Rhinoplasty Flashcards
What are the indications for rhinoplasty?
- Functional - for airway obstruction
- Reconstructive - congenital or traumatic
- Cosmetic - to change the external appearance of the nose
whats the difference between the skin of the upper 2/3 and the lower 1/3?
the skin on the upper two thirds is thinner and less sebaceous than the lower third
What is the significance of the skin quality in certain ethnicities and the role it plays in rhinoplasty?
Thicker and more sebaceous nasal skin necessitates more dramatic changes to the underlying framework are needed for a change in the outward appearance
In what plane and in what subunits of the nose can filler be safely injected?
Sub-superficial musculoaponeurotic system plane just above the plane of the periosteum; the nasal dorsum and the nasal sidewalls; They should not be placed in the tip or ala
What are some general characteristics of an Asian nose?
Alar flare, bulbous nasal tip, short retracted columella, thick subcutaneous tissue and wide flat nasal dorsum
What are some differences between a caucasian and Asian nose?
Upper and lower lateral cartilage height is shorter in the Asian nose. When a cephalic trim is performed in an Asian nose, caution for overresection
What is a tension nose?
A combination of thin, constricted nasal skin element with strong lower lateral cartilages leading to a potentially twisted or deviated nasal appearance. Also excessive growth of the quadrangular cartilage resulting in high dorsum and displaced lower lateral cartilages
What is the blood supply to the tip of the nose?
- Lateral nasal artery
- Columellar vessel arising from the superior labial artery
- All originating from facial artery
Where are the lateral nasal vessels found and what is the pitfall to avoid when performing alar resection with an open rhinoplasty?
2-3mm above the alar groove, and so the alar base resection should not extend to this area, as injury to these vessels would cause ischemia of the nasal tip
What are the sensory nerves of the nose?
External branch of the anterior ethmoid nerve
The internal branch of the anterior ethmoidal nerve Nasopalatine nerve.
The infraorbital nerve
The infratrochlear nerve
The supraorbital nerve
External branch of the anterior ethmoid nerve supplies
The distal nasal dorsum and nasal tip. This nerve is at risk during endonasal rhinoplasty.
The internal branch of the anterior ethmoidal nerve supplies sensation to
The septum and internal nasal walls.
The septum receives innervation from
the nasopalatine nerve
The infraorbital nerve supplies .
the lower lateral cartilage half of the nose and the columellar skin.
The infratrochlear nerve supplies sensation to
the cephalic portion of the nasal sidewalls and the skin overlying the radix.
The supraorbital nerve supplies
the nasal radix
What are the major tips supporting mechanisms of the nose?
- Size and shape of the lower lateral cartilages
- The attachment of the lower lateral cartilages to the septum
- The attachment of the upper and lower lateral cartilages at the scroll area
There are three nasal vaults
- Bony
- Upper cartilaginous
- Lower cartilaginous
Describe the bony nasal vault
consists of paired nasal bones and the frontal process of the maxilla and makes up the upper one third to one half of the nose
Describe the upper cartilaginous vault
consists of upper paired lateral cartilages and the dorsal cartilaginous septum and goes from the keystone area to the scroll area
Describe the lower cartilaginous vault
Consists of the paired lower lateral cartilages and begins from the scroll area on down
Describe the keystone area
It is the area of approximately 4-6 mm where the nasal bones overlap the upper lateral cartilages and septum; usually the widest portion of the dorsum
Describe the scroll area
Area where the upper lateral cartilages interdigitate/overlap with the lower lateral cartilages, held by fibrous connections
What is the significance of the fibrous connections and ligaments of the nasal tip in rhinoplasty?
THe medial, middle, and lateral crura of the lower lateral cartilages are connected to eachother and to the upper lateral cartilages and the septum by these fibrous attachments. Dissection/disruption of these may result in decreased tip projection
What is the narrowest segment of the nasal airway?
Internal nasal valve, which can be responsible for up to 50% of the total airway resisitance.
What is the internal nasal valve composed of?
- Angle formed by the intersection of the caudal margin of the upper lateral cartilages and the nasal septum
- The angle normally 10-15 degrees. If it is less than normal, airflow will be reduced and may lead to airway obstruction
What is Cottle’s sign?
A positive Cottle’s sign is improved airway with lateral traction on the cheeks, signifying collapse of the internal nasal valve. Spreader grafts are needed to increase the valve angle and improve the airway
What tool is best to dynamically evaluate nasal cavity patency and nasal function?
Rhinomanometry
What is the septum comprised of?
- Septal cartilage (quadrangular cartilage), nasal crest of the maxilla, the perpendicular plate of the ethmoid, and the vomer
Deformities of the septum can lead to
Airway obstruction, and may lead to compensatory turbinate pathology
What is the pitfall to avoid when performing septal resection?
Fracture of the cribriform plate, which is contiguous with the perpendicular plate of the ethmoid. This can lead to CSF rhinorrhea and possible ascending infection/meningitis
