ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
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
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