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Rhinoplasty Bizrah: Surgical Anatomy

March 28, 2017 by basharbizrah0

A knowledge of the basic surgical anatomy is needed for the clarification of terminology and for an understanding of the surgical procedures described in subsequent chapters. (Figs. 4 – 1,2,3,4,)

The surgeon should be familiar with the following primary anatomy and basic landmarks:
– Bony vault:             – Paired nasal bones
– Paired frontal process of the maxilla (distal portion)
– Cartilagenous vault: – Paired upper lateral cartilages
– Dorsum septum
– Tip cartilage:          – Paired lower lateral or alar cartilage
– Nasal septum:        – Quadrangular cartilage
– Perpendicular plate of the ethmoid
– Vomer
– Maxillary crest

Key Anatomical Landmarks:

  1. Naison
  2. Rhinion
  3. Supratip
  4. Infratip
  5. Double break
  6. Sheen’s four landmarks on the nasal tip:
    1. The point of tip differentiation (supratip breakpoint)
    2. The right dome
    3. The left dome
    4. The columella-lobular breakpoint
  7. Angle of divergence: which refers to the separation between the two middle crura
  8. Angle of rotation:which is essentially the columella-lobular angle
  9. Columella
  10. Nasolabial angle
  11. Supra-alar
  12. Nares
  13. Alar rim
  14. Alar flare
  15. SIL
  16. Nasofrontal suture
  17. Nasal bone
    1. Bony cartilagenous junction
    2. Upper lateral cartilage
    3. Dorsum septum
    4. Superior septal angle
    5. Dome: cartilage that lies between external and internal soft triangles (Facets)

Lower lateral cartilage

  1. Lateral crus
  2. Medial crus
  3. Intermediate crura
  4. The domal junction: the transition from middle to lateral crus in refined tip
  5. Medial crus footplate
  6. Internal soft triangle
  7. External soft triangle
  8. Pyriform aperture
  9. Interdomal space
  10. Caudal septum
  11. Nasal spine
  12. Nasal vestibule: stratified squamous epithelium
  13. Mucovestibular junction
  14. Nasal septum
  15. Inferior turbinate

 

 

Fig. 4 – 1. Key anatomical landmarks

Fig. 4 – 2. Key anatomical landmarks

Fig. 4 – 3. Nasal landmarks

Fig. 4 – 4. Anatomy of the nasal septum

Refrences
Surgical Anatomy
 

1. Anderson J: A reasoned approach to nasal bone surgery. Arch. Otolaryngol. 110:349, 1984.
2. Anderson J.R. A personal technique of rhinoplasty. Otolaryngol. Clin. North Am. 8:559, 1975.
3. Batson, O.V. The venous networks of the nasal mucosa. Ann. Rhinol. Laryngol. 63:571, 1954.
4. Bernstein, L. Surgical anatomy in rhinoplasty. Otolaryngol. Clin. North Am. 8:549, 1975.
5. Burgett, G., and Menica, F.J. Nasal support and lining: The marriage of beauty and blood supply. Plast. Reconstr. Surg. 84:189, 1989.
6. Byrd, S. aesthetic balance of the nose, lip and chin. Presented at Texas Rhinoplasty Symposium, Dallas, March 1990.
7. Converse, J.M. The cartilaginous structures of the nose. Ann. Otol. Rhinol. Laryngol. 64:220, 1955.
8. Cottle, M.H. Structures and function of the nasal vestibule. Arch. Otolaryngol. Head Neck Surg. 62:173, 1955.
9. Crumley RJ, Lancer M: Quantitative analysis of the nasal tip projection. Laryngoscope 98:202-208, 1988.
10. Daniel RK, Letourmeau A: Nasal anatomy, Ann. Plast. Surg. 205:5-13, 1988.
11. Daniel RK. The nasal tip: Anatomy and aesthetics. Plast. Reconstr. Surg. 89:216, 1992.
12. Daniel, R.K., and Lessard, M.L. Rhinoplasty: A graded aesthetic-anatomical approach. Ann. Plast. Surg. 13:436, 1984.
13. Dingman, R.O., and Natvig, P. Surgical anatomy in aesthetic and corrective rhinoplasty. Plast. Surg. Clin. 4:111, 1977.
14. Dion, M.D., Jafek, B.W., and Tobin, C.E. the anatomy of the nose. Arch. Otolaryngol. Head Neck Surg. 104:145, 1978.
15. Deneke JH, Meyer J: Plastic Surgery on the Head and Neck. New York, Springer-Verlag, 1967.
16. Faigin G: Facial Expression. New York, Watson-Guptill, 1990, pp 24-25.
17. Griesman B: Muscles and cartilages of the nose from the standpoint of a typical rhinoplasty. Arch. Otolaryngol. 39:334, 1944
18. Gilbert, J.G., and Feit, L.J. The nasal aponeurosis and its role in rhinoplasty. Arch. Otolaryngol. Head Nech Surg. 61:433, 1955.
19. Haight JSJ, Cole P: The site and function of the nasal valve. Laryngoscope 93:49, 1983.
20. Hamm J: Drawing the Head and Figure. New York, Putnam Publishing, 1963, p 29.
21. Larrabee WF Jr, Makielski KH: Surgery Anatomy of the Face. New York, Raven Press, 1993, p 154-155.
22. Lessard ML, Daniel RK: Surgical anatomy of the septorhinoplasty. Arch. Otolaryngol. 111-25, 1985.
23. McKinney, P., Johnson, P., and Walloch, J. Anatomy of the nasal hump. Plast. Reconstr. Surg. 77:404, 1986.
24. Mink PJ: Le nez comme voie respiratory. Presse Otolaryngol. (Belg) 418, 1903.
25. Parell, G.J., and Becker, G.D. The “tension nose.” Facial Plast. Surg. 1:81, 1984.
26. Peck, G.C., and Michelson, L.N. Anatomy of aesthetic surgery of the nose. Plast. Surg. Clin. 14:737, 1987.
27. Pitanguy, I. Surgical importance of a dermocartilaginous ligament in bulbous noses. Plast. Reconstr. Surg. 36:247, 1965.
28. Rohrich, R.J., and Gunter, J.P. Vascular basis for external approach to rhinoplasty. Surg. Forum 13:240, 1990.
29. Sheen, J.H., and Sheen, A.P. Aesthetic Rhinoplasty (2nd ed.). St. Louis: Mosby, 1987.
30. Sheen JH: Aesthetic rhinoplasty. St. Louis, CV Mosby, 1978.
31. Sykes JM, Senders CW: Surgery of the cleft lip nasal deformity. Operative Tech Otolaryngol 1:219-224, 1990.
32. Tardy. M.E., and Brown, R.J. Surgical Anatomy of the Nose. New York: Raven, 1990.
33. Zelnik, J., and Gingrass, R.P. Anatomy of the alar cartilage. Plast. Reconstr. Surg. 9:193, 1985.
34. Zide, B.M. Nasal anatomy: The muscles and tip sensation. Aesthetic Plast. Surg. 9:193, 1985.
35. Zmgaro, E.A., and Falees, E. Aesthetic anatomy of the non-caucasian nose. Plast. Surg. Clin. 14:749, 1987.

 

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