FPRS Rhinoplasty and Nasal Reconstruction Flashcards
What are the subunits of the nose?
Dorsum, root, sidewalls (two), tip, columella, soft tissue
triangles (two), ala (two). If more than 50% of a subunit is
injured or resected, the remaining portion should be
removed before reconstruction.
Which arteries supply the nasal septum?
● Sphenopalatine artery
● Anterior and posterior ethmoid arteries
● Superior labial artery
● Greater palatine artery
Which arteries supply the external nose?
● Facial artery ● Angular artery ● Superior labial artery ● Infraorbital artery ● Ophthalmic artery
What are some of the unique characteristics that may be found in the Asian nose?
Thick, sebaceous skin, low radix, weak lower lateral
cartilages
What are some of the typical differences in the appearance of a child’s nose compared with an
adult’s nose?
A child’s nose displays a more obtuse nasolabial angle, more
circular nares, shorter dorsum and columella, less defined and projected nasal tip, and decreased dorsal projection.
What is the primary concern of septal surgery in
prepubertal children?
Underdevelopment of the nose and maxilla
How is the nasofrontal angle determined?
A line tangent to the nasal dorsum is intersected with a line tangent to the glabella and nasion.
How is the nasofacial angle determined?
In lateral view, it is the angle created by the intersection of a line parallel to the nasal dorsum intersecting the tip and nasion and a vertical line from the glabella to the
pogonion.
How is the nasolabial angle determined?
In lateral view, it is the angle created by a line drawn perpendicular to the Frankfort horizontal at the subnasale
and a second line drawn through the midpoint of the nostril aperture.
What is meant by the term tip-defining point in the
context of nasal analysis?
The anterior most projection of the domes, which are
represented by two distinct light reflexes on the skin of the
nasal undertip
Describe the Simons method of determining nasal
projection.
A line drawn from the subnasale to the nasal tip is
compared with a line drawn from the subnasale to the
vermilion border of the upper lip. In an ideal nose, the
length of these lines should be equal.
Describe the Crumley method for determining
nasal projection.
In lateral view, the nose is seen as a 3–4–5 triangle with
points at the alar facial crease, tip, and nasion. The shortest
arm of the triangle is between the tip and the alar facial
crease. The longest arm is between the tip and the nasion.
Another alternative is to measure the distance from the
subnasale to the nasal tip and compare it with the distance from the subnasale to the vermilion border of the upper lip.
If the distance from the subnasale to the tip is greater than
the distance from the subnasale to the upper lip, the nose is
overprojected.
Describe the Goode method for determining nasal
projection.
A horizontal line drawn from the alar facial crease to the
nasal tip is 0.55 to 0.6 the length of a line drawn from the
nasion to the nasal tip. If the ratio is less than 0.55, the nose
is underprojected. If the ratio is greater than 0.6, the nose is
overprojected.
How is the ideal width of the nasal base
determined?
It should lie within vertical lines drawn inferiorly from the
medial canthi.
What is the ideal ratio of the nasal lobule and columella on basal view of the nose?
The nasal tip should occupy the upper third and the
columella the lower two-thirds. The nasal tip should be
approximately 45% the width of the base of the nose.
What is the ideal ratio of nasal lobule to columella
on base view?
1:2
On lateral view, what is the ideal amount of
columellar show?
2 to 4 mm
Describe the anatomy of the nasal bones.
Superiorly, the nasal skeleton is composed of paired nasal
bones. The premaxilla and palatine bones constitute the
floor. The lateral wall of the nose is formed by the medial
walls of the maxilla. The superior, middle, and inferior conchal
bones are attached to the lateral nasal walls. The cribriform
plate is the roof of the nose. The bony septum is formed by
the vomer and the perpendicular plate of the ethmoid.
Describe the skeletal support of the nose.
The upper third of the nose is supported by the nasal bones
and the medial portion of the frontal process of the maxilla.
The dorsal septum and upper lateral cartilages are the
framework for the middle third of the nose. The anterior
septal angle and the lower lateral cartilages suspend the lower third of the nose.
What are the major tip-supporting structures of
the nose?
● The intrinsic length and strength of the lower lateral
cartilages
● Attachment of the medial crura to the caudal aspect of
the quadrangular cartilage
● Attachment of the cephalic border of the lower lateral
cartilages to the caudal aspect of the upper lateral
cartilages
What are the minor tip-supporting structures of
the nose?
Anterior nasal spine, attachment of the skin and soft tissue
to the lower lateral cartilages, membranous septum, cartilagenous septal dorsum, sesamoid complex, interdomal ligament
What is the rhinion?
The rhinion is the point that corresponds with the junction of the bony and cartilaginous dorsum.
Which structures form the internal nasal valve?
● Medially, the nasal septum
● Laterally, the caudal border of the upper lateral cartilage
and piriform aperture
● Inferiorly and posteriorly, the head of the inferior
turbinate
What structures constitute the external nasal valve?
● Laterally, the pyriform aperture, lateral crus of the lower
lateral cartilage, fibrofatty tissue, and alar rim
● Superolaterally, the caudal aspect of the upper lateral
cartilage
● Medially, the septum and columella
What are some surgical techniques to correct
external nasal valve collapse?
The technique chosen depends on the cause of valve
compromise. Options include alar batten grafts, lateral
crural strut grafts, narrowing of a wide columella, repair of
caudal septal deflection, and alar flaring sutures.
