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By: 
Dr. Pratima Jaiswal 
HOD, Dept. of Anatomy 
Govt. Medical College, Kota 
Rajasthan, INDIA
Outline of the presentation is as follows 
 External anatomy of nose 
 Bony pyramid of nose 
 Cartilaginous vault of nose 
 Soft tissue covering 
 Nasal musculature 
 Nasal septum 
 Lateral wall 
 Nerve supply 
 Blood supply
• Consists of: 
– External Nose 
– Nasal cavity 
• The external nose : 
– Is a pyramidal projection 
of face 
– tip 
– Root 
– dorsum 
– ala of nose bounding 
inferiorly a pair of nostrils 
3 
T H E NOS E
• glabella: upper narrowed end 
of nose joins with forehead 
• nasion: Upper end of 
internasal suture 
• rhinion: Lower end 
• nasofrontal angle: A 
depression at nasion while 
rolling down finger from 
glebella 
• Limen vestibuli: jn. Between 
upper and lower cartilages 
• Nasolabial angle : b/w 
columella and upper lip 
4
Osteocartilaginous 
framework: 
• Bony pyramid –upper 1/3rd 
• Cartilaginous part – lower 
2/3rd (Upper & lower 
cartilaginous vault) 
5 
E x t e r n a l n o s e
• Formed by Nasal bones and frontal 
process of maxilla 
• Paired nasal bones, each one is tapered, 
thin and bevelled below but gradually 
thickens upwards encroaching upon the 
nasal cavity 
– Two nasal bones form a crest in midline 
Articulates 
– Upwards with nasal spine of frontal & 
perpendicular plate of ethemoid 
– Laterally with frontal process of maxilla (is 
thick below n thin above) by nasomaxillary 
suture 
– Variation in size ,shape or asymmetry of 
nasal bones seen, small nasal bones pose 
problem in rhinoplasty must be recognized 
preoperatively 
6 
B o n y p y r ami d
7 
Cartilaginous vault
• Paired, Triangular ULC and part of 
septal cartilages enclosed in 
common perichondrial sheath 
• Base at septum, Apex at pyriform 
fossa 
• Cephalic attachment to nasal bones 
– Nasal bones overlap over ULC 1cm 
– Held in place with intimate fusion b/w 
perichondrium and periostium 
• Medial borders are thick and 
continuous with dorsal border of 
septal cartilage. 
• Laterally ULC are short of pyriform 
edge of maxilla, the gap is filled by 
dense fibrofatty tissue (empty 
triangle) 
8 
Upper Cartilaginous vault-cont
• Inferiorly caudal edge is 
rolled outwards & 
upwards forming a 
scroll which widens 
dorsal and lateral walls 
• K area- 
– junction b/w nasal 
bones,ULC, septal 
cartilage & vertical plate 
of ethemoid , 
– is centre of support of 
nasal roof 
9 
Upper Cartilaginous vault-cont
• Lowermost part of nasal 
fossae, bounded superiorly 
by caudal edge of ULC is 
vestibule. 
• Lined by thin skin having 
coarse hairs and sebaceous 
, sweat glands. 
• Internal nasal valve-triangular 
area bounded lat 
by caudal edge of ULC 
,septum medially, nasal 
cavity floor inf,is narrowest 
part of nasal cavity 
10 
Upper Cartilaginous vault-cont
Lower cartilaginous vault 
• Paired alar cartilages (few sesamoid cartilages) 
• can move freely over ULC and septal 
• Contribute to formation of lobule, columella and ala. 
• Each one made up of single piece of C-shaped cartilage 
,having parts medial, middle and lateral crura 
• Lateral crus - 1 mm in thickness 
 Starts at domal segment and arch outwardly convex 
• Middle crus- 
 from columella to lateral crus 
 Divided into domal and lobular segment 
• Medial crus- 
 It starts at footplate and extends into columella 
 lies under the thin skin of columella and two med 
crura are attached by fibrous tissue and to lower end 
of septum by membranous septum
• Soft triangles- area of soft 
tissue infront of nares, 
consist of external skin, 
vestibular skin with scanty 
areolar tissue and regarded 
as sign of beauty in a 
feminine nose. 
• Laterally extend towards 
pyriform edge to variable 
extent 
• the contour of ala are 
rounded due to fibrofatty 
tissue, adherent to smaller 
alar cartilages. 
12 
Lower cartilaginous vault- cont
• Anderson has compared Lower 
Lateral Cartilage to a tripod 
1. two long legs of lateral crura, 
2. A short leg of medial crura 
joined to each other 
• Tripod is supported by ULC, 
septal cartilage,soft tissue at 
base of columella & 
membranous septum 
13 
Lower cartilaginous vault- cont
Factors affecting shape & position of nasal tip 
• Lateral crural complex 
• Thickness of overlying 
skin 
• Ligaments and fibrous 
attachments of nasal 
tip structures 
14
Columella 
• Extends between upper lip and tip of the 
nose 
• Divided into three almost equal parts , 
upper –lobular, middle and basal part – 
wider 
• Consist of paired medial crura with 
covered skin, variable length of crura 
may produce projecting or depressed tip 
• Anteriorly- diverging crura form an angle 
of 30 degrees for tip formation. 
• Posteriorly - also diverge to receive post 
septal angle, adjoining septal cartilage 
and anterior nasal spine. 
• Shape of columella depends on size and 
shape of medial crura. 15
• Nasal skin : thick over-nasion, supratip 
area and thin at rhinion 
– over lower part is thicker , firmly adherent 
to cartilages 
– over nasal bones and ULC is mobile 
• Subcutaneous tissue covering thickens 
gradually downwards from rhinion 
: has 4 layers 
1. Superficial panniculus 
2. Fibromuscular layer 
3. Deep fatty layer 
4. Periosteum/ perichondrium 
• Incisions in rhinoplasty are given deep to 
all these layers since blood vessels run in 
deep fatty layer. 
16 
Soft tissue covering
17 
Elevators: 
• Procerus 
• Levator labii 
superioris alaque 
nasi 
Depressors: 
• Alar part of nasalis 
• Depressor septi 
Compressor: 
• Tranverse part of 
Nasalis 
• Compressor narium 
minor 
Dilators: 
dilator naris 
Nasal Musculature
18 
• Bony : 
– perpendicular plate of 
ethemoid 
– vomer post 
contribution from 
– sphenoidal crest n rostrum 
– nasal spine of frontal bone 
– nasal crest by maxillae and 
palatines 
• Septal cartilage : 
– quadrilateral cartilage ,is 
– unossified part of vertical plate 
of ethemoid 
– is mobile permits side to side 
movements 
– Is major support mechanism of 
nose 
Nasal septum
NNaassaall sseeppttuumm--ccoonntt 
• A small contribution from ULC and 
LLC to ant nasal septum 
• Dorsal border of septum is 
expanded ,extends upwards under 
nasal bones to variable distance. 
• Caudal part effects position of 
columella. 
• Ant septal angle-jn of dorsal & 
caudal borders.(supratip) 
• Post septal angle-jn bet caudal 
&inf border,is anchored to ant 
nasal spine. 
• Subperichondreal &subperiosteal 
planes are not continuous hence 
attempt to join these planes may 
tear mucous memb. 19
Membranous septum 
• Between septal cartilage & 
columella ,consist of vestibular 
skin with intervening areolar 
tissue. 
• post diverging ends of medial 
crura receive post part of 
caudal edge of septal cartilage 
,columella can be retracted 
easily from septum along entire 
length. 
• In septoplasty integrity of the 
memb septum should be 
preserved. 
20 
Nasal septum-cont
Lateral wall 
• Formed by sup, middle &inf turbinates and their meatuses 
• Middle and inferior turbinate are imp surgically 
• Middle turb is extension of ethemoid 
bone,hypertrophy/malposition can cause nasal 
obstruction,headache. 
• Inf turb ,separate bonecovered with ciliated epithelium,erectile 
tissue and venous sinuses. 21
Sensory supply: 
• By branches of ophthalmic 
and maxillary div. Of 
trigeminal 
• infra trochlear branch-skin 
of root and adjacent sides 
of nose 
• infra orbital, external nasal 
nerve- skin of lower half of 
nose 
• terminal branches of 
palatine nerves – skin of 
base of columella 
22 
Nerve supply- external
23 
Nerve supply- internal
• Dorsal and external nasal 
branch of ophthalmic 
artery 
• Infra orbital br. of 
maxillary artery 
• Lateral nasal and angular 
br. of facial artery 
24 
Arterial supply- external nose
25 
Arterial 
supply 
Plane of dissection to mobilise soft tissue should be closer to bone 
or cartilage to avoid injury to muscles and superficial vessels
26 
Venous 
drainage 
•External veins of nose 
drain to angular and 
opthalmic veins
27

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Surgical anatomy of nose

  • 1. By: Dr. Pratima Jaiswal HOD, Dept. of Anatomy Govt. Medical College, Kota Rajasthan, INDIA
  • 2. Outline of the presentation is as follows  External anatomy of nose  Bony pyramid of nose  Cartilaginous vault of nose  Soft tissue covering  Nasal musculature  Nasal septum  Lateral wall  Nerve supply  Blood supply
  • 3. • Consists of: – External Nose – Nasal cavity • The external nose : – Is a pyramidal projection of face – tip – Root – dorsum – ala of nose bounding inferiorly a pair of nostrils 3 T H E NOS E
  • 4. • glabella: upper narrowed end of nose joins with forehead • nasion: Upper end of internasal suture • rhinion: Lower end • nasofrontal angle: A depression at nasion while rolling down finger from glebella • Limen vestibuli: jn. Between upper and lower cartilages • Nasolabial angle : b/w columella and upper lip 4
  • 5. Osteocartilaginous framework: • Bony pyramid –upper 1/3rd • Cartilaginous part – lower 2/3rd (Upper & lower cartilaginous vault) 5 E x t e r n a l n o s e
  • 6. • Formed by Nasal bones and frontal process of maxilla • Paired nasal bones, each one is tapered, thin and bevelled below but gradually thickens upwards encroaching upon the nasal cavity – Two nasal bones form a crest in midline Articulates – Upwards with nasal spine of frontal & perpendicular plate of ethemoid – Laterally with frontal process of maxilla (is thick below n thin above) by nasomaxillary suture – Variation in size ,shape or asymmetry of nasal bones seen, small nasal bones pose problem in rhinoplasty must be recognized preoperatively 6 B o n y p y r ami d
  • 8. • Paired, Triangular ULC and part of septal cartilages enclosed in common perichondrial sheath • Base at septum, Apex at pyriform fossa • Cephalic attachment to nasal bones – Nasal bones overlap over ULC 1cm – Held in place with intimate fusion b/w perichondrium and periostium • Medial borders are thick and continuous with dorsal border of septal cartilage. • Laterally ULC are short of pyriform edge of maxilla, the gap is filled by dense fibrofatty tissue (empty triangle) 8 Upper Cartilaginous vault-cont
  • 9. • Inferiorly caudal edge is rolled outwards & upwards forming a scroll which widens dorsal and lateral walls • K area- – junction b/w nasal bones,ULC, septal cartilage & vertical plate of ethemoid , – is centre of support of nasal roof 9 Upper Cartilaginous vault-cont
  • 10. • Lowermost part of nasal fossae, bounded superiorly by caudal edge of ULC is vestibule. • Lined by thin skin having coarse hairs and sebaceous , sweat glands. • Internal nasal valve-triangular area bounded lat by caudal edge of ULC ,septum medially, nasal cavity floor inf,is narrowest part of nasal cavity 10 Upper Cartilaginous vault-cont
  • 11. Lower cartilaginous vault • Paired alar cartilages (few sesamoid cartilages) • can move freely over ULC and septal • Contribute to formation of lobule, columella and ala. • Each one made up of single piece of C-shaped cartilage ,having parts medial, middle and lateral crura • Lateral crus - 1 mm in thickness  Starts at domal segment and arch outwardly convex • Middle crus-  from columella to lateral crus  Divided into domal and lobular segment • Medial crus-  It starts at footplate and extends into columella  lies under the thin skin of columella and two med crura are attached by fibrous tissue and to lower end of septum by membranous septum
  • 12. • Soft triangles- area of soft tissue infront of nares, consist of external skin, vestibular skin with scanty areolar tissue and regarded as sign of beauty in a feminine nose. • Laterally extend towards pyriform edge to variable extent • the contour of ala are rounded due to fibrofatty tissue, adherent to smaller alar cartilages. 12 Lower cartilaginous vault- cont
  • 13. • Anderson has compared Lower Lateral Cartilage to a tripod 1. two long legs of lateral crura, 2. A short leg of medial crura joined to each other • Tripod is supported by ULC, septal cartilage,soft tissue at base of columella & membranous septum 13 Lower cartilaginous vault- cont
  • 14. Factors affecting shape & position of nasal tip • Lateral crural complex • Thickness of overlying skin • Ligaments and fibrous attachments of nasal tip structures 14
  • 15. Columella • Extends between upper lip and tip of the nose • Divided into three almost equal parts , upper –lobular, middle and basal part – wider • Consist of paired medial crura with covered skin, variable length of crura may produce projecting or depressed tip • Anteriorly- diverging crura form an angle of 30 degrees for tip formation. • Posteriorly - also diverge to receive post septal angle, adjoining septal cartilage and anterior nasal spine. • Shape of columella depends on size and shape of medial crura. 15
  • 16. • Nasal skin : thick over-nasion, supratip area and thin at rhinion – over lower part is thicker , firmly adherent to cartilages – over nasal bones and ULC is mobile • Subcutaneous tissue covering thickens gradually downwards from rhinion : has 4 layers 1. Superficial panniculus 2. Fibromuscular layer 3. Deep fatty layer 4. Periosteum/ perichondrium • Incisions in rhinoplasty are given deep to all these layers since blood vessels run in deep fatty layer. 16 Soft tissue covering
  • 17. 17 Elevators: • Procerus • Levator labii superioris alaque nasi Depressors: • Alar part of nasalis • Depressor septi Compressor: • Tranverse part of Nasalis • Compressor narium minor Dilators: dilator naris Nasal Musculature
  • 18. 18 • Bony : – perpendicular plate of ethemoid – vomer post contribution from – sphenoidal crest n rostrum – nasal spine of frontal bone – nasal crest by maxillae and palatines • Septal cartilage : – quadrilateral cartilage ,is – unossified part of vertical plate of ethemoid – is mobile permits side to side movements – Is major support mechanism of nose Nasal septum
  • 19. NNaassaall sseeppttuumm--ccoonntt • A small contribution from ULC and LLC to ant nasal septum • Dorsal border of septum is expanded ,extends upwards under nasal bones to variable distance. • Caudal part effects position of columella. • Ant septal angle-jn of dorsal & caudal borders.(supratip) • Post septal angle-jn bet caudal &inf border,is anchored to ant nasal spine. • Subperichondreal &subperiosteal planes are not continuous hence attempt to join these planes may tear mucous memb. 19
  • 20. Membranous septum • Between septal cartilage & columella ,consist of vestibular skin with intervening areolar tissue. • post diverging ends of medial crura receive post part of caudal edge of septal cartilage ,columella can be retracted easily from septum along entire length. • In septoplasty integrity of the memb septum should be preserved. 20 Nasal septum-cont
  • 21. Lateral wall • Formed by sup, middle &inf turbinates and their meatuses • Middle and inferior turbinate are imp surgically • Middle turb is extension of ethemoid bone,hypertrophy/malposition can cause nasal obstruction,headache. • Inf turb ,separate bonecovered with ciliated epithelium,erectile tissue and venous sinuses. 21
  • 22. Sensory supply: • By branches of ophthalmic and maxillary div. Of trigeminal • infra trochlear branch-skin of root and adjacent sides of nose • infra orbital, external nasal nerve- skin of lower half of nose • terminal branches of palatine nerves – skin of base of columella 22 Nerve supply- external
  • 23. 23 Nerve supply- internal
  • 24. • Dorsal and external nasal branch of ophthalmic artery • Infra orbital br. of maxillary artery • Lateral nasal and angular br. of facial artery 24 Arterial supply- external nose
  • 25. 25 Arterial supply Plane of dissection to mobilise soft tissue should be closer to bone or cartilage to avoid injury to muscles and superficial vessels
  • 26. 26 Venous drainage •External veins of nose drain to angular and opthalmic veins
  • 27. 27