Figure 2 - uploaded by Ehab A A El-Shaarawy
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Photographs of a dissected nose (a) and (c), upper lateral nasal cartilage (b) showing: Panel a: triangular, convex upper lateral cartilage (long black arrow) having a base directed medially attached to nasal septum and apex directed laterally attached to lateral margin of piriform fossa (arrow heads). The upper border of the cartilage underlay the nasal bone (N) while the lower border underlay the lower lateral cartilages (long black arrow). Note the small rounded accessory cartilages (white arrows) lying behind the lower lateral cartilage. The lower lateral cartilage (short black arrow) appeared elliptical in shape with long axis directed backward and laterally; Panel b: triangular, convex upper lateral cartilage having a base directed medially and apex directed laterally with lateral surface slightly convex outward; Panel c: triangular, convex upper lateral cartilage having a base directed medially attached to nasal septum (long arrow) and apex directed laterally attached to lateral margin of piriform fossa (short arrows).
Source publication
Background:
Success or failure of rhinoplasty depends mainly onthe awareness of the surgeon with the construction of the nasalcartilaginous framework and the knowing of the morphology and different measurements of these cartilages.
Aim of the work:
The current study aimed at evaluation of the morphology of the nasal cartilages and to address the...
Contexts in source publication
Context 1
... examination of the cartilaginous skeleton of the dorsum and tip of the nose it was found to be formed of upper lateral cartilage, lower lateral carti- lage and small accessory cartilages (Fig. ...
Context 2
... lateral cartilage. On examination it appeared triangular in shape with base, apex and two borders (Fig. 2b). The base directed medially attached to nasal septum while the apex directed laterally attached to lateral margin of piriform fossa (Fig. 2c). The upper bor- der of the cartilage underlay the nasal bones while the lower border also underlay the lower lateral cartilages in the scroll area between the upper and lower lateral cartilages ...
Context 3
... lateral cartilage. On examination it appeared triangular in shape with base, apex and two borders (Fig. 2b). The base directed medially attached to nasal septum while the apex directed laterally attached to lateral margin of piriform fossa (Fig. 2c). The upper bor- der of the cartilage underlay the nasal bones while the lower border also underlay the lower lateral cartilages in the scroll area between the upper and lower lateral cartilages (Fig. 3). The ULC was convex in 24 out of 30 (80%) cases (Figs. 2, 3, 4a), flat in 4 out of 30 (13.5%) ( Fig. 4b) and concave in 2 out of 30 ...
Context 4
... septum while the apex directed laterally attached to lateral margin of piriform fossa (Fig. 2c). The upper bor- der of the cartilage underlay the nasal bones while the lower border also underlay the lower lateral cartilages in the scroll area between the upper and lower lateral cartilages (Fig. 3). The ULC was convex in 24 out of 30 (80%) cases (Figs. 2, 3, 4a), flat in 4 out of 30 (13.5%) ( Fig. 4b) and concave in 2 out of 30 (6.5%) (Fig. ...
Context 5
... and middle crus. The junction between lateral and middle crus showing angular change in the direction can be named as lateral genu while another one present at the junction between the middle crus and medial crus and also is named as medial genu (Fig. 5a). The lateral crus is elliptical in shape with long axis directed backward and laterally (Figs. 2a, 5b). The lateral crus is leaf-like and larger than the medial one. The medial crus bends posteriorly, then laterally flares posterosuperiorly away from nasal rim to con- nect with the accessory cartilages (Figs. 5a, 6c). The medial crura held together by ligamentous tissue in columella, oriented in the sagittal plane (Fig. 6a, b). On ...
Context 6
... cartilages. Appeared as small rounded cartilages (Fig. 2a) lying behind the lower lateral car- tilage between lateral crus and pyriform aperture and found nearly in all examined specimens. while that of the left was 15.2-29 mm with total mean 22.6 ± 1.5 and 21.11 ± 1.93, respectively. The range of length of the right ULC under the nasal bone was 2.9-7 mm while that of the left side was 2.4- ...
Similar publications
BACKGROUND: Rhinoplasty has become one of the most common aesthetic procedures in the world. Few studies from the Middle East have described rhinoplasty patients in the region.
OBJECTIVE: To investigate common nasal deformities in individuals seeking rhinoplasty at a single institution in Saudi Arabia.
DESIGN: Retrospective study and chart revie...
Citations
... The Egyptian nose has specific anatomical and morphological features of ethnic nature. Thick skin, weak cartilages, amorphous nasal structure, and bulbous tip are the unique characteristics of the Egyptian nose that should be appreciated in preoperative analysis, counseling, and choice of the operative techniques [1]. ...
... Moreover, cephalic trimming of the lateral crus of the LLC was done in 76.2% of patients. It was mandatory to reduce the characteristic large saucer-shaped lateral crus of the Egyptian nose that contribute to the bulbous nature of their nasal tip and achieve adequate cephalic tip rotation, as mentioned by El-Shaarawy [1]. Ghareeb et al. [13] who did his study on middle eastern and Egyptians, preferred lateral, cephalic, and caudal resection of the LLC to achieve appropriate cephalic tip rotation in patients with broad lateral crus. ...
... It allows better visualization and manipulation of the nasal framework and gives the surgeon the change to modify his plane according to the intraoperative analysis. However, columellar strut (100%) was mandatory for adequate nasal support owing to the weak nature of the nasal cartilage and thick skin of most of the Egyptian nose as reported by El-Shaarawy [1]. This is in contrast to Hodges et al. [11] who preferred the endonasal approach for tip rhinoplasty because it is less destructive. ...
... The Egyptian nose has specific anatomical and morphological features of ethnic nature. Thick skin, weak cartilages, amorphous nasal structure, and bulbous tip are the unique characteristics of the Egyptian nose that should be appreciated in preoperative analysis, counseling, and choice of the operative techniques [1]. ...
... Moreover, cephalic trimming of the lateral crus of the LLC was done in 76.2% of patients. It was mandatory to reduce the characteristic large saucer-shaped lateral crus of the Egyptian nose that contribute to the bulbous nature of their nasal tip and achieve adequate cephalic tip rotation, as mentioned by El-Shaarawy [1]. Ghareeb et al. [13] who did his study on middle eastern and Egyptians, preferred lateral, cephalic, and caudal resection of the LLC to achieve appropriate cephalic tip rotation in patients with broad lateral crus. ...
... It allows better visualization and manipulation of the nasal framework and gives the surgeon the change to modify his plane according to the intraoperative analysis. However, columellar strut (100%) was mandatory for adequate nasal support owing to the weak nature of the nasal cartilage and thick skin of most of the Egyptian nose as reported by El-Shaarawy [1]. This is in contrast to Hodges et al. [11] who preferred the endonasal approach for tip rhinoplasty because it is less destructive. ...
... There are recently many studies about the anatomy of lower lateral cartilage. However, the microanatomic studies to identify the segments of most LLC at the nasal tip in Vietnamese are very rare [4], [5], [6]. Based on the upper demands, we carried out the study Re ea ch acroanatomic and histologic characteristics of the lower lateral nasal ca i age i ...
... The lateral crus ran parallel to the border of the nostril, the outer part ran toward and made an angle 15 with the border of nostril [5]. However, Constantian M.B. [2] found that after moving out of a e a ge , he a e a c a a a e b de f nostril and then toward with an angle 30-45 or more; Sheen noticed that this change would make the tip of e bigge , he e a c i e i h d result that 60% lateral crus run obliquely. ...
... However, Constantian M.B. [2] found that after moving out of a e a ge , he a e a c a a a e b de f nostril and then toward with an angle 30-45 or more; Sheen noticed that this change would make the tip of e bigge , he e a c i e i h d result that 60% lateral crus run obliquely. Thus, investigating the dimensions of lateral or medial crus will help to build data for rhinoplasty in Vietnamese, the length is ranged 16 24 mm, the width is ranged 4 10 mm, the distance from the lower border of LLC to the border of nostril varies based on the measured point and the measurer, about 6mm when we chose the middle point of domal cartilage, 5 mm when we measured from the middle point of lateral crus, 13 mm when we measured from the farthest point of the end of lateral crus [5], these results are consistent with our results (the length was 18 mm, the width at the middle point was 8.5 mm and the thickness was 1 mm). ...
Background:
There are recently many studies about the anatomy of lower lateral cartilage (LLC). However, the microanatomic studies to identify the segments of most LLC at the nasal tip in Vietnamese are very rare.
Aim:
Investigate the macroanatomic and microanatomic characteristics of the LLC and the structures of the nasal tip.
Methods:
Descriptive study, 30 cadaver noses fixed by 10% formalin, 2 cadaver noses fixed by HE in 69 Institutes in Vietnam from December 2017 to April 2019.
Results:
The average length of the medial crus is 12.3 mm on the right and 13.2 mm on the left. The maximum intercrural distance is 10.7 mm. The average length of the dome is 3.7 mm and 3.9 mm on the right and left side separately, with 2 subunits are the domal and lobular segment. The average thickness of the tip points is 1.0 mm. The width of the interdomal and intercrural ligaments are 0.5-fold the height and 2-fold the thickness. The thickness of the interdomal fat pad is 3mm and about 0.5-fold the wide.
Conclusion:
The LLC has 3 parts: intermediate, medial and lateral crus. The microanatomic structures of tip consist of the interdomal ligaments, intercrural ligaments, SMAS and interdomal fat pad.
... 1,2 The Egyptian nose is an example of the mixed ethnic nature as regards the anatomy and morphology of the nose. 3,4 The predominant character in the Middle Eastern noses is the thick skin and weak cartilages if compared with the White noses. This fact undermines the aesthetic outcomes of rhinoplasty, especially when the common techniques are adopted without paying attention to inherent anatomic features. ...
Background: The predominant character in the Middle Eastern noses is the thick skin, weak cartilages, amorphous bulbous nasal tip, and high incidence of postop- erative supra-tip swelling, compared with the Caucasian noses. The purpose of this study was to describe some anatomical ndings and nd techniques to improve outcomes in these patients.
Methods: This is retrospective study in 624 patients of Middle Eastern origin, where the characteristic anatomical ndings are described and the surgical endeavors to combat their detrimental effect on the outcomes of rhinoplasty are explained. Results: The results have shown that in these 624 patients, 365 patients had excel- lent results, 223 patients had average results, while 36 patients had poor results. Conclusion: The nasal shape depends on the skin (skin barring) or the cartilages (cartilage barring), or both (skin and cartilage sharing). Middle Eastern patients are toward the skin barring category with the lateral crus of the lower lateral carti- lage very broad with a lateral brous attachment replacing the minor (sesamoid) cartilages leading to ill de nition of the alae from the sides of the nose. Outcomes in these patients were improved by identi cation and release of these lateral attach- ment to improve the bulbous tip and de ne the alar subunit from the side of the nose. Cephalic rotation is achieved mainly by M-shaped excision of the inner lining of the vestibule and the caudal part of the septum. Other methods described to combat the strong skin memory and allow skin to con gure after surgery.
The predominant characteristics in thick-skinned patients seeking rhinoplasty are a bulbous nasal tip, poor definition of the different nasal subunits, and persistence of postoperative swelling if compared with normal- or thin-skinned patients, leading to inferior esthetic outcomes. There are four main anatomical findings with varying degrees of severity that are peculiar to these kinds of noses: 1. The skin is very thick with strong memory, which prevents it from redraping over the newly modified cartilages. 2. The cartilages are thin and weak with lesser contribution to the shape of the nose. 3. The lower lateral cartilage is broad and saucer-like with a lateral fibrous attachment (lateral alar ligament) replacing the minor sesamoid cartilages described in literature in White patients. This lateral fibrous band spans between the lateral part of the lower lateral cartilage and the subcutaneous tissues deeply to the nasolabial line. 4. There is a thick subcutaneous fibro-fatty layer adherent to the lower lateral cartilage, which, during dissection of the cartilage, comes out easily with it; the thinner the cartilage, the thicker this fibro-fatty layer. All these factors lead to failure of distinction between the different subunits of the nose, so the tip is amorphous and bulbous and the lateral alar ligament blurs the distinction between the nasal sidewall subunit and the alar lobular subunit.
Background
: Recently, there has been increasing focus on understanding nasal anatomy in ethnic populations and using it to guide rhinoplasty techniques in non-Caucasian patients. Many disparate groups have historically been inappropriately clustered based on geography. However, there has been little attention on describing regional differences within these populations.
Methods
: A systematic review was conducted according to PRISMA guidelines. The search terms “African”, “Asian”, “Indian”, “Middle Eastern”, “Hispanic OR Mestizo”, “rhinoplasty”, “nasal”, “anatomy” and “ethnic” were used in combination with the Boolean operators “AND” or “OR” to identify the initial search results. Papers were included if they originated from the specific geographic region of interest, if they specifically discussed patients of one particular nationality or sub-ethnicity, or if they discussed multiple anatomical subtypes within a specific ethnicity of interest.
Results
: A total of 81 papers were identified overall. The search identified 40 articles discussing Asian nasal anatomy, 8 articles discussing Indian nasal anatomy, 6 articles discussing African nasal anatomy, 9 articles discussing Middle Eastern nasal anatomy, and 19 papers discussing Latin American nasal anatomy. Numerous regional variants were described within each historic geographic phenotype. The majority of descriptions of Asian nasal anatomy were consistent with the classical definition, whereas nasal anatomy among the other ethnicities was more variable. Very little has been written about geographic variation of nasal anatomy across the African continent. Several established sub-classification schemes exist for the Latin American nose.
Conclusions
: Awareness of the heterogeneity of ethnic nasal anatomy is critical for surgeons performing rhinoplasty on non-Caucasian patients.
