Anatomy of nose

Dr. Ra. Shivaraman

Postgraduate in plastic surgery
Govt. Kilpauk medical college
 Nose
• pyramid shaped
• Osseocartilaginous framework
• Composed of skin, sub cutaneous tissue,
muscles, bones, cartilages, ligaments
• Terminology
• Skin
• Bones
• Cartilages
• Muscles
• Blood supply
• Nerve supply
• Aesthetics
 Terminology
• Dorsum or bridge - formed by bony and
cartilaginous portions
• Radix – root of the nose. Transition point
between bony forehead and bony upper nose
• Tip – junction of the two nasal alae
• Supra tip area - area just above the tip
• Columella – portion joining the tip of nose and
the upper lip
• Sills – floor of the nostrils
• Infra tip region – transition between tip and
columella
• Soft triangle/ facet – transition point between
columella and nostril rims devoid of any
cartilaginous structure
• Pyriform aperture – area corresponding to
nasal cavity opening
 Angles
• Nasofrontal angle – angle between the
forehead, radix and dorsum
• Septal angle – angle between the caudal and
dorsal border of the septum
• Nasolabial angle – angle between base of
columella and the upper lip
• Columella lobular angle – intersection
between the plane of columella and tip
 Skin
• Over the tip it is adherent to alar cartilage
• Cranially it is loose over lateral cartilages and
nasal bones
• Caudally it is rich in sebaceous glands
• Soft tissue of the nose is rich in network of
arteries and veins
• So dissection is always done close to the
osteocartilaginous frame work
 Bone framework
• Upper third of nose
• Composed of paired nasal bones that unite in
midline
• Posteriorly in midline it is supported by the nasal
spine of frontal bone and laterally by frontal
process of the maxilla
• Nasal bone is thick and narrow above and thin
and wide below. Concave in from above to below
convex side to side
 Bony septum
• Septum has bony and cartilaginous parts
• Midline structure.
• Four bones
• Vomer
• Perpendicular plate of ethmoid
• Nasal crest of maxilla
• Nasal crest of palatine bone
 Cartilage framework
• Middle third and lower third of nose
• Upper lateral cartilages paired structures
roughly triangular in shape
• Superiorly attached to nasal bones, frontal
process of maxilla
• Midline to septum, forms the I-beam structure
• Nasal bones overlap the cartilage by 4-5mm
• Lower portion of the cartilage turns on itself
to form a cuff
• Lower third of lateral cartilage diverge away
from septum and stays mobile and forms the
internal nasal valves
• Inferiorly alar cartilage slightly overlaps the
lateral cartilage and small sesamoid cartilage
may be present near by the overlap
 Septal cartilage
• Quadrangular lamina
• Protrudes in front of the pyriform aperture
• Firmly adherent to vomer caudally and
perichondrium becomes continuous with the
periosteum of vomer
• Caudally it is mobile
• Separated from the columella and median crura
by mucocutaneous flaps - mebranous septum
• Cephalic portion of the cartilage fits in a groove on
the nasal bone and in the perpendicular plate of
ethmoid
• The septum is thicker near the ethmoid forming
central pillar that supports the nasal bones
• This pillar and the membranous septum is to be
preserved during rhinoplasty
• Septum and lateral cartilage are separated by a
cleft that becomes wider caudally helps in mobility
 Alar cartilage
• Paired structures
• Each ala has two crus which join at the most prominent
point of the tip.
• The height width and curvature – not uniform
• Accessory cartilage – larger cartilage that joins the lateral
crus to the pyriform aperture
• Sesamoid cartilage – miniscule cartilage found in
between lateral and alar cartilage and in the
superolateral portion of the ala
• Scroll area – overlap between alar and lateral cartilage
• Nostril border – composed of dense fibrofatty
tissue
• Soft triangle – area devoid of any cartilage and
fibrofatty tissue that is composed of two layers
of juxtaposed skin
• Incisions should be avoided in the soft triangle
• Weak triangle – area at the divergence of
lateral crura where septum is fitted
 Columella
• Posterior portion is wider than anterior portion due
to divergence of the medial crura
• Contour depends on divergence
• Penetrated by depressor septi muscle
• Origin – incisive fossae of maxilla
• Inserts in to the caudal portion of the septum some
fibres to the cephalic portion of ala
• So the mucoperichondrium in caudal portion is more
adherent, difficult to detach septal cartilage here
 Vestibule
• Caudal portion of the floor of nose
• Limen nasi / Nasal valve
• Fold formed by the lateral cartilage forms
posterior vestibular fold that limits the
vestibule
• Anterior narial fold formed by alar cartilage
• Lined by squamous epithelium
• Numerous vibrissae, sebaceous gland
• Serves as an air conditioning,
thermoregulation functions
• Cranially becomes respiratory mucosa- nasal
mucous membrane should be preserved
• Nasal valve controls the flow of air
• Attachment of the lateral cartilage to the
dorsum forms the nasal valves
Ligaments
• Part of static support
• pyriform ligament
• Inter alar ligament
stabilises the lower
alar cartilage at
medial middle crura
junction
 • Intrinsic – nasalis
• Two parts
Muscles
i • Lateral to incisive fossa maxilla
• By thin lamina to nasal bone,
opposite muscle and procerus,
greater alar cartilage, upper
lateral cartilage
• Alar - dilates ala
• Transverse – constricts nostrils
• Some fibres to depressor septi
• Extrinsic muscles Two muscles on alar rim –
• levator alae - maxilla along nasal bone flaring
of the nostrils
• levator labii – from orbital rim elevates the
upper lip during smile
• Depressor septi
• Procerus from nasal bone and lateral cartilage
to glabella
 Blood supply
• Extensive collateral supply All vessels lie above muscles
• Supratrochlear artery – lateral nasal, descending
external nasal and angular vessels
• Facial artery – superior labial artery, sill artery,
columellar artery is branch of superior labial
• Dissection should be above the perichondrium to
preserve the vessels
• If artery is cut it should be cauterized
• Veins accompany arteries and drain into facial vein
Septum
 Nerve supply
• Sensory by infraorbital nerve and external
nasal nerve branches of trigeminal nerve
• Infraorbital nerve – branch of V2 exits from
foramen rotundum then own foramen on
maxilla supply alar base, upper lip ad lateral
nasal wall
• Close contact with alar and sill artery
• External nasal
branch of V1
• Branch of
frontal nerve
exits through
foramen on
nasal bone
• Supplies nasal
skin
Aesthetics
Subunits of nose
• Burget and
menick
• If 50% subunit
loss then
replace the
subunit
Thank you