The document discusses the anatomy of the nose including the external nose, nasal septum, internal nasal valve, and muscles of the nose. It then covers the causes of nasal valve collapse and techniques used to treat nasal collapse such as spreader grafts, septal crossbars, and suture flaring. The conclusion states that nasal obstruction is bad and nasal surgery can help address it.

1. Rhinoplasty
(Anatomy of Nose)
Prepared by : Ahmad Abid Bin Abas
07-5-2

2. External Nose

3.  Base
 1 – infratip lobule
2 - columella
3 – alar sidewall
4 – facet, or soft-tissue triangle
5 - nostril sill
6 - columella-labial angle or junction
7 - alar-facial groove or junction
8 - tip defining points

5. Vascular Anatomy of Nose

6. Figure: Septum
 1 – quadrangular caratilage
2 – nasal spine
3 – posterior septal angle
4 – middle septal angle
5 – anterior septal angle
6 – vomer
7 – perpendicular plate of
ethmoid bone
8 – maxillary crest,
maxillary component
9 – maxillary crest –
palatine component
Nasal Septum

7. Vascular Supply of Nasal Septum

8. 1) Procerus muscle
2) Frontal sinus
3) Frontal bone
4) Frontal spine
5) Nasal bone
6) Transverse part of nasalis muscle
7) Alar part of nasalis muscle
8) Major alar cartilage and attach of nasal muscles
9) Nasal fibro-adipose tissue
10) Maxillary bone
11) Levator nasal septi muscle
12) Depressor nasal septi muscle
13) Highest part of alveolar process
Muscles of Nose

9.  1- Tip subunit
2- Columellar subunit
3- Right alar base subunit
4- Right alar side wall subunit
5- Right alar base subunit
6- Left alar base subunit
7- Dorsal subunit
8- Right dorsal side wall subunit
9- Left dorsal side wall subunit
Nasal Subunit

10.  The internal valve is defined by the angle that the septum makes with the
upper lateral cartilage.
 Usually 10-15 degrees in Caucasian
(wider in African or Asian nose)
 The narrowest portion of the nasal cavity
 Superior- Caudal end of ULC and Septum
Posterior – Head of inferior turbinate
Inferior – Nasal Floor
Lateral – Bony pyriform aperture and
adjacent fibrofatty tissue.
Internal Nasal Valve Anatomy

11.  Nasal Vestibule (compartment caudal to INV)
 Fibrofatty tissue of alar lobule
and LLC.
Fascia continuous w/perichondrium and
periosteum
Caudal septum
Pyriform aperture.
External Nasal Valve

12.  This is a condition where the sidewalls of the nostrils collapse as breathe
in.
 Causes :
1) Post Operative Stenosis (trauma,surgery,iatrogenic,reduction
rhinoplasty)
2) Deviated Septum : (most common cause of INV collapse)
3) Septoplasty and Turbinate Reduction :
(Most common procedures addressing nasal valve obstruction)
4) Turbinate Hypertrophy : (INV stenosis,mucosal or bony)
Nasal Valve Collapse

13.  Spreader Grafts (Widely used,correct lack of dorsal support to lateral
walls)
- Spreader Grafts Placement
 Endonasal Placement (Septoplasty approach)
 Endoscopic Placement (Cadaver study : Increase area on acoustic
rhinometry)
 Septal Crossbar (Increase nasal valve patency)
 Spring Graft
 ULC Suspension( Elevation of dorsal ULC)
 Flaring Suture (Improve INV angle,open approach)
 Mini Spreader Grafts
 Autospreader flap
Techniques to treat Nasal Collapse

14.  Nasal obstruction is bad.
 Nasal surgery is good.
Conclusion

15.  References: T . Fattahi - An overview of facial aesthetic units. Journal of Oral and Maxillofacial Surgery
 http://emedicine.medscape.com/article/835134-overview#aw2aab6b7
 http://www.revisionrhinoplasty.com/anatomy.html
 http://www.todaysface.com/Articles/Ch044thenasalseptum03.html
 Rhinoplasty and The Nasal Valve, University of Texas Dept of Otolaryngology Jan 16,2008.
 http://www.docstoc.com/docs/82309760/Rhinoplasty-and-the-Nasal-Valve
References