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Rhinoplasty Terminology

Anatomy

  • Glabella – point where the forehead meets the nose, in between the eyebrows.
  • Nasion – bony point where the nose begins.
  • Radix – “root” of the nose.
  • Rhinion – point of transition between the nasal bones and the nasal cartilage on the bridge.
  • Upper lateral cartilage – paired cartilages that connect the nasal bones to the nasal tip cartilages.
  • Lower lateral cartilage – tip cartilages.
  • Ala – “wing” of the nose.
  • Alar-facial groove – border of the nose and the cheek.
  • Columella – soft tissue between the nostrils.
  • Nasal valve – internal and external portions of the nose corresponding to areas of high airflow resistance.
  • Nasal vestibule – entrance to the nose, in the nostrils.
  • Nostril sill – soft tissue at the floor of the entrance to the nostril.
  • Septum – cartilaginous and bony structure that supports the nose and separates the nasal passage into left and right sides.
  • Maxilla – upper jaw bone.
  • Turbinate – bony outcroppings in the nose, covered with mucosa; assist in directing airflow and providing humidification.
  • Nasolabial angle – angle that the nose makes with the upper lip in profile.
  • Nasofrontal angle – angle that the nose makes with the forehead in profile.
  • Soft triangle – also known as the facet; the skin at the top of the nostril where it meets the tip.
  • Tip-defining points – the highest points, bilaterally, in the nasal tip.

Techniques

  • Dorsal hump (bump) removal – reduction of the bone and cartilage convexity along the bridge of the nose.
  • Rasp – use of a sharp file to reduce the height and smooth the surface of the nasal bones.
  • Osteotomy – surgical cut in a bone; used to move the nasal bones during rhinoplasty.
  • Cephalic trim – removal of a portion of the superior and medial aspects of the lateral crus of the lower lateral cartilage; a way to reduce overall tip volume.
  • Dome division – technique that divides the nasal tip cartilage at the dome in order to shorten and/or reshape the tip.
  • Lateral crural overlay – technique involving division, overlap, and repair of the lateral crus of the lower lateral cartilage; allows for narrowing of the tip without significantly weakening its structure.
  • Lateral crural strut grafts – cartilage placed underneath the lateral crura to flatten and strengthen the sides of the tip.
  • Alar rim grafts – cartilage placed along the rim of the nostril to support the soft tissue and reduce the risk of alar retraction.
  • Spreader grafts – cartilage placed along the dorsal septum to widen the internal nasal valve region and support the sidewalls of the nose.
  • Batten grafts – cartilage placed along the nasal sidewalls to prevent collapse; commonly used in closed (endonasal) rhinoplasty.
  • Flaring suture – mattress suture placed in the upper lateral cartilages, cantilevered on the dorsal septum, to reduce sidewall collapse with inspiration.
  • Septoplasty – alternation of the shape or structure of the nasal septum.
    Inferior turbinate reduction – reduction of the volume of the inferior turbinates; performed to open the airway.
  • Rotation – increase in the nasolabial angle.
  • Alar base modification – changes in the shape and/or width of the base of the nose.

Problems

  • Alar retraction – elevation of the alar rim, frequently from scar tissue and healing forces.
  • Bulbous tip – wide or full tip region.
  • Columella show – visibility of the inside of the nose on the profile view.
  • Deviated septum – deviation of the septal bone and cartilage from the midline, frequently causing nasal obstruction.
  • Droopy (ptotic) tip – tip position that is under-rotated or downward in orientation.
  • Inverted “V” deformity – visibility of the nasal bone edges due to poorly supported upper lateral cartilages.
  • Nasal valve collapse (external) – collapse of the nostrils and alar tissues with inspiration.
  • Nasal valve stenosis (internal) – tightness of the area inside the nose bounded by the septum, inferior turbinate, and upper lateral cartilage; narrowest part of the nasal airway.
  • Polly beak deformity – fullness in the area above the tip, causing the appearance of convexity.
  • Saddle nose deformity – collapse of the bridge of the nose due to failure of the internal support.
  • Turbinate hypertrophy – enlargement of the turbinate tissues, most commonly the inferior turbiantes.

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Osteotomy-Technique-Final

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