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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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Fig. 2.4C-shaped deviation of the pyramid. The bony pyramid deviates to the right, the
cartilaginous pyramid and lobule lean to the left.
The deformities of the various parts of the pyramid and the
septum are similar to the ones described earlier. They may
occur in different combinations, however.
Reversed C-Shaped Pyramid
The bony pyramid deviates to the left, whereas the
cartilaginous pyramid leans to the right. The lobule usually
deviates to the same side as the cartilaginous pyramid (▶
Fig. 2.5 and ▶ Fig. 2.6).
Deviated Cartilaginous Pyramid
The bony pyramid is straight and symmetrical, whereas the
cartilaginous pyramid and lobule are deviated and
asymmetrical (▶ Fig. 2.7 and ▶ Fig. 2.8). The cartilaginous
septum deviates to the same side, and its caudal end is
usually dislocated to the side of the deviation and protrudes
into the vestibule and nostril. The valve area is mostly
obstructed by a fracture or a convexity of the septal
cartilage. The posterior septum is normal or deviated.
Inspiratory breathing is usually impaired, especially on the
side of the narrowed valve area.
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Fig. 2.5Reversed C-shaped deviation of the pyramid.
Fig. 2.6Reversed C-shaped deviation of the pyramid. The bony pyramid deviates to the
left, the cartilaginous pyramid and lobule lean to the right.
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Fig. 2.7Deviated cartilaginous pyramid.
Fig. 2.8Deviated cartilaginous pyramid. The bony pyramid is normal, the cartilaginous
pyramid and lobule are deviated.
2.1.2Hump Nose (Dorsal Nasal
Deformity)
The nasal dorsum is convex. This may concern the bony
pyramid, the cartilaginous pyramid, or both the bony and
the cartilaginous pyramid. The nasal tip is often relatively
low or depressed. A hump may occur as a single deformity
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or variation. It may also occur in combination with various
types of septal and pyramidal pathology. A hump itself
usually only causes aesthetic complaints. We distinguish
the following types:
Bony and cartilaginous hump
Both the bony and the cartilaginous dorsa are
convex (humped). The maximum convexity is
usually located at the K area (▶ Fig. 2.9).
Bony hump
The convexity is confined to the bony pyramid (see
▶ Fig. 2.48).
Cartilaginous hump
The convexity is limited to the cartilaginous dorsum
(see ▶ Fig. 2.49).
Relative hump (pseudohump)
The bony dorsum is projecting due to saddling of
the cartilaginous pyramid (see ▶ Fig. 2.50).
These different types of humps are discussed and
illustrated in more detail in the section on ▶ Humps.
Fig. 2.9Bony and cartilaginous hump. Both the bony and cartilaginous pyramid are
convex and projecting.
2.1.3Prominent-Narrow Pyramid
Syndrome (Tension Nose)
The prominent-narrow pyramid syndrome is characterized
by a (abnormally) prominent and narrow external nasal
pyramid. It is of genetic ethnic origin, and rather common
in Caucasians. It is seen more frequently in females than in
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males. The prominent-narrow pyramid syndrome is
essentially a pronounced form of leptorrhine (▶ Fig. 2.10, ▶
Fig. 2.11, and ▶ Fig. 2.12).
Fig. 2.10Prominent-narrow pyramid syndrome. The entire external nasal pyramid is
prominent, narrow, and long; the dorsum may be straight, slightly convex, or show a
bony and cartilaginous hump; the lobule is narrow and projecting; the nasolabial angle is
large.
Fig. 2.11Prominent-narrow pyramid syndrome. The external pyramid is narrow and
prominent; the lobule is narrow and projecting.
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