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Rhinoplasty: the nasal bones - anatomy and analysis
Goran D Lazovic1, Rollin K Daniel1, Ljiljana B Janosevic1
1Dr Lazovic is Clinical Assistant Professor of Plastic Surgery, University of Belgrade, School of Medicine, Belgrade, Serbia; and Clinic of Burns, Plastic, and Reconstructive Surgery, Clinical Center of Serbia, Belgrade, Serbia. Dr Daniel is Clinical Professor of Plastic Surgery and Dr Kosins is Clinical Assistant Professor, Aesthetic and Plastic Surgery Institute, University of California, Irvine, Orange, California. Dr Janosevic is Professor of Otorhinolaryngology, University of Belgrade, School of Medicine, Belgrade, Serbia; and Clinic of ENT and MFS, Clinical Center of Serbia, Belgrade, Serbia. Dr Kosanovic is a Professor of Otorhinolaryngology, Faculty of Stomatology, University of Belgrade, Belgrade, Serbia; and Clinic of ENT and MFS, Clinical Center Zvezdara, Belgrade, Serbia. Dr Colic is a plastic surgeon in private practice in Belgrade, Serbia.
Background:
The analysis of nasal anatomy, and especially the nasal bones including the osseocartilaginous vault, is significant for functional and aesthetic reasons.
Objectives:
The objective was to understand the anatomy of the nasal bones by establishing new descriptions, terms, and definitions because the existing parameters were insufficient. Adequate terminology was employed to harmonize the anthropometric and clinical measurements.
Methods:
A two-part harvest technique consisting of resecting the specimen and then creating a replica of the skull was performed on 44 cadavers to obtain specific measurements.
Results:
The nasal bones have an irregular, variable shape, and three distinct angles can be found along the dorsal profile line beginning with the nasion angle (NA), the dorsal profile angulation (DPA) and the kyphion angulation (KA). In 12% of cases, the caudal portion of the nasal bones was straight and without angulation resulting in a "V-shape" configuration. In 88% of cases, the caudal portion of the bone was angulated, which resulted in an "S-shape" nasal bone configuration. The intervening cephalic bone, nasion to sellion (N-S), represents the radix while the caudal bone, sellion to r (S-R), represents the bony dorsum.
Conclusions:
By standardizing and measuring existing nasal landmarks and understanding the different anatomic configurations of the nasal bones, rhinoplasty surgeons can better plan their operations within the radix and bony and osseocartilaginous vaults.
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