External nasal anatomy

nasal anatomy, rhinoplasty

1. External nasal anatomy Dr safika zaman Dept of ent & head neck surgery Vims,rkmsp

2. Components Skin Subcutaneous tissue Bone Cartilage & alar fibro-fatty tissue Mucosa

3. Skin Variable thickness. Glands are more towards tip. Changes are detectable

4. Subcutaneous tissue of the nose Superficial fatty- connected to dermis. Fibromuscular-SMAS Deep fatty- contains neurovascular structures periosteal layers.

5. subcutaneous musculo -aponeurotic system Functions of nasal muscles Mummified nose

6. Superficial arterial blood supply Facial artery Ophthalmic artery Surgical anatomy for Asian rhinoplasty Taek Kyun Kim, Jae Yong Jeong The PLUS Plastic Surgery Clinic, Seoul, Korea

7. Venous and lymphatic drainage Danger area of face Parotid nodes Submandibular nodes

8. Sensory nerve supply Ophthalmic and Maxillary branch of trigeminal nerve

9. bones Mainly 3 bones: Frontal Nasal Maxillary

10. cartilage

11. terminology

12. Inspection of the external nose Skin quality Length of the nose: nasion to the tip.

13. Nasal deviations Source- Scott Brown 8th edition

14. Tip projection Goode’s ratio, where a line drawn from the alar-facial groove to the nasal tip measures 0.55–0.60 of the distance from the nasion to the nasal tip. Source- scott browns text book 8th edition

15. Lip-chin relationship calculated from nasomental line- retrognathic or prognathic . Source- Scott Browns text book 8th edition

16. Columellar show Source- Scott Browns text book 8th edition

17. Tip configuration Four tip-defining points identified by light reflection- domes, supra tip and infra-tip. Appearances: normal, boxy, bifid, bulbous and amorphous.

18. Tip rotation position of the tip along an arc with its radius centred on the nasolabial angle.

19. Basal view Alar base configuration: isosceles triangle with pear-shaped nostrils lying at an angle of 45 °to the vertical.

20. Internal nose inspection Septum Turbinates Valve area

21. palpation Skin elasticity and skin texture Bony irregularities Tip recoil Alar cartridges and septum strength .

22. Angle of nose in relation to rhinoplasty

23. Triangle of powell and humphrey Source- scott browns text book 8 th edition

24. rhinoplasty photography Light Sources:  shadow-less image The optimal lighting set-up includes two flash units on both side of camera with an angle of 45 degree.  Important considerations include focus, depth of field, distortion, consistency, and well as patient preparation and positioning.

25. Cont.. Positioning: Frankfort plane is parallel to the floor. standard photographic views- 1.frontal 2. left and right lateral. 3. left and right oblique 4. basal.

26. Summary for planning Source- Scott Browns text book 8th edition

27. Thank you