Dallas Rhinoplasty (eBook)

1

Preferred Anatomic Terms for Rhinoplasty

Rod J. Rohrich Jamil Ahmad Robert M. Oneal

Precise and universally understood terminology is essential for clear communication in any field. Rhinoplasty surgeons have individually developed and defined a variety of terms to use in nasal analysis and to describe their anatomic findings. During our 30-year experience with presenting the Dallas Rhinoplasty Symposium, we have assembled and refined a lexicon of preferred anatomic terms for use in rhinoplasty. These are terms and definitions derived from and used by the leading educators of the present generation of rhinoplasty surgeons. We hope the following terminology will provide a standardized and universal vocabulary for rhinoplasty surgeons.

accessory cartilages Cartilages connecting the lateral ends of the lateral crura to the piriform aperture edge (Fig. 1-1).

alae The lateral wings. The rounded eminence forming the lateral nostril wall that extends from the tip medially to the nasolabial fold laterally and the nasal sidewall superiorly to the alar rim inferiorly.

alar groove The external oblique skin depression that follows the caudal margin of the lateral crus as it leaves the alar rim to run in a more cephalic direction. It separates the tip superomedially from the thickened portion of the ala inferolaterally and joins the face at the superior cheek-lip junction.

alar rim The inferior free edge of the ala that extends from the tip medially to the nasolabial fold laterally.

anatomic dome Junction of the medial and lateral crura, also known as the middle crus.

anterior septal angle The anterior edge of the cartilaginous septum at the juncture of the dorsal and caudal cartilaginous septum (Fig. 1-2).

bony vault The superior third of the nose comprising the nasal bones, frontal processes of the maxilla, and nasal processes of the frontal bone.

caudal Means the same as inferior when referring to the nose.

caudal septum Free inferior border of the septum.

cephalic Means the same as superior when referring to the nose.

clinical dome The anteriormost projecting portion of the lower lateral cartilage. The external projection of the dome is the tip-defining point (Fig. 1-3).

columella The column at the base of the nose separating the nostrils and connecting the tip to the upper lip.

columellar-labial angle Curved junction of the columella with the upper lip (Fig. 1-4).

columellar-lobular angle The angle formed by the junction of the columella with the infratip lobule (see Fig. 1-4).

dorsal Means anterosuperior, in the direction of the nasal dorsum, when referring to the nose.

dorsal aesthetic lines Bilateral light reflexes from the medial aspects of the brow that proceed along the dorsum to the tip.

dorsum of the nose Where the lateral surfaces of the upper two thirds of the nose join in the midline; located between the radix superiorly, the tip inferiorly, and the bilateral nasal sidewalls.

external nasal valve External opening of the nostril bordered by the columella medially, soft triangle anteriorly, alar rim laterally, and upper lip posteriorly (Fig. 1-5).

hemitransfixion incision An incision through the vestibular skin on one side of the membranous septum.

infracartilaginous (marginal) incision An incision of varying length along the caudal border of the medial, middle and lateral crus (Fig. 1-6).

infratip lobule The portion of the lobule between the tip-defining points and the columellar-lobular angle.

intercartilaginous incision An incision placed just on the lower lateral cartilage side of the junction of the upper lateral cartilage with the lateral crus of the lower lateral cartilage.

internal nasal valve The area of the junction of the caudal edge of the upper lateral cartilage with the nasal septum.

intracartilaginous (cartilage-splitting) incision An incision extending medial to lateral through the lateral crus separating the lateral crus into a superior and an inferior portion.

keystone area Junction of the perpendicular plate of the ethmoid with the septal cartilage, nasal bones, and upper lateral cartilages at the dorsum of the nose (Fig. 1-7).

lateral crus The portion of the lower lateral cartilage extending from the anatomic dome medially to the accessory cartilages laterally.

limen vestibule Line of the vestibule; junction of vestibular skin with nasal mucosa; line of junction of the cephalic margin of the lateral crus of the lower lateral cartilage with the caudal edge of the upper lateral cartilage.

lower cartilaginous vault The lower third of the nose comprised of the paired lower lateral cartilages.

lower lateral cartilages The paired inferior nasal cartilages consisting of the medial, middle, and lateral crura.

medial crus The portion of the lower lateral cartilage extending from the upper lip posteriorly to the anatomic dome anteriorly.

middle crus The portion of the lower lateral cartilage that forms the anatomic dome extending from the medial crus to the lateral crus.

naris Nostril.

nasal lobule The lower part of the nose bounded by the anterior nostril edge posteroinferiorly, the supratip area superiorly, and the alar grooves laterally.

nasal pyramid The bony portion of the nose made up bilaterally of the nasal bone and frontal process of the maxilla.

nasal septum Divides the nasal passage into two cavities. It consists of a bony (perpendicular plate of ethmoid, vomer, and premaxillary crest), cartilaginous (quadrangular), and membranous portion.

nasal sidewall The lateral surfaces of the upper two thirds of the nose located between the dorsum medially, cheek laterally and alae inferiorly.

nasofrontal angle Angle of demarcation between the forehead and nasal dorsum; best seen on lateral view.

nasolabial angle Angle seen on lateral view formed by a line drawn through the most anterior to the most posterior point of the nostril intersecting the vertical facial plane. The desired angle in males is 90 to 95 degrees and 95 to 110 degrees in females (Fig. 1-8).

natural horizontal facial plane A horizontal line extending through the lateral facial profile with the head in a normal relaxed position with the eyes looking straight ahead.

periapical hypoplasia Maxillary bone or soft tissue deficiency at the inferior piriform aperture most evident on the frontal and basal views of the nose. piriform aperture The pear-shaped external bony opening of the nasal cavity. radix Junction between the frontal bone and the dorsum of the nose.

rim incision An incision placed just within the vestibular edge of the rim of the naris.

scroll area Area of recurvature of the lateral crus of the lower lateral cartilage at its junction with the upper lateral cartilage.

sesamoid cartilages Small cartilages found in the lateral space between the upper and lower lateral cartilages.

soft triangle Thin skin fold between the alar rim and the curved caudal border of the junction of the medial and lateral crura. When this is well defined, it is referred to as a facet.

supratip area The area just superior to the nasal tip at the inferior aspect of the nasal dorsum.

tip Apex of the lobule; also frequently used when referring to the lobule.

tip projection Distance from the tip of the nose to the most posterior point of the nasal-cheek junction seen on lateral and basal views (the distance that the nose projects from the face) (Fig. 1-9).

tip rotation Movement of the tip cephalad or caudad from the fixed alar base. tip-defining points The most projecting area on each side of the tip, which produces an external light...