Rh i noplasty

Question 1

Skin: Thicker over the upper and lower third of the nose and thinner over the middle third muscle-osseocartilaginous framework

Answer 1

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Question 2

The nasal veins do not have valves

Answer 2

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Question 3

The nasal venous system has direct communication to the
cavernous sinus, thus making nasal infections potentially a
life-threatening event

Answer 3

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Question 4

Trigeminal-ophthalrnic-nasociliary-anterior ethmoid: supplies
the anterior halfofnasal cavity

Answer 4

T

Question 5

External branch of the anterior ethmoid: supplies the nasal
skin from rhinion to tip

Answer 5

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Question 6

Posterior ethmoid: supplies the superior half of nasal cavity

Answer 6

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Question 7

Mucosa (lining of vestibule )

Answer 7

The vestibule is lined by hair-bearing squamous epithelium up
to the level of the caudal margin of the alar cartilage
where
it transitions to pseudostratified ciliated columnar respiratory
epithelium with abundant seromucinous glands

Question 8

Anatomic dome

Answer 8

The area of transition between the medial and lateral crura of the alar/lower lateral cartilage. The anatomic dome usually but not always
corresponds to the most projecting point of the nasal tip (the clinical dome)

Question 9

Columellar labial angle vs Columellar lobular angle

Answer 9

Columellar labial angle: Formed by the angle between the columella and the upper lip. Th.is angle is not dependent on the nasal base position, as in the nasolabial
angle

Columellar lobular angle: The angle formed at the junction of the columella and the infratip lobule. The angle is usually 35°-45° in females and 0°-35° in males.

Question 10

Dorsal aesthetic lines: Imaginary lines starting at the medial edge of the brows and tracing a gentle curve down the lateral side ofthe dorsum to the tip-defining
points

Answer 10

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Question 11

Infratip lobule: Transition area between the tip (domes) and the columella

Answer 11

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Question 12

the Frankfort Horizontal line

Answer 12

the plane defined by a 90° plane from the vertical facial plane, with the line
drawn from the inferior portion of the external auditory canal to the bony inferior orbital rim

Question 13

Pogonion: The most anterior projection ofthe mandible as seen on a cephalogram

Answer 13

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Question 14

Scroll area: The area where the cephalic edge of the lower lateral cartilage interlocks with the caudal edge of the upper lateral cartilage

Answer 14

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Question 15

Tip projection

Answer 15

(A) the length from the nasal base crease to the tip on the lateral view and (B) the length of the nose on the lateral view from the radix to nasal tip.
A should be about 0.67 the length of (B divided by A = 0.67)

Question 16

The use of computer imaging can help to determine the types of
changes that can reasonably be made,

Answer 16

T It is important to stress to the patient that
computer-imaged results cannot be construed as a guarantee of that
exact result

Question 17

Nasal Analysis DON BY ?

Answer 17

Byrd analysis
computer imaging

Question 18

Byrd analysis

Answer 18

looks at idealized relationships between nasal
landmarks. Comparison of these idealized measurements with the
patient’s actual measurements suggests quantifiable changes that can
be made in that patient’s nose

Question 19

Midline facial vertical This line can be used to help
determine nasal symmetry in the anterior-posterior view

Answer 19

T

Question 20

Bony base width; This distance should be roughly
80% of the distance between the medial canthi

Answer 20

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Question 21

the supratip break, tip-defining points, and columellar lobular angle are used to define two opposing triangles over
the tip of the nose. The intersecting bases of these triangles form
a horizontal line through the tip-defining points. These triangles
should be roughly symmetrical

Answer 21

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Question 22

The nostrils should be roughly teardrop shaped with the base wider than the apex and with the axis
oriented in a slight medial direction from based apex.

Answer 22

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Question 23

radix to tip = stomion to the menton

Answer 23

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Question 24

The apparent length of the nose can be
changed how ?

Answer 24

by changing the position ofthe nasal frontal angle or the
tip-defining point

Question 25

more anterior position ofthe nasal frontal angle can
make the nasal tip look less projecting while a more posterior or
deeper position for the nasal frontal angle can make the nasal tip
look relatively more projecting.

Answer 25

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Question 26

A vertical line can
be drawn from a point that is one-half the distance between the
radix and the nasal tip and tangent to the anterior most projection of the upper lip. The anterior most projection of the lower
lip should be about 2 mm posterior to this line

Answer 26

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Question 27

line
dropped from the anterior most projection ofthe lower lip should be anterior to the anterior projection of the chin in women and
should be tangent to the anterior projection of the chin in men

Answer 27

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Question 28

The degree of rotation of
the nasal tip is assessed by evaluating the nasolabial angle

Answer 28

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Question 29

Nasofrontal angle normal range

Answer 29

128-140 female 134 male 130

Question 30

Columellar lobular angle normal range

Answer 30

This angle is ideally 30° to 45°

Question 31

Supratip break

Answer 31

This is
a slightly greater dorsal angulation between the plane of the nasal
dorsum and the plane from the cephalic edge of the dome to the
tip-defining point

Question 32

Tip projection

Answer 32

This can be measured by drawing a line
from the alar cheek junction to the nasal tip, and the distance
between these two points should be approximately equal to the
distance of the alar base width and should be approximately 0.67
times the radix-to-tip distance or the nasal length

Question 33

Another measure of tip projection

Answer 33

that 50% to 60% ofa line
drawn from the alar cheek junction to the tip should lie anterior to
a line drawn tangent to the most projecting portion of the upper
lip

Question 34

the tip projection as measured from the
alar base should equal the alar base width

Answer 34

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Question 35

The alar-columellar relationship

Answer 35

Two lines are drawn, one through the long axis of the nostril and the other from the alar rim to the columellar rim at the midpoint of the first line. The distance from the alar rim to the first line should be the same as the distance from the columellar rim to the first line. Increase in either
of those distances may represent alar retraction or columellar show.

Question 36

Intranasal cottonoids soaked in Afrin or epinephrine 1:1000 are used to decrease bleeding and to shrink the turbinates

Answer 36

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Question 37

If the continuity of this
L-shaped strut is accidentally interrupted, it must be repaired and
reinforced with cartilage or polydioxanone suture plate gussets

Answer 37

T

Question 38

out-fracture of the inferior turbinate, Dennis bipolar cautery of
the inferior turbinate or anterior turbinectomy can be done. The flap
should be inspected for perforations but unless they are large and/or
they communicate with a perforation on the opposite flap at the same
level repair is not necessary

Answer 38

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Question 39

Spreader Grafts can also be used to strengthen the
dorsal septum as well as to help straighten dorsal septa! deviations

Answer 39

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Question 40

tip modifications options?

Answer 40

ephalic lateral alar crural
resection, intradome and interdome suturing, and/or the placement
of a columellar strut.

Question 41

If there is unwanted cephalic fullness but
the cartilages of questionable strength than the removed cephalic segment can be slid into a pocket made between the nasal mucosa and
the remaining caudal cartilage and sutured into position to bolster
the lateral alar crus

Answer 41

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Question 42

If the done separated or are of unequal height, they can be adjusted by interdomal mattress sutures of 5-0 PDS

Answer 42

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Question 43

Boundaries of strut graft

Answer 43

to be 0.5 cm in width and
up to 3 cm or more in length

Question 44

the Webster triangle, where
the lateral most aspect ofthe alar cartilage anchor and provide stability to the nasal valve.

Answer 44

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Question 45

An advantage of the 2-mm osteotome is that the periosteum is not elevated and therefore remains
intact on both the nasal and the facial side ofthe bone adding stability to that bony segment

Answer 45

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Question 46

If an osteotome is
to be used to lower the bony dorsum, then modification of the cartilaginous dorsum is done first.

Answer 46

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Question 47

Routine
nasal packing is not necessary. in closed rhinoplasty

Answer 47

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Question 48

lnfratrochlear: supplies the nasion and bony dorsum

Answer 48

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Question 49

Nasolabial angle: Formed by a line drawn through the anterior and posterior ends of the nostril and vertical facial plane. The angle is usually 95°-100° in
females and 90°-95° in males

Answer 49

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Question 50

Gull wing line : A line drawn along the superior
border of the ala from one side curving around the columellar to
the other side should describe a gentle curve similar to the sweep
of a seagull in flight

Answer 50

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Question 51

Draw two equilateral triangles with their bases opposed to one another. The corners
of the diamond thus formed are the two tip-defining points-the
supratip break and the columellar lobular angle. These structures
should ideally be symmetrical

Answer 51

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Question 52

Decreasing the rotation of the tip and/or elevating the area of the radix thus moving the nasal frontal angle
cephalad will give the perception ofa longer nose while increasing
tip rotation and/or lowering the radix thus moving the nasal frontal angle caudad will give the appearance of shortening the nose.

Answer 52

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Question 53

When injecting the nasal septum, use a 3-cc syringe with a 20 gauge
1.5-inch needle

Answer 53

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Question 54

Spreader grafts or flaps are useful to prophylactically maintain or
to widen the internal valve area when a narrow valve angle is contributing to obstructive symptoms

Answer 54

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Question 55

When both nasal septa! surgery and turbinate modification are
done, a Doyle septa! splint is placed in each nostril and suture to the
membranous columella with a 3-0 Prolene through-and-through
suture. The purpose of this splint is not to prevent septa! hematoma
but rather to provide insulation preventing the formation of synechiae between the septum and the inferior turbinate

Answer 55

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Question 56

If the rasp is to be used the bony modification is done at this point
followed by reduction of the cartilaginous dorsum. If an osteotome is
to be used to lower the bony dorsum, then modification of the cartilaginous dorsum is done first

Answer 56

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Question 57

Many surgeons prefer the rasp, because
it allows a more incremental reduction of the dorsum and is less likely
to result in accidental overcorrection

Answer 57

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Question 58

Tip modifications are considerably more difficult in the closed rhinoplasty

Answer 58

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Question 59

Steri-Strips are placed in such a way
as to try to eliminate any dead space between the skin and the refined
cartilage and bone.

Answer 59

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Question 60

A positive Cottle test reveals incompetent unilateral internal nasal valve or bilateral internal nasal valves

Answer 60

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Question 61

The osteotomy line is carried in oblique fashion away from
the Keystone area for about 5 to IO mm. This helps to control the
position of the osteotomies preventing injury to the Keystone area
or the creation ofa rocker deformity

Answer 61

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Question 62

If the bony bases are to be narrowed, the
osteotomies are carried from this position staying low on the nasal
bones (low to low) to the level ofthe previously made medial oblique
osteotomy. Gentle inward digital pressure will green stick fracture

Answer 62

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Question 63

If narrowing ofthe nasal bony base
is not indicated, then the osteotomy can curve in a more dorsal
direction, low to high, joining and closing the open roof directly

Answer 63

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