – facet, or soft-tissue triangle 5 - nostril sill 6 - columella-labial angle or junction 7 - alar-facial groove or junction 8 - tip defining points
  4. 4. Vascular Anatomy of Nose
  5. 5. Figure: Septum 1 – quadrangular caratilage 2 – nasal spine 3 – posterior septal angle 4 – middle septal angle 5 – anterior septal angle 6 – vomer 7 – perpendicular plate of ethmoid bone 8 – maxillary crest, maxillary component 9 – maxillary crest – palatine componentNasal Septum
  6. 6. Vascular Supply of Nasal Septum
  7. 7. 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 processMuscles of Nose
  8. 8.  1- Tip subunit 2- Columellar subunit 3- Right alar base subunit 4- Right alar side wall subunit 5- Right alar base subunit 6- Left alar base subunit 7- Dorsal subunit 8- Right dorsal side wall subunit 9- Left dorsal side wall subunitNasal Subunit
  9. 9.  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 turbinate Inferior – Nasal Floor Lateral – Bony pyriform aperture and adjacent fibrofatty tissue.Internal Nasal Valve Anatomy
  10. 10.  Nasal Vestibule (compartment caudal to INV) Fibrofatty tissue of alar lobule and LLC. Fascia continuous w/perichondrium and periosteum Caudal septum Pyriform aperture.External Nasal Valve
  11. 11.  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)Nasal Valve Collapse
  12. 12.  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 flapTechniques to treat Nasal Collapse
  13. 13.  Nasal obstruction is bad. Nasal surgery is good.Conclusion
  14. 14.  References: T . Fattahi - An overview of facial aesthetic units. Journal of Oral and Maxillofacial Surgery Rhinoplasty and The Nasal Valve, University of Texas Dept of Otolaryngology Jan 16,2008.