Surgical anatomy of the nose

A good anatomical knowledge is a pre-requisite to all surgeries. In rhinoplasty, where many steps are performed without visual control and are only guided by palpation, anatomy must be mastered. Based on classical static anatomy and dynamic surgical modifications of the nose, this study analyses anatomical and surgical correlation and reports their technical implications. Correction of the shape of the nose is to be able to conceptualize the underlying skeleton and to program adapted surgical procedure for each case.     

Surgical anatomy of the nose

It is imperative to know the details of the anatomy of the nose before understanding any surgical procedure performed on the nose. The details presented in this article should help the experienced and the novice surgeon accomplish the difficult task of a rhinoplasty.     

Revisiting human nose anatomy: phylogenic and ontogenic perspectives

This review suggests revisiting nose anatomy by considering the ethmoidal labyrinths as part of the olfactory nose and not as paranasal sinuses. Phylogenetically, the olfactory and respiratory organs of the most primitive vertebrates are separated. Exaptation, a mechanism of evolution, may explain the fusion of the olfactory and respiratory organs in dipnoi. The respiratory and olfactory noses remain anatomically separated by the transverse lamina in most mammals, whose olfactory labyrinth is a blind recess housing the ethmoturbinates. In humans, the partitioning between the olfactory cleft and the ethmoid labyrinth seems to be a consequence of ethmoid bone remodeling induced by the acquisition of an upright posture. The ethmoid bone is derived from the cartilaginous nasal capsule of primitive vertebrates and considered to be a highly conserved region among the bony elements of the skull base. It appears to be involved only in housing and protecting the olfactory function. During the early stages of human fetal development, rupture of the oronasal membrane leads to the integration of the primary olfactory sac in the future respiratory organ. The cartilaginous nasal capsule appears in the tissue under the brain and around the olfactory channels. Its early fetal development is classically regarded as the beginning of paranasal sinus formation. From phylogenic and ontogenic perspectives, it may be regarded as the development of the olfactory labyrinth as modified by the remodeling process of the human face and skull base. The endochondral bony origin of the ethmoid labyrinths makes them substantially different from the other paranasal sinuses.     

Artistic anatomy of the nose: proposals for a simplified project of rhinoplasty

OBJECTIVE: The authors developed an original and simple method of evaluation of the aesthetic lines of the nose adapted to the harmony of the face. METHOD: Initially based on their experience, the authors propose an evaluation of the nose in 2 stages and 5 sequencies based on the construction of single circuit lines according to various incidences. They checked thereafter the validity of this method on the operative project and on the appreciation of the results of the rhinoplasties. RESULTS: Controlled on several types of faces, the method suggested by the authors proved to be reliable, simple, reproducible. CONCLUSION: The authors proposed a method of evaluation of the aesthetic lines of the nose integrated to the harmony of the face. This method relies on the construction, in 5 stages, of single circuit lines not requiring any particular material. The artistic method of evaluation of the nose proposed by the authors is very simple. Rapid and immediately usable, it makes it possible to schedule a rhinoplasty in a few minutes. The evaluation of the aesthetic results of the rhinoplasties is also very simple and reproducible. It has moreover the merit to propose a model of teaching making it possible to the rhinoplastician to criticize his results and thus to progress in its technical training and its operational indications.     

The anatomy of the lacrimal bone at the lateral wall of the nose: its significance to the lacrimal surgeon

The position, dimension and thickness of the exposed lacrimal bone at the lateral nasal wall in 10 cadaveric half-heads were examined. In all cases, the lacrimal bone at the lateral nasal wall was found to be just anterior to the mid-third of the uncinate process. The average length and width was 7.4 mm and 2.5 mm, respectively. In nine of the 10 half-heads, the lacrimal bone was very thin with an average thickness of 57 mm. In all the cases, the position of the lacrimal passage covered by the lacrimal bone corresponded to the postero-medial aspect of the upper lacrimal duct and the lower lacrimal sac. This study shows that the uncinate process is a reliable landmark for the lacrimal bone in endoscopic nasal surgery. The paper-thin lacrimal bone allows a bone rongeur to infracture through and nibble away the bony covering of the lacrimal sac in a dacryocystorhinostomy.     

Architectural deficiencies of the nose: treatment of the saddle nose and short nose deformities

The saddle nose and short nose deformities are challenging surgical problems characterized by significant architectural deficiencies of the nasal framework. These defects produce cosmetic and functional nasal problems. Reconstructive techniques and augmentation materials are reviewed. Case examples illustrate the authors currently preferred techniques.     

Cross-sectional anatomy of the nose and paranasal sinuses. A correlative study of computer tomographic images and cryosections

Anatomic relations in the nose and paranasal sinuses have been studied in computer tomographic images and cryosections, to highlight some details that are of importance for the functional nasal surgeon. From three heads the sections were obtained in three perpendicular planes (coronal, axial and sagittal). The most interesting sections are depicted in three ways: a computer tomographic image, the surface photography of the tissue block in the microtome and a stained section of 20 microns. A number of interesting relations that are clearly depicted are discussed.     

The anatomy of the lacrimal bone at the lateral wall of the nose: its significance to the lacrimal surgeon.

The position, dimension and thickness of the exposed lacrimal bone at the lateral nasal wall in 10 cadaveric half-heads were examined. In all cases, the lacrimal bone at the lateral nasal wall was found to be just anterior to the mid-third of the uncinate process. The average length and width was 7.4 mm and 2.5 mm, respectively. In nine of the 10 half-heads, the lacrimal bone was very thin with an average thickness of 57 mm. In all the cases, the position of the lacrimal passage covered by the lacrimal bone corresponded to the postero-medial aspect of the upper lacrimal duct and the lower lacrimal sac. This study shows that the uncinate process is a reliable landmark for the lacrimal bone in endoscopic nasal surgery. The paper-thin lacrimal bone allows a bone rongeur to infracture through and nibble away the bony covering of the lacrimal sac in a dacryocystorhinostomy.     

Hamartomas of the nose

Three cases of hamartomas of the nose, very rare conditions in otolaryngology are reported. According to the Willis (1953) classification two of these cases, belonged to the angiomatous, and the third one to the lipomatous, group of hamartomas.