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Fig. 2.43Low nose. The projection of the pyramid (the dorsum–nasal base line distance)
is smaller than normal.
The projection of the nasal pyramid is less than normal. In
most cases, the nose is also short and wide. A low nose is
often combined with a concave nasal dorsum. We then
speak of a saddle nose, a sagging dorsum, or low-wide
pyramid syndrome (see also ▶ Fig. 2.13, ▶ Fig. 2.14, ▶ Fig.
2.15, ▶ Fig. 2.16, and ▶ Fig. 2.17).
Wide Nose (▶ Fig. 2.44)
Fig. 2.44Wide nose. The width of the pyramid (the distance between the left and right
baselines) is larger than normal.
The width (horizontal dimension) of the nasal pyramid is
abnormally large. In most cases, the bony pyramid, the
cartilaginous pyramid, and the lobule are unusually wide.
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Usually, the nose is both shorter and less prominent than
normal.
Narrow Nose (▶ Fig. 2.45)
Fig. 2.45Narrow nose. The width of the pyramid (the distance between the left and
right baselines) is smaller than normal.
The width of the nasal pyramid is small. This condition is
generally combined with a greater length and prominence.
We then speak of prominent-narrow pyramid syndrome (see
also ▶ Fig. 2.10, ▶ Fig. 2.11, and ▶ Fig. 2.12).
“Greek Nose” (▶ Fig. 2.46)
Fig. 2.46“Greek” nose. The nasofrontal angle is almost 180°.
The forehead and nasal dorsum are almost in line. The
frontonasal angle is almost 180°. This profile was adopted
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in ancient Greece as the ideal and was used in sculptures of
gods and heroes.
2.2.2Humps
A hump is a convexity of the nasal dorsum. When both the
bony and the cartilaginous pyramid are involved, we speak
of a hump nose. To a certain extent, a hump nose may be
considered a syndrome (see ▶ Hump Nose (Dorsal Nasal
Deformity)), though a hump may also occur in isolation as a
deformity or variation. Sometimes it is seen along with
pathology of the septum and pyramid. We distinguish the
bony hump, the cartilaginous hump, a combination of these
two, and the relative hump or pseudohump.
Bony and Cartilaginous Hump (▶ Fig. 2.47)
Fig. 2.47Bony and cartilaginous hump. Both the bony and cartilaginous dorsum are
abnormally convex.
Both the bony and the cartilaginous dorsum are convex
(humped). The maximum convexity is usually located at the
K area. This type of hump may be of genetic or traumatic
origin. In some ethnic groups, a convex nasal dorsum is
normal.
Bony Hump (▶ Fig. 2.48)
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Fig. 2.48Bony hump. The bony dorsum is abnormally convex and projecting.
The convexity is confined to the bony pyramid. A bony
hump is usually due to previous trauma or to inadequate
surgery.
Cartilaginous Hump (▶ Fig. 2.49)
Fig. 2.49Cartilaginous hump. The cartilaginous dorsum is abnormally convex and
projecting.
The convexity is limited to the cartilaginous dorsum. A
cartilaginous hump is usually of traumatic origin. It may
also be of genetic origin, or occur as a side effect of
inadequate lobular surgery, resulting in loss of tip
projection.
Relative Bony Hump (▶ Fig. 2.50)
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Fig. 2.50Relative bony hump. The bony dorsum seems overprojected due to sagging of
the cartilaginous dorsum.
The bony dorsum seems overprojected due to saddling of
the cartilaginous pyramid. The convexity of the bony
dorsum is relative, which means we are dealing with a
pseudohump. The condition is often misdiagnosed by both
patient and doctor. The underlying cause is usually a
defective anterior septum. Treatment must therefore
consist of septal reconstruction with an additional
transplant, rather than resection of the pseudohump.
2.2.3Saddling and Sagging
Saddling (a saddle) and sagging denote concavity of the
nasal dorsum. This is often due to extensive pathology, such
as the low-wide pyramid syndrome (see ▶ Resistance and
Capacitance Vessels). It may be an isolated deformity, or it
may occur in combination with other types of pathology. We
distinguish the bony saddle, the cartilaginous saddle or
sagging, the linea nasalis dorsalis, the dorsal step, and
sagging of the supratip area.
Bony and Cartilaginous Saddle Nose (▶ Fig. 2.51)
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