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External nasal anatomy
Externally, the nose can be divided in subunits that include the dorsum, the sidewalls (paired), the hemilobules (paired), the alae (paired), the soft triangles (paired) and the columella for the purpose of analysis and surgical planning.
Ethnic influences can result in different appearances of the nose: Caucasian, African, Hispanic, and Asian as the main groups, presenting more or less common features like projection, wideness and bulbar volume.

Internal nasal anatomy
The septum is a midline bony and cartilaginous structure that divides the nose into 2 similar halves.
Regarding the lateral nasal wall and paranasal sinuses, the superior, middle, and inferior concha form corresponding superior, middle, and inferior meatus on the lateral nasal wall. The superior meatus is the drainage area for the posterior ethmoid cells and the sphenoid sinus. The middle meatus provides drainage of anterior ethmoid and the maxillary and frontal sinuses. The inferior meatus provides drainage of the nasolacrimal duct.
The internal nasal valve involves the area bounded by upper lateral cartilage, septum, nasal floor, and anterior head of the inferior turbinate. This comprises the narrowest portion of the nasal airway in the Caucasian nose. Generally, an angle wider than 15° is needed in this area. The width of the nasal valve can be increased with spreader grafts and flaring sutures.

Nasal Analysis
Viewing the external nasal anatomy by its subunits is important because defects that span an entire subunit are usually repaired with reconstruction of that subunit.  Aesthetically, the nose—from the nasion (nasofrontal junction) to the columella-labial junction—ideally occupies one third of the face in the vertical dimension. From ala to ala, it should ideally occupy one fifth of the horizontal dimension of the face.
The nasofrontal angle between the frontal bone and nasion is usually 120° and slightly more acute in males than in females. The nasofacial angle, or the slope of the nose compared with the plane of the face, is approximately 30-40°. The nasolabial angle between the columella and philtrum is about 90-95° in males and 100-105° in females.
On profile view, normal columella show, i.e., the height of the nasal aperture visible is 2-4 mm. The dorsum should be straight. Appropriate projection of the nasal tip, or the distance of the tip from the face, is judged by using the Goode rule. Tip projection should be 55-60% of the distance between the nasion and tip-defining point.
During the nasal analysis, the following features must be taken in account:

Frontal view

  • General aspect and congruence with other facial features and discussion of the primary reason for the patient's consultation, palpation of the nose and examination of the interior chamber through nasoscopy.
  • Skin quality: Thin, medium or thick.
  • Following of the brow to nose tip lines: Narrow, wide, normal, wide-narrow-wide, deviated.
  • Tip: Deviated, bulbous, asymmetric, amorphous, and other.
  • Base view:


Base View

  • Triagularity: Good versus trapezoidal shape
  • Tip: Deviated, wide, bulbous, bifid, asymmetric
  • Base: Wide, narrow, normal and inspection of lower septum
  • Columella: Columella-Lobule ratio (Normal is 2:1 ratio)


Lateral View

  • Nasofrontal angle: Shallow or deep.
  • Nasal starting point: High or low
  • Dorsum: Straight, concavity, convexity, bony-cartilaginous component.
  • Nasal length: Normal, short or long.
  • Tip projection: Normal, decreased or increased.
  • Alae-columella relationship (collumelar show): Normal or abnormal, 2-4 mm of collumelar show is normal.
  • Naso-labial angle: Obtuse or acute (90 to 120 degrees, within this range, more obtuse angle more favorable in female, and more acute in male patients)


Oblique View

  • Similarity to the other views (frontal, lateral, basal)External nasal anatomy
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