Widened Dorsum: Bony and Cartilaginous Contributions

2018 ◽  
Vol 34 (05) ◽  
pp. 443-447
Author(s):  
Gary Linkov ◽  
Gregory Branham
Keyword(s):  
Nasal Airway ◽  
Nasal Dorsum ◽  
Airway Compromise ◽  
Nasal Function ◽  
Upper Third ◽  
Nasal Vault ◽  
Proper Analysis

AbstractCreation of a pleasing dorsal nasal profile in the anterior and lateral views requires proper analysis and planning to determine the required series of steps to accomplish the desired outcome. The widened nasal dorsum is a common esthetic complaint of the patient seeking rhinoplasty. Often patients seek an unrealistic result that, if accomplished, would leave them with a restricted nasal vault and nasal airway compromise. Nasal function must be balanced with the patient and surgeon's desire to narrow the nasal dorsum. Various techniques are used to control the width of the upper third, or bony vault, and middle third, or cartilaginous vault.

Medial Nasal Bone Scoring: A Novel Technique for Improving Osteotomies During Rhinoplasty

2019 ◽  
Vol 37 (3) ◽  
pp. 138-142
Author(s):  
Paul P. Daraei ◽  
Hardik Doshi ◽  
Louis M. DeJoseph
Keyword(s):  
Nasal Bone ◽  
Contralateral Side ◽  
Bone Architecture ◽  
Nasal Dorsum ◽  
Fracture Patterns ◽  
Lateral Osteotomy ◽  
Invasive Method ◽  
Upper Third ◽  
Formalin Fixed

Nasal bone osteotomies are commonly performed in rhinoplasty to manipulate the upper third of the nose. In patients with a dorsal hump, reduction is often performed, followed by lateral osteotomies to medialize the nasal bone complex. However, fracture patterns are often unknown in vivo. We intend to map nasal bone osteotomies and describe a novel and minimally invasive method of performing medial scoring osteotomies to improve fracture patterns and surgical speed, and decrease complications. In total, 19 formalin-fixed cadavers were dissected to reveal nasal bone architecture. The nasal dorsum (bony and cartilaginous) was reduced to form an open roof deformity. Osteotomies were then performed on all 19 specimens, followed by digital infracture. Medial scoring osteotomies were performed unilaterally, along with a lateral osteotomy. On the contralateral side, only lateral osteotomies were performed. Fracture patterns were mapped and compared. Of 19 cadaver specimens, 38 sides were examined in total: 19 sides underwent medial scoring and 19 sides served as controls. Fracture patterns were linear with less comminution on sides with medial scoring osteotomies. Sides with medial scoring osteotomies also achieved uniform closure of the open roof deformity, compared with 73% in sides without. Rocker deformity was not seen in either group. Osteotomies are integral to nasal dorsum reduction and modification of the upper third of the nose in rhinoplasty. Scoring of the medial nasal bone prior to lateral osteotomy and digital infracture allows for an increased rate of open roof closure. Furthermore, medial scoring osteotomies create smooth, linear fracture patterns that prevent bony spicules, comminution, and irregularities that may be evident in patients with thin nasal skin. Performing the medial scoring osteotomy is a fast, safe method of achieving consistent nasal bone infracture during rhinoplasty.

Addressing the Upper Third of the Nose in Endonasal Rhinoplasty

2021 ◽  
Author(s):  
Amar Gupta
Keyword(s):  
Effective Management ◽  
Detailed Understanding ◽  
Form And Function ◽  
Closed Approach ◽  
And Function ◽  
Upper Third ◽  
Nasal Vault ◽  
Anatomic Region ◽  
Preoperative Analysis

AbstractEffective management of the upper nasal vault is based on a thorough preoperative analysis and detailed understanding of the requisite principles and techniques utilized to modify the anatomic structures in this region. The surgeon must equally consider form and function when performing manipulation of the upper nasal vault. Special considerations apply when managing this anatomic region via an endonasal or closed approach. A review of this topic is presented with a focus on techniques as they apply to the endonasal rhinoplasty patient.

Overlay grafting for lateral nasal wall concavities

1998 ◽  
Vol 119 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Scott E. Gilbert
Keyword(s):  
Patient Satisfaction ◽  
Revision Rate ◽  
Bone Fractures ◽  
Nasal Bone ◽  
Lateral Nasal Wall ◽  
Nasal Airway ◽  
Nasal Cartilage ◽  
Crooked Nose ◽  
Nasal Vault

One of the most difficult maneuvers in rhinoplasty is achieving a straight dorsum in the patient with a crooked nose. Often this deformity is a result of trauma involving the bony and cartilaginous vaults, resulting in nasal bone fractures and avulsion of the lateral cartilages into the nasal airway. Reduction of nasal bone fractures is fairly straightforward, but the repair of nasal cartilage trauma is more problematic. The cartilage of the nasal vault possesses fibrous attachments, which when disturbed, are difficult to reestablish. Overlay grafts are known to be effective in filling these defects and creating the illusion of a straight nose. In this series, during an 8-year period, 89 grafts were placed over lateral nasal wall concavities during rhinoplasty. Results after a minimum of 1 year follow-up are reviewed, as well as technique, materials, complications, revision rate, and patient satisfaction.

scholarly journals Evaluation of Nasal Airway Volume of Operated Unilateral Cleft Lip and Palate Patients Compared With Skeletal Class III Individuals

2018 ◽  
Vol 56 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Ümit Ertaş ◽  
Mert Ataol
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Nasal Passage ◽  
Study Group ◽  
Nasal Airway ◽  
Class Iii ◽  
Skeletal Class ◽  
Alar Base ◽  
Nasal Function

Cleft lip and palate (CLP) patients have various problems with nasal anatomy beyond just oronasal separation. The alar base, concha, and septum are over impressed in these individuals. Additionally, skeletal class III deformity is seen. These conditions may limit nasal function. In our study, 15 unilateral patients with CLP older than 15 years (10 females, 5 males; mean age: 19.13) who had received surgery were included as the study group, and 15 participants with noncleft skeletal class III deformities were included as the control group (10 females, 5 males; mean age: 19.20). The individuals’ nasal airway volumes (total/cleft side/noncleft side/control/ nasal passages) were examined and compared statistically. The results showed that the study group had significantly higher values in terms of total airway volume ( P < .05). Additionally, there were significant differences between the cleft side and noncleft side volumes, between the cleft side volumes and the volumes of the control group participants, and between the noncleft side volumes and the volumes of the control group participants ( P < .05). There was no difference between the groups in terms of nasopharyngeal ( P = .39) and nasal passage volumes ( P = .73). The results show there are some problems regarding nasal airway volume in patients with CLP, even when lip, palate, and alveolar cleft operations have been performed. The aim of this study was to evaluate differentiation of nasal airway volumes between unilateral patients with CLP and individuals with noncleft skeletal class III serving as the control group.

Nasal Airway in Breathing and Speech

1992 ◽  
Vol 29 (6) ◽  
pp. 511-519 ◽  
Author(s):  
Donald W. Warren ◽  
Amelia F. Drake ◽  
Jefferson U. Davis
Keyword(s):  
Energy Source ◽  
Respiratory Tract ◽  
Respiratory System ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Correction ◽  
Nasal Airway ◽  
Airway Compromise ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function

Clefts of the lip and palate frequently produce nasal deformities that tend to reduce the size of the nasal airway. Approximately 70% of the cleft population have nasal airway impairment and about 80% “mouth-breathe” to some extent. Surgical correction of nasal, palatal, and pharyngeal structures may further compromise breathing. Type of cleft appears to affect airway size, with unilateral clefts demonstrating the smallest airway. Although a pharyngeal flap may further decrease airway size, some individuals do not notice a postoperative change because of airway compromise prior to flap placement. Speech is a modified breathing behavior that uses the respiratory system to provide an energy source and involves structures within the respiratory tract to modulate this energy into meaningful sounds. The oral, nasal, and pharyngeal structures that are affected by cleft lip and palate during breathing are often compromised for speech as well. The nasal airway plays an important role in controlling speech pressures when velopharyngeal function is impaired. A “good” nose for breathing is often a “bad” nose for speech under such circumstances.

scholarly journals Numerical Analysis of the Relationship between Nasal Structure and Its Function

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Shen Yu ◽  
Xiu-zhen Sun ◽  
Ying-xi Liu
Keyword(s):  
Nasal Cavity ◽  
Three Dimensional ◽  
Heating Process ◽  
Nasal Airway ◽  
Airflow Distribution ◽  
Dimensional Finite Element ◽  
Approximate Function ◽  
Three Dimensional Finite Element ◽  
Nasal Function ◽  
The Relationship

The functions of the nasal cavity are closely related to its structure. In this study the three-dimensional finite element models were established based on the clinical data of twenty-four volunteers to study the influence of nasal structure on nasal functions of heating the inhaled airflow. Numerical simulations mainly concerning the airflow distribution and the airflow temperature are performed. The character of airflow heating process in these models is gained from the simulation results of these nasal cavities. The parameters describing the geometry of nasal cavity, such as the surface area of nasal airway and the volume of nasal cavity, are considered to be related to the nasal function of heating the inhaled airflow. The approximate function describing the relationship between the geometric parameters of the nasal airway and the nasal functions is gotten. This study can provide a numerical platform for studying some clinical problems and will contribute to the further research on the relationship between nasal structure and nasal functions.

Treating the Deviated or Wide Nasal Dorsum

2017 ◽  
Vol 33 (02) ◽  
pp. 139-156 ◽  
Author(s):  
Richard Davis ◽  
Allen Foulad
Keyword(s):  
Treatment Plan ◽  
Specific Treatment ◽  
Preoperative Assessment ◽  
Patient Specific ◽  
Nasal Airway ◽  
Nasal Dorsum ◽  
Suture Fixation ◽  
Nasal Surgery ◽  
Developmental Growth ◽  
Nasal Trauma

AbstractBoth deviation and excessive width of the nasal dorsum result in conspicuous facial disharmony and are often attended by nasal airway dysfunction. Whether the result of developmental growth disturbances, nasal trauma, failed nasal surgery, or combinations therein, deviation and splaying of the nasal dorsum can be exceedingly difficult to treat. Individualized treatment is paramount because contour variations are seemingly endless, and a careful preoperative assessment of the anatomic, physiologic, cosmetic, and psychosocial factors that characterize the deformity is necessary to devise an effective patient-specific treatment plan. Ensuring the linearity, strength, alignment, and aesthetically pleasing profile dimensions of the nasal L-strut is the requisite first step in successful treatment. Releasing all deformed components in a controlled and precise manner using powered instrumentation (whenever possible) to facilitate minimally traumatic and effective repositioning, followed by structural reconstitution of the skeletal framework using autologous graft materials, and then consolidation of the newly created construct with suture fixation completes the transformation to normalcy. Paying equal attention to both cosmetic and functional wellness, while simultaneously seeking to maximize structural stability, serves to optimize the final outcome.

An Evaluation of Nasal Response following Different Treatment Regimes of Oxymetazoline with Reference to Rebound Congestion

1997 ◽  
Vol 11 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Sara Morris ◽  
Ronald Eccles ◽  
S. Jawad Martez ◽  
Donald K. Riker ◽  
Theodore J. Witek
Keyword(s):  
Day Treatment ◽  
Nasal Congestion ◽  
Vehicle Group ◽  
Controlled Study ◽  
Nasal Airway ◽  
Visual Examination ◽  
Double Blind ◽  
Treatment Groups ◽  
Treatment Regimes ◽  
Nasal Function

This was a randomized, double-blind vehicle controlled study aimed at investigating the effects on nasal function of 7 days treatment with the topical decongestant oxymetazoline (0.05% w/v). Fifty healthy volunteers took part in the study and these were randomly allocated to three treatment groups (i) daily oxymetazoline (b.i.d. 150 μl per nostril) (ii) intermittent oxymetazoline, with oxymetazoline being substituted for vehicle at the morning doses on days 1, 3, and 7; and (iii) daily vehicle (b.i.d. 150 μl per nostril). The nasal airway was assessed by measurement of nasal airway resistance (NAR) using posterior rhinomanometry, subjective scaling of nasal patency by means of a visual analogue scale (VAS), and clinical visual examination. On days 1, 2, 3, and 7, NAR and VAS measurements were obtained before the morning dose and up to 6 hours after dosing; clinical visual examinations were also performed before dosing on these days. NAR and VAS measurements were also made following withdrawal of treatment on Days 8 and 9. Nonparametric analysis of the results showed that therapeutic tolerance to oxymetazoline did not develop over the 7-day treatment period, and visual examination of the nasal mucosa failed to find significant evidence of rhinitis. Evidence of rebound nasal congestion was found following 3 days of oxymetazoline treatment, with baseline NAR within the daily and intermittent oxymetazoline groups being significantly greater on Day 3 compared to Day 1 (p < 0.05). However, there was a trend toward increasing baseline NAR in the vehicle group over the course of the study, suggesting that the vehicle may have contributed to the rebound congestion. Following the withdrawal of treatments, only the intermittent oxymetazoline group had significantly higher NAR on Days 8 and 9 compared to Day 1 (p < 0.05). Subjective VAS measurements generally followed trends in NAR.

Ultrastructure of superficial neuromasts in the mottled sculpin, Cottus bairdi

1989 ◽  
Vol 47 ◽  
pp. 958-959
Author(s):  
W.R. Jones ◽  
S. Coombs ◽  
J. Janssen
Keyword(s):  
Hair Cells ◽  
Lateral Line System ◽  
Electron Microscopic ◽  
Line System ◽  
Dense Cores ◽  
Sensory Hair Cells ◽  
Cytoplasmic Vesicles ◽  
Cottus Bairdi ◽  
Mottled Sculpin ◽  
Upper Third

The lateral line system of the mottled sculpin, like that of most bony fish, has both canal (CNM) and superficial (SNM) sensory end organs, neuromasts, which are distributed on the head and trunk in discrete, readily identifiable groupings (Fig. 1). CNM and SNM differ grossly in location and in overall size and shape. The former are located in subdermal canals and are larger and asymmetric in shape, The latter are located directly on the surface of the skin and are much smaller and more symmetrical It has been suggested that the two may differ at a more fundamental level in such functionally related parameters as extent of myelination of innervating fibers and the absence of efferent innervation in SNM. The present study addresses the validity of these last two features as distinguishing criteria by examining the structure of those SNM populations indicated in Fig. 1 at both the light and electron microscopic levels.All of the populations of SNM examined conform in general to previously published descriptions, consisting of a neuroepithelium composed of sensory hair cells, support cells and mantle cells, Several significant differences from these accounts have, however, emerged. Firstly, the structural composition of the innervating fibers is heterogeneous with respect to the extent of myelination. All SNM groups, with the possible exception of the TRrs and CFLs, possess both myelinated and unmyelinated fibers within the neuroepithelium proper (Fig. 2), just as do CNM. The extent of myelina- tion is quite variable, with some fibers sheath terminating just before crossing the neuroepithelial basal lamina, some just after and a few retaining their myelination all the way to the base of the hair cells in the upper third of the neuroepithelium. Secondly, all SNMs possess fibers that may, on the basis of ultrastructural criteria, be identified as efferent. Such fibers contained numerous cytoplasmic vesicles, both clear and with dense cores. In regions where such fibers closely apposed hair cells, subsynaptic cisternae were observed in the hair cell (Fig. 3).

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