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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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shift”). Hereby, the oxygen consumption of vital organs is
reduced.
Apart from the above-described reflexes, several other
nasal reflexes have been described and studied. These
reflexes are clinically less important. Therefore, they are
only listed in brief.
Nasocardiac Reflex (Cranial Nerve V–Cranial Nerve X)
Strong stimulation of the nasal mucosa produces
bradycardia and a reduction of cardiac output with
lowering of the blood pressure.
Nasovascular Reflex
Nasal stimulation causes peripheral vasoconstriction.
Genitonasal Reflex
Sexual arousal and orgasm cause swelling of the nasal
mucosa, particularly of the turbinates.
Gastronasal Reflex (Cranial Nerve X–
Parasympathicus)
Strong gastric stimulation by irritation (e.g., alcohol,
coffee) or gastritis may cause nasal secretion and
vasodilatation on the homolateral (left) side of the nose.
1.4.5Speech
The nose and the paranasal cavities are an essential part of
the speech-production apparatus. The nasal cavity is one of
the resonators that play a role in production of some
vowels and several consonants. Typical examples are “m”
and “n,” the so-called nasal consonants.
The amount of nasal resonance is called “nasalance.”
Previously, it was common to speak of “rhinolalia clausa”
when nasal resonance was decreased, and of “rhinolalia
aperta” when nasal resonance was present in consonants
requiring closure of the nasopharynx by the soft palate.
Many rhinological patients suffer from decreased nasalance
because of nasal obstruction due to mucosal swelling,
polyposis, or septal deformity. Surgery may have a
considerable effect on their speech and singing.
Professional (and amateur) singers may benefit
considerably from functional reconstructive nasal surgery.
1.4.6Facial Beauty and Facial Expression
The nose plays a dominant role in concepts of facial beauty
and expression. In almost all cultures, we find indications
of the dominant role that the shape of the nose plays in life.
A nose perceived as beautiful enhances facial beauty and
helps make a person attractive. A deformed or damaged
nose may be perceived as ugly.
Beauty
Different cultures have developed different concepts of
nasal beauty. We find evidence of this in the special “rules”
that were conceived for describing ideal body proportions,
and from works of art.
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When discussing beauty, it is of utmost importance to take
into consideration the many ethnic differences in the shape
of the face and nose. The faces and noses of blacks and
Asians are very different from those of the Caucasians. The
rhinoplasty surgeon should be aware of this and should
attempt to preserve some ethnic character when
performing an operation.
Aversion to One’s Own Nose
Many patients visit the nasal surgeon because they dislike
their nose. In many cases their problem is understandable:
a deviated pyramid, a large hump, a severe saddle, etc.
Mostly, their complaints are not only cosmetic; function is
impaired too. Where there is no real “deformity” but a
minor “abnormality” or nothing more than a “variation,”
the surgeon should be warned. A careful analysis of the
“problem,” sometimes including a psychological analysis, is
then required. Nothing is more disappointing, both for the
patient and the doctor, than a patient who is dissatisfied
with a “good” result. According to recent studies, a
significant number of patients with aesthetic nasal
complaints have symptoms of a body dysmorphic disorder
(BDD).
Chapter 2
Pathology and Diagnosis
2.1 Nasal Syndromes
2.2 Nasal Symptoms—The Most Common
Deformities, Abnormalities, and Anatomical
Variations
2.3 Diagnosis and Documentation
2.4 Function Tests
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2Pathology and Diagnosis
2.1Nasal Syndromes
In health and disease, signs and symptoms frequently occur
in more or less fixed combinations. We then speak of a
syndrome (in Greek, “syndrome” = “come together”). In
the domain of functional corrective nasal surgery, we
suggest distinguishing the following syndromes:
2.1.1Deviated Pyramid Syndromes
The “deviated nose” is characterized by a deviation of the
external nasal pyramid in combination with a deformity of
the nasal septum. In the great majority of patients, the
underlying cause is mechanical trauma with a lateral,
frontolateral, or laterobasal impact. A genetically deviated
nose has been observed in some families. In rare cases, a
deviated nose is of intrauterine origin. Patients with a
deviated external nose generally have both functional and
aesthetic complaints.
Depending upon which part of the pyramid is deviated, we
distinguish four types:
Deviated pyramid
The bony and cartilaginous pyramid and lobule
deviate to the same side.
C-shaped pyramid
The bony pyramid deviates to the right, the
cartilaginous pyramid to the left.
Reversed C-shaped pyramid
The bony pyramid deviates to the left, the
cartilaginous pyramid to the right.
Deviated cartilaginous pyramid
The cartilaginous pyramid is deviated, whereas the
bony pyramid is in the midline.
Deviated Pyramid
Both the bony and the cartilaginous pyramid, and usually
the lobule as well, deviate to one side (▶ Fig. 2.1 and ▶ Fig.
2.2). When the nasion–stomion line is drawn, deviation of all
parts of the nasal pyramid becomes obvious.
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Fig. 2.1Deviated pyramid.
Fig. 2.2Deviated pyramid. The bony and cartilaginous pyramid, including the lobule,
deviate to one side.
The bony pyramid leans to one side. It is asymmetric, with
a short, steep slope on the side of the deviation (due to an
infraction of the nasal bone) and a long, shallow slope on
the opposite side.
The cartilaginous pyramid is deformed in a similar way. The
triangular cartilages are asymmetric, especially when the
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trauma occurred in childhood. Some sagging of the
cartilaginous dorsum may be present.
The lobule often leans to the same side. The tip deviates to
the side of the deviation. The columella is oblique, with its
upper (ventral) part leaning to the side of the deviation. It
may also be broadened, due to dislocation of the caudal end
of the septum. The alae differ in length and the nostrils are
asymmetric. These lobular asymmetries are usually
automatically corrected by repositioning of the septum and
the cartilaginous pyramid. Only in patients with a longstanding severe deviation might additional lobular surgery
be needed.
The septum may show a variety of deformations. The
anterior septum is usually dislocated to the side of the
deviation, whereas its posterior part is either in the midline
or deviated to the contralateral side. The caudal septal end
often protrudes into the vestibule, and the valve area may
be narrowed by a septal convexity or fracture. A basal
bony–cartilaginous crest and/or a vomeral spur deformity
are common.
Breathing is generally impaired on both sides, the most
severe symptoms occurring on the side of the valvular
obstruction.
C-Shaped Pyramid
The bony pyramid deviates to the right, whereas the
cartilaginous pyramid leans to the left. The lobule usually
leans to the same side as the cartilaginous pyramid (▶ Fig.
2.3 and ▶ Fig. 2.4). This type of deformity is also called a
“twisted” nose.
Fig. 2.3C-shaped deviation of the pyramid.
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