Surgical Anatomy of the External and Internal Nose

Abstract

Knowledge of surgical anatomy is critical to the success of septoplasty and rhinoplasty. In particular, the anatomy of the nose and surrounding structures must be well known to surgeons. The nose consists of three basic components: the nasal framework, the support, and the external cover. The nasal framework consists of both the cartilage and bones. The nasal support is generated through tissue and ligaments that hold the intrinsic framework together, while the skin and soft tissues form the nasal external cover. Conservation or reconstruction of the normal anatomy and maintenance or restoration of the nasal airway are important in rhinoplasty operations. Dermal layer thickness is among the utmost essential elements in the preoperative assessment for rhinoplasty. The subcutaneous tissue, a crucial concern in rhinoplasty, is located within the dermis and the osseocartilage. The muscles of the nose are comprised of four major sets: compressors, elevators, dilators, and depressors. The arteries of the nose primarily come from branches of (Oneal et al. Oper Tech Plast Reconstr Surg. 2000;7(4):158–67) the ophthalmic artery of the internal carotid and (Kenyon G. Otolaryngol Clin An Int J. 2013;5(1):34–42) the external carotid arteries. Sensory innervation of the nasal area comes from the trigeminal nerve. The parasympathetic innervation comes from the seventh cranial nerve greater superficial petrosal (GSP) branch. The GSP connects to the deep petrosal nerve and carries the sympathetic innervation. The vidian nerve goes through the pterygopalatine ganglion and traverses the glands of the nasal mucosa and palate. In this chapter, surgical anatomy of the external and internal nose is presented.