Rhinoplasty

Question 1

What are the indications for rhinoplasty?

Answer 1

1. Functional - for airway obstruction
2. Reconstructive - congenital or traumatic
3. Cosmetic - to change the external appearance of the nose

Question 2

whats the difference between the skin of the upper 2/3 and the lower 1/3?

Answer 2

the skin on the upper two thirds is thinner and less sebaceous than the lower third

Question 3

What is the significance of the skin quality in certain ethnicities and the role it plays in rhinoplasty?

Answer 3

Thicker and more sebaceous nasal skin necessitates more dramatic changes to the underlying framework are needed for a change in the outward appearance

Question 4

In what plane and in what subunits of the nose can filler be safely injected?

Answer 4

Sub-superficial musculoaponeurotic system plane just above the plane of the periosteum; the nasal dorsum and the nasal sidewalls; They should not be placed in the tip or ala

Question 5

What are some general characteristics of an Asian nose?

Answer 5

Alar flare, bulbous nasal tip, short retracted columella, thick subcutaneous tissue and wide flat nasal dorsum

Question 6

What are some differences between a caucasian and Asian nose?

Answer 6

Upper and lower lateral cartilage height is shorter in the Asian nose. When a cephalic trim is performed in an Asian nose, caution for overresection

Question 7

What is a tension nose?

Answer 7

A combination of thin, constricted nasal skin element with strong lower lateral cartilages leading to a potentially twisted or deviated nasal appearance. Also excessive growth of the quadrangular cartilage resulting in high dorsum and displaced lower lateral cartilages

Question 8

What is the blood supply to the tip of the nose?

Answer 8

1. Lateral nasal artery
2. Columellar vessel arising from the superior labial artery
3. All originating from facial artery

Question 9

Where are the lateral nasal vessels found and what is the pitfall to avoid when performing alar resection with an open rhinoplasty?

Answer 9

2-3mm above the alar groove, and so the alar base resection should not extend to this area, as injury to these vessels would cause ischemia of the nasal tip

Question 10

What are the sensory nerves of the nose?

Answer 10

External branch of the anterior ethmoid nerve
The internal branch of the anterior ethmoidal nerve Nasopalatine nerve.
The infraorbital nerve
The infratrochlear nerve
The supraorbital nerve

Question 11

External branch of the anterior ethmoid nerve supplies

Answer 11

The distal nasal dorsum and nasal tip. This nerve is at risk during endonasal rhinoplasty.

Question 12

The internal branch of the anterior ethmoidal nerve supplies sensation to

Answer 12

The septum and internal nasal walls.

Question 13

The septum receives innervation from

Answer 13

the nasopalatine nerve

Question 14

The infraorbital nerve supplies .

Answer 14

the lower lateral cartilage half of the nose and the columellar skin.

Question 15

The infratrochlear nerve supplies sensation to

Answer 15

the cephalic portion of the nasal sidewalls and the skin overlying the radix.

Question 16

The supraorbital nerve supplies

Answer 16

the nasal radix

Question 17

What are the major tips supporting mechanisms of the nose?

Answer 17

1. Size and shape of the lower lateral cartilages
2. The attachment of the lower lateral cartilages to the septum
3. The attachment of the upper and lower lateral cartilages at the scroll area

Question 18

There are three nasal vaults

Answer 18

1. Bony
2. Upper cartilaginous
3. Lower cartilaginous

Question 19

Describe the bony nasal vault

Answer 19

consists of paired nasal bones and the frontal process of the maxilla and makes up the upper one third to one half of the nose

Question 20

Describe the upper cartilaginous vault

Answer 20

consists of upper paired lateral cartilages and the dorsal cartilaginous septum and goes from the keystone area to the scroll area

Question 21

Describe the lower cartilaginous vault

Answer 21

Consists of the paired lower lateral cartilages and begins from the scroll area on down

Question 22

Describe the keystone area

Answer 22

It is the area of approximately 4-6 mm where the nasal bones overlap the upper lateral cartilages and septum; usually the widest portion of the dorsum

Question 23

Describe the scroll area

Answer 23

Area where the upper lateral cartilages interdigitate/overlap with the lower lateral cartilages, held by fibrous connections

Question 24

What is the significance of the fibrous connections and ligaments of the nasal tip in rhinoplasty?

Answer 24

THe medial, middle, and lateral crura of the lower lateral cartilages are connected to eachother and to the upper lateral cartilages and the septum by these fibrous attachments. Dissection/disruption of these may result in decreased tip projection

Question 25

What is the narrowest segment of the nasal airway?

Answer 25

Internal nasal valve, which can be responsible for up to 50% of the total airway resisitance.

Question 26

What is the internal nasal valve composed of?

Answer 26

1. Angle formed by the intersection of the caudal margin of the upper lateral cartilages and the nasal septum
2. The angle normally 10-15 degrees. If it is less than normal, airflow will be reduced and may lead to airway obstruction

Question 27

What is Cottle’s sign?

Answer 27

A positive Cottle’s sign is improved airway with lateral traction on the cheeks, signifying collapse of the internal nasal valve. Spreader grafts are needed to increase the valve angle and improve the airway

Question 28

What tool is best to dynamically evaluate nasal cavity patency and nasal function?

Answer 28

Rhinomanometry

Question 29

What is the septum comprised of?

Answer 29

1. Septal cartilage (quadrangular cartilage), nasal crest of the maxilla, the perpendicular plate of the ethmoid, and the vomer

Question 30

Deformities of the septum can lead to

Answer 30

Airway obstruction, and may lead to compensatory turbinate pathology

Question 31

What is the pitfall to avoid when performing septal resection?

Answer 31

Fracture of the cribriform plate, which is contiguous with the perpendicular plate of the ethmoid. This can lead to CSF rhinorrhea and possible ascending infection/meningitis