Rhinoplasty: New York... Anatomy

The nose, the peripheral organ of smell, consists of two parts: an outer, or "external nose," which projects from the center of the face; and an internal, "nasal cavity," which is divided by a "septum" into right and left nasal chambers.

External Nose—The external nose is pyramidal in form, and its upper angle or "root" is connected directly to the forehead. Its free angle is called the "apex." The base of the nose is perforated by two elliptical openings called the "nares," each separated from the other by an antero-posterior septum, the "columna." The margins of the nares are provided with a number of stiff hairs, or "vibrissæ," which help trap foreign substances carried in inspired air. The lateral surfaces of the nose form, with their union in the midline, what is called the nasal "dorsum," the shape of which varies greatly in different people. The upper part of the dorsum known as the "bridge" is supported by the nasal bones. The lateral surface ends below in a rounded eminence called the "ala nasi", (lateral wall of the "nostril.")

Structure—The frame-work of the external nose is composed of bones and cartilages that are covered by the skin and lined by mucous membrane. The bony frame-work occupies the upper part of the nose and consists of the nasal bones and the frontal processes of the upper jaw, (called the "maxillæ"). The cartilage frame-work is made up of five main pieces, including the cartilage of the septum, the two "lateral" and the two greater "alar" cartilages. There are also several smaller pieces called the lesser alar cartilages. The cartilages are connected to each other and to the bones by a tough, fibrous membrane. (See Fig. 1)

The cartilage of the septum is quadrilateral in form, thicker at its margins than at its center, and provides the separation between the nasal cavities in front. Its anterior margin is connected with the nasal bones, and is continuous with the anterior margins of the upper lateral cartilages. Below, it is connected by fibrous tissue to the "medial crura" of the greater alar cartilages. Its posterior margin is connected with the perpendicular plate of the ethmoid bone, and its inferior margin with the vomer and the palatine processes of the maxillæ. (See Fig. 3)

The lateral cartilages are situated below the inferior margin of the nasal bones, and are flattened, and triangular in shape. Their anterior margins are thicker than the posterior, and are continuous above with the cartilage of the septum. Their superior margins are attached to the nasal bone and the frontal processes of the maxillae; their inferior margins connect by fibrous tissue with the greater alar cartilages. (See Fig. 1)

Each greater alar cartilage is a thin, flexible structure, situated immediately below the upper lateral cartilage, and bent upon itself to form the medial and lateral walls of the "naris," (nostril). The portion which forms the medial wall ("medial crus") is loosely connected with the corresponding portion of the opposite cartilage, and the two form, (together with the skin and subcutaneous tissue), the "mobile" septum. The part which forms the lateral wall ("lateral crus"), is curved to create the "ala" of the nose, (the lateral nostril edge). it is connected with the frontal process of the maxilla by a tough fibrous membrane. Above, it is connected to the upper lateral cartilage and front part of the cartilage of the septum; below, it helps to form the margin of the naris, together with fatty and fibrous tissue covered by skin. (See Fig. 2)

Nasal Cavity—The nasal chambers are situated on either side of the median septal plane. They open in front through the nares (nostrils), and communicate behind through the "choanæ" with the nasopharynx. The nares are somewhat pear-shaped openings. The choanæ are two oval openings each measuring 2.5 cm. in the vertical, and 1.25 cm. in the transverse direction in a typical adult.
Inside the aperture of the nostril is found a slight dilatation known as the "vestibule." It is bounded laterally by the ala and lateral crus of the greater alar cartilage, and medially by the medial crus of the same cartilage. It is lined by skin with hairs and sebaceous glands, and extends as a small recess toward the apex of the nose. Each nasal cavity, above and behind the vestibule, is divided into two parts: an "olfactory" (smell) region, consisting of the superior nasal concha and the opposed part of the septum, and a "respiratory" region, which comprises the rest of the cavity. (See Fig. 4)

Lateral Nasal Wall— On the lateral wall of the nose are found the superior, middle, and inferior nasal conchæ, (also called "turbinates"), and below and lateral to each is a corresponding nasal passage called a "meatus." The superior meatus is a short oblique passage extending about half-way along the upper border of the middle concha; the posterior ethmoidal cells open into the front part of this meatus. The middle meatus is below and lateral to the middle concha. The inferior meatus is below and lateral to the inferior nasal concha; the nasolacrimal duct (carrying tears from the eye) opens into this meatus under cover of the anterior part of the inferior concha. (See Figs. 4, 5)

Medial Wall—The medial wall or septum is frequently deflected from the midline, lessening the size of one nasal cavity and increasing that of the other. Spurs of bone growing into one or other cavity from the septum are also sometimes present. (See Fig. 3)