Aesthetic Nasal Surgery

pich88's version from 2017-05-15 17:38


Question Answer
Major tip supportscroll region (attachment of upper lats to lower lats), size shape and resilience of lower lats, attachment of medial crura to to inferior septal angle
minor tip supportmembranous septum, cartilaginous septal dorm, anterior nasal spine, skin/soft tissue envelope, sesamoid complex, interdomal ligament btw lower lats
Frankfort horizontal lineinferior border of etc (superior tragus) to infraorbital rim
photo viewsleft and right lateral, 3/4 oblique, lateral with smile, frontal, base
scrollregion of abutment btw the upper and lower lats
keystone arearegion of overlap of upper lats to nasal bone
internal nasal valveseptum, upper lat, head of inferior turn (normal = 10-15 degrees)
spreader graftwidens internal nasal valve. placed btw upper lat and septum
external nasal valvenasal sill, caudal septum and medial crura, alar cartilage
external nasal valve obstruction managementbreathing strips, septoplasty, suspension sutures, spreader frats
onlay batten graftsplaced under edges of lower lateral cartilage. augments lower lat support. helps external valve collapse
columellar strutimproves tip ptosis
depressor septidraws nasal tip down when smiling
what muscle draws nasal tip downward when smilingdepressor septillion's
acceptable columellar show2-3mm
tip projection60% of tip length (3,4,5 triangle) (tip lenth= 1/3 of face)
frontal viewwidth of nasal dorsum and alar base (1/5 face), nasal length (1/3 of face), nasal tip, gull in flight outline
nasofrontal angle 120%
profile viewnasofrontal angle (115-130), columelar show, nasal dorsum, dorsal height, tip projection, tip rotation
tip rotationnaso labial angle ( 90-95 in men 95-110 in women)
base viewcolumella to lobule ratio of 2:1, size of nostril, height of lobule
bulbous tip correctioncephalic trim, interdomal sutures
Increase tip projectioninterdomal suture, columelar strut, shield graft
decrease tip projectioncomplete transfixion incision overlap medial or lateral crura
increase tip rotationanterior placement of medial crura along septum (tongue in groove), remove dorsal hump, reduce caudal septum, shorten lateral crura
decrease tip rotationshorten medial crura, dorsal augmentation, caudal septum excision near spine
polybeak deformitysupratip prominence extending beyond the nasal tip
causes of polybeak deformityexcessive resection of dorsum, inadequate removal of cartilaginous dorsum, loss of nasal tip support, scaring in supratip
management of polybeak deformitysteroid injection or excision of soft tissue scaring, olay grafting or supratip cartilage resection, columellar strut
saddling causesexcessive reduction of nasal dorsum
management of saddle noselateral osteotomies, dorsal only graft, extended height spreader frats
inverted V deformityvisible transition btw caudal border of nasal bone and cephalic border of upper lats - medial prolapse of upper lats
causes of inverted V deformityweekending of attachment of upper lats to nasal bone, over resection of dorsum
management of inverted V deformityspreader grafts, osteotomies, only grafts