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Author: Edward W Chang, MD, DDS; Chief Editor: Arlen D Meyers, MD, MBA more... Updated: May 19, 2009
The developmental precursors of the nose are the neural crest cells, which commence their caudad migration toward the midface around the fourth week of gestation (see the image below). Two nasal placodes develop inferiorly in a symmetrical fashion. Nasal pits divide the placodes into medial and lateral nasal processes. The medial processes become the septum, philtrum, and premaxilla of the nose; whereas the lateral processes form the sides of the nose. Inferior to the nasal complex, the stomodeum, or future mouth, forms.
A nasobuccal membrane separates the oral cavity inferiorly from the nasal cavity superiorly. As the olfactory pits deepen, the choanae are formed. Primitive choanae form initially, but with continued posterior development, the secondary or permanent choanae develop. By 10 weeks, differentiation into muscle, cartilage, and bony elements occurs. Failure of these carefully orchestrated events in early facial embryogenesis may result in multiple potential anomalies, including choanal atresia, medial or lateral nasal clefts, nasal aplasia, and polyrrhinia. Neonates are obligate nasal breathers for the first 6 weeks. When bilateral choanal atresia is present in a neonate, emergency action is needed.
Skin and soft tissues
Like the underlying bony-cartilaginous framework of the nose, the overlying skin may also be divided into vertical thirds. The skin of the upper third is fairly thick but tapers into a thinner mid-dorsal region. The inferior third regains the thickness of the upper third owing to the more sebaceous nature of the skin in the nasal tip. The dorsal skin is usually the thinnest of the 3 sections of the nose. The difference in the skin thickness must be appreciated during dorsal reduction. The nasal muscles are encountered deep to the skin and comprise 4 principal groups: the elevators, the depressors, the compressor, and the dilators. The elevators include the procerus and levator labii superioris alaeque nasi. The depressors are made up of the alar nasalis and depressor septi nasi. The compressor of the nose is the transverse nasalis, whereas the dilators are the dilator naris anterior and posterior. The muscles are interconnected by an aponeurosis termed the nasal superficial musculoaponeurotic system (SMAS).
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External nares Zygomatic 2 of 6 Friday. and bony dorsum Maxillary division Maxillary Infraorbital .. and (2) branches from the external carotid. This transitions to pseudostratified ciliated columnar respiratory epithelium with abundant seromucinous glands within the nose. forehead. and angular arteries. The nasal septum also derives its blood supply from the sphenopalatine and the anterior and posterior ethmoid arteries with the added contribution of the superior labial artery (anteriorly) and the greater palatine artery (posteriorly). has an abundant blood supply. like the rest of the face. The internal nasal lining consists of squamous epithelium in the vestibule. and scalp Supratrochlear . Ophthalmic division Lacrimal . greater palatine..ethmoid and frontal sinuses and (2) external . Subunit principal The external soft tissue of the nose can be divided in subunits. or the Little area.Eyelid skin.Skin of the nose and mucous membrane of anterior nasal cavity Anterior ethmoid .Medial eyelids. 2011 11:00 PM . namely the sphenoid and ethmoids Intratrochlear . represents a region in the anteroinferior third of the nasal septum. these features potentiated the intracranial spread of infection.Skin of forehead and scalp Supraorbital . one would strive to replace the whole unit with regional tissue or tissue from a donor site. smoking does compromise postoperative healing. palpebral conjunctiva. The following outline effectively delineates the respective sensory distribution of the nose and face of the trigeminal nerve. superior labial.Superior half of nasal cavity. namely the sphenopalatine.nasal skin from rhinion to tip Posterior ethmoid . where all 3 of the chief blood supplies to the internal nose converge. Even with the abundant blood supply of the nose. the lateral nasal wall is supplied by the sphenopalatine artery posteroinferiorly and by the anterior and posterior ethmoid arteries superiorly. the hemi-lobule segment.Anterior half of nasal cavity: (1) internal . namely the branches of the anterior and posterior ethmoid arteries from the ophthalmic artery. The sellar and dorsal regions of the nose are supplied by branches of the internal maxillary artery (namely the infraorbital) and ophthalmic arteries (which are from the internal carotid system). The subunits includes the dorsal nasal segment. which becomes the angular artery coursing over the superomedial aspect of the nose. nasion. Blood supply The nose.medscape. soft tissue triangle segments. They are significant for their direct communication with the cavernous sinus and for their lack of valves. The Kiesselbach plexus. The arterial supply to the nose may be principally divided into (1) branches from the internal carotid. Lymphatics Lymphatics arise from the superficial mucosa and drain posteriorly to the retropharyngeal nodes and anteriorly to the upper deep cervical nodes and/or submandibular glands Nerves The sensation of the nose is derived from the first 2 branches of the trigeminal nerve. lateral nasal wall segments. 15 April. Internally. the alar segments and the columellar segment. The external nose is supplied by the facial artery. The purpose of subunits is to divide the nasal anatomy into segments useful for reconstruction.Medial eyelid and medial forehead Nasociliary . Veins in the nose essentially follow the arterial pattern. If more than 50% of the subunit is lost.com/article/835134-ove.Nose Anatomy http://emedicine.Skin of lateral orbital area except lacrimal gland Frontal .
which comes from the carotid plexus to form the vidian nerve in the vidian canal. The quadrangular cartilage.. Cartilaginous pyramid The cartilaginous septum extends from the nasal bones in the midline above to the bony septum in the midline 3 of 6 Friday. The vidian nerve travels through the pterygopalatine ganglion (with only the parasympathetic nerves forming synapses here) to the lacrimal gland and glands of the nose and palate via the maxillary division of the trigeminal nerve.Divides into lateral and septal branches and conveys sensation from posterior and central regions of the nasal cavity The parasympathetic supply is derived from the greater superficial petrosal (GSP) branch of cranial nerve VII. 15 April. 2011 11:00 PM . middle. they are attached to the ascending processes of the maxilla.Nose Anatomy http://emedicine. which form the bony framework of the turbinates.. The lateral nasal walls contain 3 pairs each of small. The floor comprises the premaxilla and the palatine bones. sloping down at an angle. and inferolaterally. Posteroinferior to this structure. shown below. Superior posterior dental Superior anterior dental . The GSP joins the deep petrosal nerve (sympathetic supply). Image used with permission. the paired nasal bones are attached to the frontal bone. thin. Nose anatomy. eg. Posterosuperiorly. with names that correspond to the above turbinate.com/article/835134-ove. is the bony face of the sphenoid sinus. superior turbinate. as shown below. Superolaterally. they are connected to the lacrimal bones. Lateral to these curved structures lies the medial wall of the maxillary sinus. the vomer. the bony nasal septum is composed of the perpendicular plate of the ethmoid. which in part forms the choanal opening into the nasopharynx. the perpendicular plate of the ethmoid and aspects from the premaxilla and palatine bones form the nasal septum.medscape. Bony anatomy Superiorly. Nose anatomy.Mediates sneeze reflex Sphenopalatine . Posteroinferiorly lies the vomer. and inferior conchae. Inferior to the turbinates lies a space called a meatus. shell-like bones: the superior. superior meatus. The roof of the nose internally is formed by the cribriform plate of the ethmoid.
base. that is. then down along the bony floor.medscape. The inferior ends of the upper lateral cartilages are free. Several variations exist. Structure External nasal anatomy The first image below depicts the external nasal anatomy. It assumes a quadrangular shape. Nasal scroll. an outcurving of the lower borders of the upper lateral cartilages and an incurving of the cephalic borders of the alar cartilages. The paired lower lateral cartilages swing out from medial attachments to the caudal septum in the midline. Adjacent sesamoid cartilages may be found lateral to the upper lateral cartilages in the fibroareolar connective tissue. These upper lateral cartilages are fused to the dorsal septum in the midline and attached to the bony margin of the pyriform aperture laterally by loose ligaments. These cartilages are frequently mobile.Nose Anatomy http://emedicine. They finally flare out superolaterally as the lateral crura. These are found variably. the hemilobules. posteriorly. Its upper half is flanked by 2 triangularto-trapezoidal cartilages: the upper lateral cartilages. shown below.com/article/835134-ove. as depicted below. Image used with permission. the alae. Nose anatomy. The internal area or angle formed by the septum and upper lateral cartilage constitutes the internal valve. and the columella. in contradistinction to the upper lateral cartilages. Beneath the upper lateral cartilages lie the lower lateral cartilages. to an intermediate crus area. the sidewalls. Subunits include the dorsum. 4 of 6 Friday. the soft triangles.. 15 April. In some individuals. shown in the second image below. 2011 11:00 PM .. called the medial crura. evidence of a scroll may exist.
shape. the superior. The nasofrontal angle between the frontal bone and nasion is usually 120° and slightly more acute in males than in females. Nasal subunits include the dorsum. 2011 11:00 PM .. or the slope of the nose compared with the plane of the face. normal columella show. and inferior concha form corresponding superior.medscape. The inferior meatus provides drainage of the nasolacrimal duct. Viewing the external nasal anatomy by its subunits is important because defects that span an entire subunit are usually repaired with reconstruction of that subunit. alae. The internal nasal valve involves the area bounded by upper lateral cartilage. Nose anatomy. the sidewalls (paired). leptorrhine. an angle wider than 15° is needed in this area. is approximately 30-40°. and the columella. Aesthetically. with the apex at the infratip lobule just beneath the tip. the height of the nasal aperture visible. The nasofacial angle. The superior meatus is the drainage area for the posterior ethmoid cells and the sphenoid sinus. and strength of the lower lateral cartilage. and inferior meatus on the lateral nasal wall. sidewalls. paraleptorrhine. From ala to ala. Burget suggests replacement of the entire subunit if more than 50% of the subunit is lost during resection. The external valve is a variable area dependent on the size. as follows: Caucasian. subplatyrrhine. 15 April. The middle meatus provides drainage of anterior ethmoid and the maxillary and frontal sinuses.com/article/835134-ove. alae (paired). The nasolabial angle between the columella and philtrum is about 90-95° in males and 100-105° in females. lobule. Regarding the lateral nasal wall and paranasal sinuses.  Internal nasal anatomy The septum is a midline bony and cartilaginous structure that divides the nose into 2 similar halves. African American. the nose—from the nasion (nasofrontal junction) to the columella-labial junction—ideally occupies one third of the face in the vertical dimension. is 2-4 mm.  5 of 6 Friday. The width of the nasal valve can be increased with spreader grafts and flaring sutures.Nose Anatomy http://emedicine. it should ideally occupy one fifth of the horizontal dimension of the face. platyrrhine. Hispanic. On profile view. the soft triangles (paired). and anterior head of the inferior turbinate. This comprises the narrowest portion of the nasal airway in the leptorrhine nose. the hemilobules (paired). middle.. ie. Ethnic influences can result in different appearances of the nose. and Asian. Nasal Analysis The nose can be conveniently divided into several subunits: the dorsum. and columella. nasal floor. the alar base forms an isosceles triangle. soft triangles. The dorsum should be straight. Generally. From below. middle. septum.
Appropriate projection of the nasal tip. marking the transition between the intermediate crus of the lower lateral cartilage and the medial crus. Tip projection should be 55-60% of the distance between the nasion and tip-defining point. is judged by using the Goode rule.. 6 of 6 Friday. 15 April. 2011 11:00 PM . A columellar double break may be present.medscape.Nose Anatomy http://emedicine.com/article/835134-ove. or the distance of the tip from the face..
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